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
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