Diabetes: Glucagon Injections

What is glucagon?

Glucagon is a hormone made in the pancreas, like insulin. However, it has the opposite effect of insulin. It raises the blood sugar level rather than lowering it. Glucagon injections are used in emergency situations when someone is having a severe low blood sugar reaction (hypoglycemia). It is rarely needed, but if your child has diabetes, you should keep glucagon on hand in case of an emergency.

Glucagon comes in a bottle containing a 1 mg tablet or powder. It also comes with a bottle of fluid. A Glucagon Emergency Kit has the fluid in a syringe to inject into a vial with powder. After mixing, an insulin syringe and needle can be used (preferably a 0.5-cc or 1.0-cc syringe) to give the shot just as you would give insulin.

• Keep the glucagon in a convenient place. Check the expiration date regularly and replace it when it becomes outdated.
• Store the glucagon in a refrigerator during hot weather. Protect it from freezing. It should not reach temperatures above 90°F. Take it in a cooler for trips away from home during hot weather.
• Know the dose you should give your child in case of emergency. If you are confused about the dosage or how to use the glucagon, talk to your health care provider or pharmacist.

When and how should I use glucagon?

Use glucagon when your child is unconscious or having a seizure.

Emergency Kit: Follow the directions on the kit for mixing. You will need to inject the fluid in the syringe into the bottle, mix it with the glucagon, and then draw the fluid back into the syringe (you can use an insulin syringe).

Regular Glucagon: Insert 1/2 cc of air into the fluid bottle (1 cc won't fit). Draw out 1 cc of fluid from the fluid bottle. Inject the 1 cc of fluid into the bottle with the tablet. Mix. Draw the fluid mixture back into the syringe. To give glucagon:

1. Inject the amount prescribed by your health care provider. The dose will be lower for small children than it is for bigger children or adults. Read the instructions that come with this medicine so that you will know what to do.
2. Inject the proper dose deep into the muscle (in front of leg or upper, outer arm) or into the subcutaneous fat (just as you would an insulin shot). Both work fine.
3. Wait 10 minutes. Check the blood sugar. If your child is still unconscious and the blood sugar is still below 60 mg/dl (3.2 mmol/L), inject a second dose of glucagon (same amount as first dose).
4. If your child does not respond to the second dose of glucagon or if your child has any trouble breathing, call 911.
5. Give your child sips of juice, nondiet soda or sugar water as soon as he awakens. After 10 minutes, encourage your child to eat solid food (crackers and peanut butter or cheese sandwich, etc.).
6. Call your diabetes care provider to report the severe reaction before you give your child another insulin injection (so your provider can prescribe a change in the dose if needed). Complete recovery may take 1 to 6 hours.

Are there any other uses for glucagon?

Glucagon can also be used in small doses when a child is vomiting and has low blood sugar (<60 mg/dl). This situation may occur when your child can't keep food down. In these cases, glucagon can be mixed and given just like insulin using an insulin syringe. The usual dose is 1 unit for each year of age up to 15 units. Before giving glucagon, call your diabetes care provider to ask for the appropriate dose. If the blood sugar is not higher in 20 to 30 minutes, the same dose can be repeated. This treatment has saved many people from having to go to the emergency room.