Glucagon is a hormone produced by the pancreas that regulates blood glucose levels by signaling the liver to release stored glucose. This medication is the standard emergency treatment for severe hypoglycemia, a life-threatening condition where blood sugar drops dangerously low. Severe hypoglycemia is defined by the inability of the affected person to safely consume oral carbohydrates, often because they are unconscious, confused, disoriented, or having a seizure. Glucagon acts rapidly to restore consciousness by triggering the body’s stored sugar reserves, which quickly raises the blood glucose concentration.
Understanding the Available Forms of Glucagon
The method for administering emergency glucagon depends entirely on the type of kit available, and it is important to know which device you possess before an emergency occurs. Historically, the only option was a traditional emergency kit that required the user to mix a dry powder with a liquid solution, a process called reconstitution, before injection. This multi-step process often created delays and carried a risk of user error during a highly stressful situation.
These modern options include pre-filled pens or auto-injectors and a powder formulation delivered through a nasal spray device. The injectable pens contain the drug already mixed and require only a simple two-step process, such as removing a cap and pressing the device against the skin. Nasal glucagon is delivered as a dry powder into one nostril, where it is absorbed through the nasal lining, and importantly, the person does not need to inhale the powder for it to be effective.
Step-by-Step Guide for Emergency Administration
Traditional Kit (Powder and Liquid)
Open the kit and remove the cap from the vial containing the glucagon powder, then remove the needle cover from the accompanying pre-filled syringe of diluting liquid. Inject the entire amount of liquid into the powder vial and gently shake or swirl the vial until the powder is fully dissolved and the solution is clear. The glucagon must be used immediately after mixing, as it is not stable for long in its liquid form.
After mixing, keep the needle inside the vial and turn the vial upside down to draw the entire mixed solution back into the syringe. Once the syringe is filled, select an injection site on the person’s body, such as the outer thigh, upper arm, or outer buttock area. Glucagon should be administered as an intramuscular or subcutaneous injection, similar to an insulin shot, by inserting the needle straight into the skin at a 90-degree angle. Push the plunger down completely to inject the full dose and then remove the needle, disposing of the used syringe immediately in a sharps container if one is available.
Ready-to-Use Devices (Pen and Nasal)
The caregiver must first remove the pre-filled auto-injector pen from its protective pouch and take off the cap as directed by the product instructions. The pen is then pressed firmly against the skin of the outer thigh, lower abdomen, or outer upper arm, and held in place for approximately five seconds until the injection is complete, often indicated by a click or a change in the viewing window.
Remove the nasal glucagon device from its container and hold it between your fingers, making sure not to press the plunger prematurely. Gently insert the tip of the device into one of the person’s nostrils until your fingers touch the bottom of the nose. Push the plunger firmly all the way until it stops to deliver the single dose of dry powder.
Regardless of the method used, immediately after administering the glucagon, you must turn the person onto their side. This specific positioning is a preventative measure because nausea and vomiting are common side effects of glucagon, and positioning the person on their side helps to prevent choking or aspiration.
Actions Following Emergency Use and Recovery
Remain with the person and monitor their condition closely while waiting for the medication to take effect. Glucagon works quickly, and the person should begin to regain consciousness and respond within 10 to 15 minutes of the injection or spray. If the person does not wake up or show signs of recovery after 15 minutes, administer a second dose of glucagon if a second kit is readily available.
Call emergency medical services immediately after giving the glucagon, even if the person begins to wake up. Medical evaluation is recommended after any severe hypoglycemic episode, and the medical team can provide intravenous glucose if the person does not respond to the glucagon.
Once the person is fully awake, alert, and able to swallow safely, they must consume a fast-acting carbohydrate source to prevent the blood sugar from dropping again. Fast-acting carbohydrates like fruit juice, regular soda, or glucose tablets should be followed by a small snack containing a longer-acting source of carbohydrate and protein, such as crackers with cheese or peanut butter. This second step is important because the effect of the glucagon will begin to wear off after about 60 to 90 minutes. Notify the person’s healthcare provider about the emergency use of glucagon to make any necessary adjustments to the diabetes management plan.