First aid glucose administration routes for symptomatic hypoglycaemia

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Based on the current evidence (1) the oral route for the administration of glucose appears to be the preferred route when compared with the buccal route, (2) dextrose gels administered through the combined oral and buccal mucosal route may perform equally to oral glucose in raising blood glucose, and (3) sublingual administration might be preferable over oral administration for the very specific setting of children with hypoglycaemia and moderate clinical symptoms of concomitant malaria or respiratory tract infections and potential difficulty in swallowing.

Hypoglycaemia, or having low blood sugar levels, is a common occurrence in people with diabetes but may also occur in other persons due to an imbalance in blood sugar regulation. Symptoms of mild or moderate hypoglycaemia are for example, shakiness, dizziness, sweating or nervousness, First aid for this condition is usually self‐administered but is often provided by family or friends, and glucose tablets compared with dietary forms of sugar such as juice, candies or dried fruit strips have shown to result in a better resolution of symptoms. Glucose can be given orally (swallowed), but also inside the cheek against the buccal mucosa (‘buccal administration’), under the tongue (‘sublingual administration’) or via the rectal route. In the latter three ways of treatment, the glucose is not being swallowed as with the oral route.

Providing sugar under the tongue (sublingual) resulted in a greater rise in blood glucose after 20 minutes than giving the sugar orally, but this was in a specific setting including children with hypoglycaemia and symptoms of concomitant malaria or respiratory tract infection. On the other hand, giving glucose by the buccal mucosa route resulted in a lower plasma glucose concentration than with the oral route. For dextrose gel (where uptake of the glucose occurs through a combination of oral swallowing and via the buccal mucosa), no clear benefit was shown compared to oral glucose administration (glucose tablets or glucose solutions). Most studies did not report on time to resolution of symptoms, resolution of hypoglycaemia as defined by blood glucose levels above a certain threshold, time to resolution of hypoglycaemia, adverse events, and treatment delay.

The evidence is of very low certainty due to limitations in study design, few studies and small number of participants in the studies, and because half of the studies were performed with healthy volunteers rather than in people with characteristic hypoglycaemia.

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