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ELECTRONIC ARTICLE:
Hubert Barennes, Innocent Valea, Nicolas Nagot, Philippe Van de Perre, and Eric Pussard
Sublingual Sugar Administration as an Alternative to Intravenous Dextrose Administration to Correct Hypoglycemia Among Children in the Tropics
Pediatrics 2005; 116: e648-e653 [Abstract] [Full text] [PDF]
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[Read P3R] Sublingual Sucrose: Wrong Sugar ? !
Harry W. Gedney   (25 May 2007)

Sublingual Sucrose: Wrong Sugar ? ! 25 May 2007
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Harry W. Gedney,
Park Ranger, MS, NREMT-B, RN
National Park Service

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Re: Sublingual Sucrose: Wrong Sugar ? !

hwgedney{at}aol.com Harry W. Gedney

This article has bothered me for months. Helping malarial kids with hypoglycemia is a great objective, but I think the science is wrong. The methodology is unclear in that it talks about "moistened sugar," but I presume that it is sucrose (table sugar) that has been moistened with water and administered. Sucrose is a disaccharide, a complex sugar, that cannot be used by the human body until it is processed into a monosaccharide (simple sugar) - such as glucose,fructose, or maltose.

An alternate portion of the study injects Dextrose (another name for glucose, the simple sugar that is primarily used by the body). Intravenous dextrose is of course fast and effective. However, it may be difficult and expensive in some less-developed regions.

Sublingual absorption takes place by diffusion. A familiar example is sublingual Nitroglycerin tablets absorbed into the sublingual artery to rapidly relieve angina pectoris. Swallowing Nitro would not work - it would be destroyed by stomach acid before it could function as a vasodilator. That is why sublingual absorption is necessary, and as fast as a minute or two.

The only problem with table sugar (wet or dry) is that it cannot be absorbed into the blood in its complex form (so I thought) and therefore cannot be a sublingual treatment for hypoglycemia. Hypoglycemic diabetics are often treated with oral glucose treatment between cheek and gum. However, dissoved table sugar or other complex sugars and carbohydrates need to be swallowed and digested to get the resulting simple sugar into the bloodstream.

The idea of oral sugar treatment for malaria victims is wonderful! It is easy, non-invasive, readily available, cheap, safe (with gag reflex), even pleasurable for kids. But I have to believe that the sugar is just being slowly dissolved in saliva and trickling down the throat (being swallowed). Only problem, it should take closer to 30 minutes to start to reach the bloodstream via the digestive system, not the 20 minutes claimed in the study.

If I am right, drinking sucrose in water would be the same as their experiment (and more comfortable than sugar under the tongue). And drinking a glucose/water mix or fruit drink would be faster because some would be absorbed in the bucchal mucosa and go directly/quickly (minutes) into the blood stream. That is why hypoglycemic diabetics are given glucose paste between cheek and gum and told to not swallow it.

I thought this was such basic pharmacokinetics that it would have been challenged by peer review before publication. Unfortunately I do no have the technical credentials to discuss this in any greater detail. I would think that the study would be improved with the patients sipping, swishing and swallowing a fruit drink. However, there may be nutrition concerns about using fructose (a simple fruit sugar) if the diet is already high in fructose.

Conflict of Interest:

None declared