Just pulling from my head here, but also, doesn't Glucagon make the in hospital management of IDDM patients much more complex by burning their entire store of glycogen? No idea if that is true, or where I may have come to believe it..but it's the reason I've always considered Glucagon to be the ugly, illegitimate stepchild of Glucose. I've always questioned EVER using Glucagon in a system that allows I/Os. Am I completely off in the ditch?
I can't really comment about the in-hospital complications, as I have never had too care for a post Gucagon pt in-hospital before. However, anecdotally, my uncle is a fragile diabetic on sliding scale insulin says any competent diabetic should be able to adjust his/her dosages to accomodate. Anecdote though....
As far as your thoughts on Glucagon vs I.O. I am hardly interested in trying to tell you what is "right" or "wrong", but I will tell you my opinion.
When I am making the decision to use Glucagon, it is on a hard IV start (after 2 attempts) or a combative pt. These are the factors between my 3 choices; Glucagon, IO, Multiple IV attempts.
Which is safer for me?
Which has less complications for the pt?
Are thier other life threatening issues?
I am pretty quick to go with Glucagon if I miss my IV's because of it's peripheral arteriole and venous dilation properties. Even if the Glucagon does not work 100%, suddenly there is veins!
Although I do not see IO as a dangerously invasave procedure as some others do, I do see it as more invasive than venipuncture and IM injection, therefore I go Glucagon 1st.
There is the idea of pt comfort too.... Waking up with a small IM wound is quite different than waking with a needle in your bone. When going IO I always have to use some form of analgesia and that is a step I can skip with IM.
Just my opinion