Glucagon is a naturally occurring hormone produced in the pancreas that regulates blood sugar levels. It works in opposition to insulin, signaling the liver to release stored glucose into the bloodstream. This rapid release of sugar makes glucagon a prescription emergency medication used to treat severe hypoglycemia, a condition where blood glucose drops dangerously low. For individuals who use insulin, having an emergency glucagon kit available and knowing how to use it is lifesaving.
Recognizing the Signs of Severe Hypoglycemia
Emergency glucagon is used only when a person with diabetes experiences severe low blood sugar and cannot safely consume oral carbohydrates. Early signs of a low blood sugar episode include shakiness, sweating, confusion, and slurred speech, which should be treated immediately with fast-acting sugar like juice or glucose tablets.
Severe hypoglycemia occurs when the blood sugar level is dangerously low, often below 54 mg/dL. At this point, the individual is no longer able to self-treat and typically has an altered mental state or loss of consciousness. The person may be too drowsy, disoriented, or confused to swallow safely, or they may have experienced a seizure. If someone is unresponsive or having a seizure, giving them anything by mouth poses a serious risk of choking or aspiration, necessitating the use of emergency injectable glucagon.
Preparing the Glucagon Delivery System
Preparation steps for injectable glucagon vary depending on the type of kit. Older emergency kits contain powdered glucagon in a vial and a separate syringe filled with a sterile diluting solution. This traditional system requires the caregiver to inject the liquid into the powder vial. The vial must then be gently swirled until the powder is fully dissolved and the solution appears clear and colorless.
Once mixed, the correct dose must be drawn back into the syringe before injection. Adults and children weighing over 44 pounds (20 kg) typically receive the full dose of 1 milligram (mg), while a half dose (0.5 mg) is often used for smaller children. Newer, ready-to-use devices, such as pre-filled syringes or auto-injector pens, simplify this process. These modern systems contain the glucagon in a stable liquid form, eliminating the complex mixing steps required in an emergency.
Selecting the Injection Site and Administration Technique
The injectable form of glucagon is given as an intramuscular (IM) injection for rapid absorption. The medication is injected directly into a large muscle, allowing it to enter the bloodstream quickly to trigger the liver’s glucose release. Acceptable injection sites are areas where muscle mass is easily accessible: the upper arm, the mid-outer thigh, or the upper outer quadrant of the buttocks.
The outer thigh is often the preferred site in an emergency because it is easily accessible even if the person is lying down. When administering the injection, the needle should be inserted straight into the muscle at a 90-degree angle to ensure it reaches the intended depth.
For traditional kits, the injection is performed using the provided syringe after mixing the solution. Auto-injectors are pressed firmly against the injection site until the mechanism clicks and the medicine is delivered, then held for a few seconds. The injection technique involves pushing the plunger all the way down to deliver the full or measured dose. After the injection, the needle is removed, and the site can be pressed lightly with a clean cotton ball or wipe.
Immediate Care After Injection
After administering the glucagon injection, immediate action must shift to patient safety and monitoring. The person should be turned onto their side, into the recovery position. Glucagon commonly causes nausea and vomiting, and positioning them on their side prevents the risk of choking or aspiration.
Call for emergency medical help immediately after the injection, even if the person appears to be recovering. The patient should begin to awaken and become conscious within 15 minutes of receiving the dose. If the person does not respond after this time, a second dose of glucagon may be given if available, but medical assistance is still required.
Once the person is fully awake and can swallow safely, they need to consume fast-acting carbohydrates, such as fruit juice or a regular soft drink, to prevent the blood sugar from dropping again. This should be followed by a snack containing longer-acting carbohydrates and protein, like crackers and cheese, to fully restore the liver’s glucose stores. Blood sugar should be checked frequently, often every hour for several hours, to ensure the level remains stable.