Glucagon is a hormone naturally produced by the pancreas that maintains stable blood sugar levels. Its primary function is to signal the liver to release stored glucose into the bloodstream, raising the body’s sugar concentration. Emergency glucagon kits are administered when a person with diabetes experiences severe hypoglycemia (dangerously low blood sugar), rendering them unconscious or unable to consume oral sugar sources. Administering this medication quickly is paramount, as severe hypoglycemia can lead to seizures, coma, or death. The process requires reconstituting a powder and liquid mixture before injection.
Gathering the Kit and Preparing for Injection
The first step is to ensure the patient’s safety and activate emergency services. Before handling the kit, a caregiver should immediately call 911 or the local emergency number to ensure professional medical help is on the way. The patient should be gently turned onto their side, a position that helps prevent choking if vomiting occurs after the injection.
Next, locate the glucagon emergency kit, which typically contains a vial of powdered glucagon and a pre-filled syringe containing a diluent, usually sterile water. Quickly check the expiration date printed on the kit, as expired medication may not be effective. The kit components must also be visually inspected for any damage or tampering. Place the full contents of the kit, including the vial and the syringe, on a clean, flat surface within easy reach.
Step-by-Step Glucagon Reconstitution
Reconstitution begins by removing the protective plastic cap from the vial containing the dry glucagon powder. This cap covers the rubber stopper, which will be punctured by the syringe needle. Next, remove the needle cover from the pre-filled syringe, which holds the sterile diluent.
Inject the diluent into the glucagon vial by pushing the syringe needle through the center of the rubber stopper. Slowly and completely empty the entire liquid contents into the vial by depressing the plunger. Do not remove the needle from the vial after injecting the liquid.
With the needle still inserted, gently swirl or roll the vial and syringe to mix the powder and the diluent. Avoid vigorous shaking, as this can cause foaming and make it harder to draw the correct dose. The solution is correctly mixed when the liquid is clear and colorless, with no visible powder particles remaining.
Once dissolved, turn the vial and syringe upside down, positioning the needle tip near the rubber stopper. Pull the plunger down to draw the reconstituted solution back into the syringe. For adults and children weighing 20 kilograms or more, draw up the entire 1 milligram (1 milliliter) dose. For smaller children weighing less than 20 kilograms, only half the dose, or 0.5 milligrams (0.5 milliliters), is needed, depending on kit instructions. After drawing the correct dose, remove the needle from the vial. The reconstituted solution must be used immediately, as it is not stable for later use.
Injecting Glucagon and Immediate Follow-Up
With the correct dose loaded, the injection is administered into a large muscle mass. Common injection sites include the outer thigh, the upper arm, or the buttocks. The injection is given intramuscularly, meaning the needle must penetrate the skin and fatty tissue to reach the muscle beneath.
The skin at the chosen site can be gently pinched to stabilize the area. Insert the needle quickly at a 90-degree angle, and push the plunger down until the entire dose is delivered. After the injection, withdraw the needle and apply gentle pressure to the site.
The patient must remain on their side to maintain an open airway, as nausea and vomiting are common side effects. Glucagon causes blood sugar levels to rise, and the patient should regain consciousness within 10 to 15 minutes. If no response is observed after 15 minutes, a second dose from a new kit may be administered, if available, while waiting for emergency medical personnel.
Once the patient is awake and fully able to swallow safely, provide a source of fast-acting carbohydrates, such as fruit juice or glucose tablets. This should be followed by a longer-acting carbohydrate and protein source, like crackers and peanut butter, to replenish the liver’s glycogen stores and prevent recurring low blood sugar. Even if the patient recovers quickly, medical attention is necessary to determine the cause of the severe hypoglycemia and ensure complete recovery.