Glucagon is a naturally occurring hormone that regulates blood glucose levels. When a person with diabetes experiences severe hypoglycemia (dangerously low blood sugar), glucagon acts rapidly to prompt the liver to release stored glucose into the bloodstream. This medication is administered as an emergency treatment when the person is unable to consume sugar orally. Understanding the correct preparation and administration procedure for the traditional powder and liquid kit is necessary for caregivers during this urgent situation. This guide provides step-by-step instructions for using the glucagon injection kit.
Pre-Injection Readiness and Safety Checklist
The decision to use a glucagon injection rests on recognizing signs of severe hypoglycemia. Symptoms include unresponsiveness, confusion severe enough to prevent safe eating, or seizures. Since the patient cannot self-treat, the assistance of a trained bystander is required.
Before mixing, verify the glucagon kit is within its expiration date and has been stored correctly, as temperature instability can compromise its effectiveness. The older style of glucagon kit requires mixing, distinguishing it from newer, pre-filled auto-injectors.
Immediately turn the person onto their side, especially if they are unconscious. Glucagon can cause nausea and vomiting, and this position prevents the risk of choking or aspiration should they vomit. Instruct a second person to call emergency medical services (EMS) immediately upon recognizing the need for the injection.
Reconstituting the Glucagon
The glucagon powder and the diluent must be combined immediately before the injection. Begin by removing the cap from the vial containing the dry glucagon powder. Next, take the pre-filled syringe, which contains the diluting solution, and remove its needle cover.
Insert the needle through the rubber stopper at the top of the powder vial. Inject the entire contents of the syringe (typically 1 milliliter of solution) into the vial to mix with the dry powder. Keep the needle inserted into the vial after injecting the liquid.
Gently swirl the vial and syringe together until the powder is fully dissolved and the solution appears clear. Avoid vigorous shaking, as this can damage the medication. If the resulting liquid is cloudy or contains undissolved particles, it should not be used.
To prepare the syringe for injection, keep the needle within the vial and turn the assembly upside down. Carefully pull back the plunger to draw the entire mixed solution back into the syringe barrel. For an adult or a child weighing over 44 pounds (20 kg), the full 1 milligram dose (1 mL) is typically drawn up.
Proper Injection Technique
Once the medication is drawn, administer the injection immediately, as the reconstituted solution degrades quickly. The injection is given into a large muscle, generally the upper arm, thigh, or buttocks. Intramuscular (IM) injection is the preferred route because muscle tissue allows for faster absorption of the drug.
If an alcohol swab is available, clean the chosen injection site. For a person with significant body mass, pinch the skin and muscle tissue at the injection site. Insert the needle quickly at a 90-degree angle directly into the muscle.
Push the plunger down completely to ensure the full dose of glucagon is delivered. If clothing cannot be quickly moved, the injection may be given through light fabric in an urgent situation. After the plunger is depressed, withdraw the needle straight out of the skin.
Apply light pressure to the injection site after the needle is removed. Do not attempt to recap the used needle to prevent accidental needle-stick injuries. The entire syringe and needle assembly should be discarded into a designated sharps container or back into the plastic kit casing.
Immediate Post-Injection Protocol
Calling for emergency medical help immediately after administration is necessary. This ensures professional medical personnel are on the way, as follow-up care or additional treatment may be necessary. The patient must be continuously monitored while awaiting the arrival of EMS.
Glucagon typically begins to work within 10 to 15 minutes, and the person generally regains consciousness within that time. If there is no response after 15 minutes, a second dose may be administered, but only if another kit is available and a medical professional has previously recommended this course.
Once the person is awake and able to swallow safely, they must be given a source of sugar to prevent blood glucose from dropping again. This initial step involves a fast-acting carbohydrate, such as juice or a soft drink. Follow this with a longer-acting source of carbohydrates and protein, like crackers and cheese or a sandwich, to stabilize blood sugar levels.
Inform the arriving medical personnel about the time the glucagon was administered and the dosage given. This information is necessary to determine the next steps in treatment and assess the overall situation. The patient’s blood sugar levels should be checked frequently for several hours after the event.