Dex4 Shortage: What’s Going On and What Can You Do?

It’s recommended that people with type 1 diabetes (T1D) keep a source of rapid-acting sugars on hand in case of hypoglycemia. According to data from the BETTER registry, juice is a very popular option (first choice for 45% of respondents). Dex4 tablets are also very popular (first choice for 24% of respondents) because they’re easy to carry and consume, they provide a very specific quantity of sugar (each tablet is the equivalent of 4 g of sugar), and they increase blood sugar quickly.

But since December 2022, Dex4-brand tablets, gel pouches and liquid blasts have become very scarce, and have even disappeared from the shelves of most Canadian pharmacies. 

But there’s good news! Dex4 will gradually return to the market this summer. 

An inventory shortage caused by a labelling problem

According to Quebec-based company AMG Medical, the manufacturer and distributor of Dex4 tablets in Canada, the problem doesn’t concern the product itself, but rather, certain aspects of its labelling. For 20 years, Dex4 had been sold as a food product, but according to Canadian regulation, it’s a natural health product because it’s used to treat hypoglycemia. So, following Health Canada’s demand, AMG Medical updated the content of its labels, which interrupted the distribution of these products. 

A few alternatives to consider while you wait for Dex4 or if you’re looking to switch it up

Dex4 products are essentially dextrose (also known as glucose), a simple sugar, which has the same make-up as blood glucose. That’s why it’s easily and quickly absorbed by the body to make blood sugar rise. To treat hypoglycemia, it’s recommended that people with T1D take a source of either dextrose, maltose (a combination of two glucose molecules) or glucose syrup. There are other brands of glucose tablets or liquid shots, such as Lift GlucoTabs (European product) or ReliOn (American product), which are available online in Canada.

Some types of candy are also made up almost entirely of dextrose. Their weight in grams is equal to their carb content. Here are a few examples (based on the candy’s nutrition label):

Aside from dextrose or maltose, there are other foods that contain rapid-acting sugars, such as fructose (another simple sugar) or saccharose (also known as sucrose). They’re considered effective for correcting hypoglycemia, although they may increase blood sugar more slowly than a source of pure dextrose (values based on Health Canada’s website):

For more information, see our Treatment of Hypoglycemia tool.

Children especially should be supervised when treating hypoglycemia on their own to make sure they don’t overtreat it by taking too many carbs, which could affect their dental health, as well as their long-term general health.

Some foods to avoid when correcting hypoglycemia

To treat hypoglycemia, you need sources of simple sugar that are quickly absorbed by the body (dextrose and maltose are the best choices). The current recommendation is to take 15 g of quick-acting carbohydrates and to measure blood sugar 15 minutes later; this is to be repeated every 15 minutes as long as blood sugar hasn’t climbed back up to more than 4 mmol/L.   

Foods that are high in fat (e.g., ice cream, cake), fiber (e.g., fruit, nuts) or protein (e.g., chocolate milk) should not be used to treat hypoglycemia because they take longer to be digested and slow down the absorption of carbs. Your blood sugar level will rise back up more slowly, and this could lead you to take more carbs, which could have the undesirable effect of causing hyperglycemia in the following hour. But once hypoglycemia has been treated, you can eat a protein-rich snack, such as cheese or nuts, to avoid another drop in blood sugar before your next meal.

Sugar substitutes (such as aspartame, sucralose or stevia) should never be used to treat hypoglycemia because they have no effect on blood sugar!

Always be prepared!

Hypoglycemia needs to be treated quickly to avoid any excess carb intake. Prepare your own hypoglycemia treatment kits with pre-portioned, dextrose-based products. Check the labels for the dextrose content. You may want to try several different products, as each person’s needs will be different. 

References :

JDRF. Not all sugars are the same: Using glucose to treat hypoglycemia. Page viewed on June 7, 2023. https://www.jdrf.ca/not-all-sugars-are-the-same-using-glucose-to-treat-hypoglycemia/

Diabetes Canada. Hypoglycémie : Comité d’experts des Lignes directrices de pratique clinique de Diabète Canada. 2018. Canadian Journal of Diabetes 42 : S104-108. https://guidelines.diabetes.ca/CDACPG/media/documents/French%202018%20CPG/14-Hypoglycemia-FR.pdf

Health Canada. Nutrient Value of some Common Food. Page viewed on June 14, 2023. https://www.canada.ca/en/health-canada/services/food-nutrition/healthy-eating/nutrient-data/table-15-sweets-sugars-nutrient-value-some-common-foods-2008.html