Background: Severe hypoglycaemia may induce a life-threatening condition. Rapid diagnosis and prompt administration of sugar (oral or IV) and/or, if appropriate, intramuscular or intranasal glucagon is key to its management. However, there are many barriers to glucagon use.
Objective: To assess the performance of medical dispatchers at suspecting hypoglycaemia, proposing glucagon treatment and facilitating its use.
Methods: This was a retrospective study. Calls classified as “hypo(-glycaemia)” by medical dispatchers or containing the words “diabetes” or “glucagon” within the free text were included and voice recordings were reviewed. Clinical, environmental and operational variables were collected. Hypoglycaemia was suspected if the patient was unconscious or presenting with altered consciousness or abnormal movements, and if the patient was suspected to present diabetes.
Results: The dispatch centre handled 66,393 calls during the study period. Dispatchers suspected 100 (0.15%) cases of hypoglycaemia. There were 48 patients with suspected severe hypoglycaemia. Among those, four patients received glucagon prior to the dispatcher’s advice and the dispatchers proposed the use of glucagon in another 18 patients. Glucagon was available in five of those situations (27.8%), and relatives agreed to its use in each case. The injection was performed in three out of these five situations. The median time between the dispatcher’s proposal to use glucagon and its injection was 6 minutes.
Conclusion: Trained dispatchers are able to suspect hypoglycaemia, and decide when to treat and provide guidance on using IM glucagon, although the absolute number of cases was low. Asking the patient or bystander about the availability of glucagon when facing such situations should be done systematically. Diabetic patients, especially those treated using insulin, should have their own supply of glucagon. The introduction of intranasal glucagon may be a game changer.