Treating Severe Low Blood Sugar with Glucagon

Updated May 12, 2014.

Severe hypoglycemia (extremely low blood sugar) occurs rarely for some people with type 1 diabetes, but is unfortunately common for others. The important point is to be prepared for such an emergency. Every person with type 1 diabetes should have at least one (and preferably two) glucagon emergency kits on hand to treat severe low blood sugar reactions. Having these as an ongoing part of your diabetes supplies is especially important when your child has type 1.

Here are some of the most frequently asked questions about glucagon and how to use it properly.

What Is Glucagon?

Glucagon is a hormone (like insulin) that is made in the pancreas. The difference between glucagon and insulin is that insulin lowers your blood glucose (sugar) by helping your body to use the glucose in the blood for energy. In contrast, glucagon helps to raise the level of glucose in the blood. But glucagon is not sugar. It raises the blood sugar by sending a signal to the liver and muscles (where your body naturally stores glucose) to release glucose into the blood.

When Should Glucagon Be Used?

Glucagon injections should be used when the person with type 1 diabetes is having a severe low blood sugar reaction (hypoglycemia) and is unconscious or can’t swallow. Any responsible person can be trained to give a glucagon injection. Never try and force a person who is unconscious from hypoglycemia to eat or drink.

You should keep at least one glucagon kit with you at all times.

How Do I Prepare and Inject Glucagon?

Glucagon comes in a package that contains a vial of powder and a syringe filled with liquid.

Directions for mixing and injecting glucagon are contained in the package. Here is a summary of the basics:

1. Inject all of the liquid in the syringe into the vial of powder. Gently swirl the vial until fully mixed.
2. Using the syringe from the glucagon kit, insert the needle into the vial and withdraw all of the liquid into the syringe.
3. Turn the person on their side. Glucagon injections can cause a person to vomit. By turning the person on his or her side you avoid the possibility of choking.
4. Inject all of the glucagon into a major muscle such as the buttock, thigh or upper arm. It’s important that you inject the glucagon deeply enough into the muscle so that it will have the full effect. Some physicians recommend giving only half of the syringe's contents to young children, waiting about 20 minutes, and if necessary, giving the other half. Consult your doctor to know the appropriate amount for your child. There is no danger of overdose with glucagon.

Once you mix glucagon, it must be used immediately (within the hour). If you mix and don’t use it, or only use a portion, discard what is not used.

What Results Can I Expect?

In most cases, blood sugar should begin to rise within minutes. After about 10 minutes, check blood sugar. If the person is still unconscious and the blood sugar is below 60 mg/dl, inject a second dose of glucagon. This implies that you have a second emergency kit since you injected the full available dose in the first kit. If the person does not respond to the second dose, or has difficulty breathing, call 911. This treatment will usually allow the person to fully recover from a severe bout of hypoglycemia within 1 to 6 hours and avoid a trip to the emergency room.

What Additional Action Should Be Taken During Recovery?

Once the person regains consciousness, they should be given a snack that contains both carbohydrates and protein, such as a peanut butter or a cheese sandwich. Check blood sugar over the next couple of hours to ensure that glucose levels are adequate. You should also contact the person’s doctor to report the incident.

How Should Glucagon Be Stored?

Glucagon should be stored at room temperature. If there is a danger of exposure to temperatures above 90°F, it can be stored temporarily in the refrigerator or a cooler. But, never freeze glucagon.

How Long Will Unmixed Glucagon Last?

Each glucagon kit has an expiration date. It’s often helpful to write this expiration date in your calendar to remind you to purchase a new kit (or two) about a week before your current one expires. It’s often helpful to keep expired glucagon kits to train others how to mix and administer glucagon. You can inject the glucagon into a piece of fruit, such as an orange or lemon.

Where Can I Get a Glucagon Emergency Kit?

You need a doctor’s prescription to purchase glucagon. Once you have the prescription you can get it at any local or online pharmacy.

_Sources:

Tips and Advice for Storing, Injecting and Teaching Others About Glucagon. Islets of Hope. Accessed March 5, 2009. http://www.isletsofhope.com/diabetes/care/tips_glucagon_1.html

What is Glucagon? Juvenile Diabetes Foundation. Accessed March 5, 2009. http://www.jdrf.org/index.cfm?fuseaction=home.viewpage&page_id=EC8C8253-1321-C844-132C3FAA3A7E01D3