Glucagon is a polypeptide hormone produced by the pancreas that regulates blood glucose levels. Its function is to stimulate the liver to convert stored glycogen into glucose, which is then released into the bloodstream to raise sugar levels. This medication is administered to treat severe hypoglycemia, a condition characterized by extremely low blood sugar where the person is often unconscious, seizing, or too disoriented to safely consume oral carbohydrates. Understanding the various administration methods is important for anyone who might need to deliver this life-saving medication.
Understanding the Routes: IM vs. SQ
The question of whether glucagon is given intramuscularly (IM) or subcutaneously (SQ) arises because traditional emergency kits typically allow for both routes of injection. Intramuscular injection delivers the medication deep into a muscle, such as the thigh, upper arm, or buttocks, where blood flow is generally robust. This delivery method is often favored in an emergency setting due to the potential for faster absorption into the bloodstream.
Subcutaneous injection, in contrast, involves delivering the medication into the layer of fatty tissue just beneath the skin, commonly in the abdomen or upper arm. Absorption via the subcutaneous route may take slightly longer compared to the intramuscular route because fat tissue has less blood flow than muscle. However, studies have shown that the maximum effect achieved is similar regardless of whether the injection is IM or SQ. The choice between the two routes often depends on the specific product instructions and the urgency of the situation.
Modern Glucagon Delivery Systems
The landscape of glucagon administration has evolved significantly beyond the traditional kit, which required the user to manually mix a powdered drug with a liquid diluent immediately before injection. This multi-step process was complex and prone to error, especially during a high-stress emergency. Newer options have emerged that simplify the process, largely eliminating the need for mixing and reducing the chance of administration error.
One major innovation is the development of pre-filled, ready-to-use autoinjector pens that contain a liquid-stable form of glucagon. These devices function similarly to an epinephrine pen, requiring only a simple push against the skin to deliver the dose. Depending on the specific product, these devices are typically designed for either subcutaneous or intramuscular injection, and the manufacturer’s instructions must be followed precisely.
Another significant advancement is nasal glucagon, which is a dry powder formulation administered through a single-use dispenser inserted into one nostril. This delivery method is non-injectable and does not require the person to inhale the powder, making it a needle-free and user-friendly option. The specific delivery system—traditional kit, autoinjector, or nasal powder—determines the exact administration route. The clinical efficacy of the nasal powder is comparable to that of injectable glucagon for treating severe hypoglycemia.
Emergency Administration and Recovery Protocol
When a person is experiencing severe hypoglycemia and is unable to safely swallow, the first step is to position them safely on their side. This is a safety measure because a common side effect of glucagon administration is vomiting, and the side position helps prevent the person from choking on vomit or secretions. Immediately after positioning, emergency services should be called to ensure professional medical help is on the way.
The next step is to administer the glucagon according to the specific product instructions. If using a traditional kit, the powder and liquid must be mixed until the solution is clear before injecting into the chosen site. With modern autoinjectors or nasal devices, the process is streamlined, but the instructions for that specific device must still be followed exactly. The person should begin to show signs of improvement, such as regaining consciousness, typically within 15 to 20 minutes of the injection.
Once the person is fully awake and alert, and can safely swallow, they should be given fast-acting carbohydrates, such as juice or a regular soft drink. This is followed by a snack containing both protein and longer-acting carbohydrates, like cheese and crackers, to replenish liver glycogen stores and prevent the blood sugar from dropping again. Continuous monitoring is necessary until emergency medical personnel arrive and take over care.