Introduction

32ml sachet of fruit punch flavoured glucose gel. Contains 15g of glucose, the solution consists primarily of dextrose and water, along with small amounts of other compounds. The product is gluten free, lactose free, and fat free.

Uses within SJA

Demonstrated hypoglycaemia in either;

• A known diabetic patient who exhibits an altered conscious state.
• Where there is an altered mental state of unknown cause AND the patient has a blood glucose level below 4mmol/L.

Pharmacokinetics

Onset

Onset is generally rapid (2-5 minutes) through the oral/buccal mucosa (mucous membrane lining the inside of the mouth)

Absorption

Glucose molecules will absorb directly though oral tissue. It is either swallowed directly, or allowed to stay in the mouth momentarily to facilitate rapid absorption via various areas of the mouth cavity and then swallowed to allow absorption into the blood via the small intestine.

Distribution

Glucose is transported across the apical membrane and basal membranes of the enterocytes (intestinal absorptive cells) by specialized glucose transporter enzymes. Some of the glucose is converted to lactic acid by astrocytes (star-shaped glial cells in the brain and spinal cord), which is then utilized as an energy source by brain cells; some of the glucose is used by intestinal cells and red blood cells, while the rest reaches the liver, adipose tissue and muscle cells, where it is absorbed and stored as glycogen (under the influence of insulin)

Metabolism

Gluconeogenesis maintains blood glucose concentrations, for example during starvation and intense exercise. Insulin and glucagon work synergistically to keep blood glucose concentrations normal.

• Insulin: An elevated blood glucose concentration results in the secretion of insulin: glucose is transported into body cells. The uptake of glucose by liver, kidney and brain cells is by diffusion and does not require insulin.
• Glucagon: The effects of glucagon are opposite to those of insulin.

Excretion

If excretion of glucose is require, this is via the kidneys. Ordinarily, urine contains no glucose because the kidneys are able to reclaim all of the filtered glucose back into the bloodstream. Glycosuria is nearly always caused by elevated blood glucose levels, most commonly due to untreated diabetes mellitus.

Pharmacodynamics

Desired Effects

• Improvement in level of consciousness
• Increase in BSL
  

Side Effects

Possible airway obstruction where patients have a reduced level of consciousness. Hyperglycaemia is unlikely

Duration of Action

Duration of action is dependent on the severity of the hypoglycaemia, though we should expect a duration of approximately 12-25 minutes.

Other Drug Interactions

Not applicable