Glucagon for Hypoglycemia

(Written by Shirley Powell, PA-C)

Summary

Glucagon is a hormone made by the pancreas. Glucagon is one of the major hormones that raises the blood glucose. Since it has the opposite effect of insulin, raising the blood sugar levels, glucagon is used to treat hypoglycemia, low blood glucose. Glucagon is rarely needed, but if you were unable to swallow, unconscious, or severe vomiting a family member or someone else would give an injection of Glucagon.

Glucagon comes in a kit with a bottle of glucagon containing 1 mg of glucagon as a tablet or powder. The kit also has a syringe containing a diluting solution. The expiration on the box should be checked regularly and if out-dated obtain a new kit. The Glucagon kit can be stored at room temperature but should not reach above 90º or below freezing.

Who should have a glucagon emergency kit?

  • Anyone on any insulin
  • Anyone on 3 or more insulin injections per day or on an insulin pump
  • Anyone on oral hypoglycemia agents that can cause a low blood glucose
  • Anyone who have ever passed out from a low blood glucose
  • Anyone unable to feel the symptoms of low blood glucose (hypoglycemia unawareness)

When to use glucagon

  • Severe low blood sugar, hypoglycemia
  • If you have severe low blood glucose and are unconscious or unable to swallow. (See instructions for using, below)
  • Caution with using glucagon with severe hypoglycemia reaction in that vomiting may occur. This can be from glucagon injected or glucagon made by the body. If the person is lying down the head should be turned to avoid choking. Urine ketones should also be checked.
  • If a unconscious person does not respond in 10 minutes a second dose may be given
  • Low blood sugar and vomiting
  • If the blood sugar is low (less than 60 mg/dl) and you are unable to swallow or keep any food down glucagon may help raise the blood sugars.(See instructions for using)
  • Glucagon can be mixed and given just like insulin and with an insulin syringe. The dose is one unit per year of age up to age 15 years. After age 15 years, people can just take 15 units.
  • For example:
  • A five year old would get 5 units
  • A ten year old would get 10 units
  • If the blood sugar is not higher in 20-30 minutes the same dose may be repeated

Glucagon Injections – When and how to

(From Understanding Diabetes, a handbook for people living with diabetes, H Peter Chase, MD)

  • Use when a person is unconscious or having a seizure.
  • Keep in a convenient and known place. Store in the refrigerator during hot weather. Protect from freezing.
  • Keep a 3 cc syringe available or use the fluid filled syringe in the emergency kit. An insulin syringe or needle can also be used. An insulin syringe and needle can also be used (preferably a 1 cc syringe). Some people tape the syringe to the kit so they have this readily available.
  • If you have the emergency kit the fluid does not need to be withdrawn from the bottle and it is already in the syringe. Put the liquid into the glucagon vial and swirl gently to mix. The large syringe that the liquid was in can also be used to give the glucagon injection. Draw up the dose indicated below. Clear the air pointing the needle upward.
  • Withdraw from the mixed glucagon bottle:
  • If using an insulin syringe, put needle into the center of the stopper. (Estimated dose if using the emergency kit syringe)
  • Dose
  • 0.3 cc (30 units) for a child less than six years old
  • 0.5 cc (50 units) for a child 6-18 years of age
  • 1 cc (100 units) for an adult over 18 years of age
  • If using the syringe that comes in the emergency kit, inject into deep muscle (in front of leg or upper, outer arm) though it is OK to inject into the subcutaneous fat, Inject through clothing if needed. If glucagon is drawn into an insulin syringe then give it just as you would an insulin shot. If a blood sugar has not yet been done, it can be done now.
  • Wait 10 minutes. Check blood sugar. If still unconscious and blood sugar is still below 60 mg/dl, inject a second dose of glucagon (same amount as the first).
  • If there is no response to the glucagon, or if there is difficulty breathing, call paramedics(or 911)
  • As soon as he/she awakens, give sips of juice, sugar pop or sugar in water initially. Honey may help raise the blood sugar for children over the age of 1 year. After 10 minutes, encourage solid food (crackers and peanut butter or cheese, sandwich, etc).
  • Notify diabetes care team of a severe reaction prior to next insulin injection (so dose can be changed if needed). Complete recovery may take 1-6 hours.

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