Glucagon is administered in three main ways: as a nasal spray, an autoinjector pen, or a traditional injection kit that requires mixing before use. All three forms are designed for emergency treatment of severe low blood sugar in people with diabetes, particularly when the person is unconscious or unable to swallow food or drink. The method you use depends on which product you have on hand.
When Glucagon Is Needed
Glucagon is used when someone with diabetes has blood sugar low enough to cause serious symptoms and can’t take sugar by mouth. Blood sugar below 70 mg/dL is generally considered low, but the more dangerous symptoms typically kick in around 50 to 55 mg/dL. At that point, the brain isn’t getting enough fuel, which can cause confusion, behavioral changes, seizures, or loss of consciousness. Earlier warning signs include trembling, a pounding heart, anxiety, sweating, and intense hunger.
The key trigger for using glucagon is that the person can’t safely eat or drink. If someone is conscious and able to swallow, juice or glucose tablets work faster and more simply. Glucagon is for situations where that isn’t possible.
Nasal Spray
The nasal spray (sold as Baqsimi) is the simplest option to use in an emergency. It delivers a single dose of dry powder into one nostril. The person does not need to inhale or be conscious for it to work.
To use it, peel the shrink wrap off the tube by pulling the red stripe, open the lid, and remove the device. Hold it between your fingers and thumb, then gently insert the tip into one nostril until your fingers touch the outside of the nose. Push the plunger firmly all the way in. You’ll know the dose is complete when the green line on the device disappears. That’s it.
A few important details: don’t open the tube until you’re ready to use it, because moisture exposure can make the powder ineffective. Don’t press the plunger to test it beforehand. Each device contains one dose and cannot be reused.
Autoinjector Pens and Prefilled Syringes
Autoinjector pens (like the Gvoke HypoPen) and prefilled syringes come with liquid glucagon that’s ready to use with no mixing required. This is a major advantage over older kits, especially in a high-stress emergency. The solution should look clear and colorless to pale yellow before you inject it.
These are injected just under the skin (subcutaneously) in one of three locations: the lower abdomen, the outer thigh, or the outer upper arm. Don’t open the foil pouch until you’re ready to use the device. Each pen or syringe contains a single dose.
The standard adult dose is 1 mg for anyone 12 years or older. For children ages 2 to 11 who weigh less than 45 kg (about 99 pounds), the dose is 0.5 mg.
Traditional Reconstitution Kits
Older glucagon kits (like the GlucaGen HypoKit) require you to mix a powder with liquid before injecting. This takes more steps and more time, which can feel stressful when someone is unresponsive. If you carry one of these kits, practicing the steps in advance is worth doing.
Here’s the process:
- Prepare the vial: Remove the orange cap from the vial of powdered glucagon. Pull the needle cover off the syringe.
- Mix: Insert the needle through the rubber stopper on the vial and inject all the liquid from the syringe into the powder. Without removing the needle, gently shake the vial until the powder dissolves completely. The solution should be clear with no particles.
- Draw the dose: With the needle still in the vial, flip it upside down. Slowly pull back the plunger to draw the solution into the syringe. Flick the syringe to move air bubbles to the top, then gently push the plunger to expel them back into the vial.
- Inject: Remove the syringe from the vial and inject into the upper arm, thigh, or buttocks. These kits allow subcutaneous or intramuscular injection.
The dose for adults and children over 25 kg (about 55 pounds) is 1 mg. For children under 25 kg, it’s 0.5 mg. If the weight is unknown, the cutoff is roughly age 6: full dose for kids 6 and older, half dose for younger children.
What to Do After Giving Glucagon
Regardless of which form you use, call for emergency help immediately after administering the dose. Glucagon works quickly. After a subcutaneous or intramuscular injection, it reaches peak levels in the blood within minutes, and it has a short working window of roughly 8 to 18 minutes.
If the person is unconscious, roll them onto their side. Nausea and vomiting are common during recovery, and the side position prevents choking. Once they’re awake and able to swallow safely, give them a fast-acting sugar source like juice, followed by a more substantial snack like crackers with cheese or peanut butter. The snack matters because glucagon works by releasing stored sugar from the liver, and those stores need to be replenished to prevent blood sugar from dropping again.
If there’s no response after 15 minutes, a second dose can be given using a new device or kit. Don’t try to reuse a spent one.
Choosing the Right Option
All three delivery methods achieve the same goal: raising blood sugar in an emergency. The practical differences come down to ease of use and who’s likely to be giving the dose. The nasal spray requires no needles and no mixing, making it the most straightforward option for family members, teachers, or coworkers who may have no medical training. Autoinjector pens are nearly as simple, requiring just a press against the skin. Traditional kits are the least intuitive under pressure, with multiple steps that can go wrong when hands are shaking.
Whichever form you carry, keep it sealed in its original packaging until use. Make sure the people around you, whether that’s a partner, a coworker, or a school nurse, know where it’s stored and how to use it before an emergency happens.