When and how to use glucagon. Treatment of severe hypoglycemia. By the diabetes education program at
The Hospital for Sick Children. This video explains how to treat severe hypoglycemia with glucagon.
Please note, the images in this video are for illustrative purposes only and do not constitute
the hospital's endorsement of a specific brand or product. What is hypoglycemia? Hypoglycemia, or low
blood sugar, is a blood sugar level lower than four millimole per litre. To treat hypoglycemia, it is
important to always have a source of fast-acting sugar such as juice or dextrose tablets with you.
What is severe hypoglycemia? Hypoglycemia is considered severe when your child is unable
to help themselves and requires assistance from another person.
During severe hypoglycemia, a person may experience any of the following:
Drunken-like behavior that can include slurred speech, staggering, combative behavior and confusion.
Very low energy. Your child may appear extremely tired or be difficult to wake up.
Loss of consciousness. Your child May faint or be unable to wake up.
Temporary paralysis down one side of the body.
And/or convulsions or seizures.
What is glucagon? Glucagon is an emergency medication used to treat severe hypoglycemia
or low blood sugar. Glucagon is a hormone made in the pancreas. It stimulates the liver to release
stored glucose into the bloodstream when blood sugar levels are too low.
When is glucagon used? When your child with diabetes has severe hypoglycemia, the production
of their own body's glucagon is turned off by the insulin that is working too well. Glucagon is
given when your child cannot independently and/or safely take an oral hypoglycemia treatment.
How is glucagon given? Glucagon can be given either by syringe or nasal spray.
Preparing to give glucagon. If you can, check your child's blood sugar level before giving this
medication. If you cannot check your child's blood sugar level before giving the glucagon that is
okay. Give the glucagon as you do not want to delay treatment if a severe low blood sugar is happening.
Giving the glucagon when the blood sugar level is not low will not cause harm to your child.
Preparing and giving nasal glucagon. How to prepare nasal glucagon. Step one: Remove the shrink wrap by
pulling on the red stripe. Caution: Do not remove the shrink wrap until you are ready to give the
medication. Step two: Open the lid and remove the device from the tube. Caution: Do not press the
plunger until you are ready to give the dose. There is only a single dose in the device. How to give
nasal glucagon. Step one: Hold the device between your fingers and thumb. Do not push the plunger yet.
Step two: Insert the tip gently into one nostril until your fingers touch the outside of the nose.
Step three: Push the plunger firmly all the way in. The dose is complete when the green line disappears.
Preparing and giving injectable glucagon.
How to prepare injectable glucagon. Step one: Flip off the seal from the vial of glucagon powder.
Step two: Remove the needle cover from the syringe. Step three: insert the needle into the rubber stopper
on the vial, then inject the entire contents of the syringe into the vial of glucagon powder.
Step four: Remove the syringe from the vial. Then gently swirl the vial until the liquid becomes
clear. Glucagon should not be used unless the solution is clear and of a water-like consistency.
If the vial is not gently swirled, the medication may foam and become
very bubbly. This will make it hard to withdraw the medication.
Step five: Insert the same syringe into the vial and slowly withdraw the liquid.
For children five years of age or younger, withdraw only half of the liquid to the 0.5 milligram line.
For children older than five years of age, withdraw the liquid to the one milligram line.
How to give injectable glucagon. Inject the glucagon immediately after mixing into the
buttock, arm or thigh, and then withdraw the needle. Apply light pressure against the injection site.
In this video I'm going to show you how to mix and prepare glucagon.When you receive your glucagon
from the pharmacy, it will either be in a white and red box or in an orange or red hard case.
Regardless of what your package looks like, you will find the same items inside.
Inside the package you will find: Instructions on how to use and give this medication,
a vial with a small white glucagon tablet inside as well as a syringe filled with sterile water.
In order to give the glucagon, we must first mix the syringe of sterile water with the
glucagon tablet to dissolve it. Step one is to remove the gray cap from the vial.
Step two is to remove the protective cap off of the syringe - it pulls straight off.
On the top of the vial, there is a soft gray center this is where we will insert the needle.
Once the needle is inside the vial, you will push down on the plunger to move all of the water
inside the vial. Once the water is inside, remove the needle and we will gently swirl the vial.
You want to swirl the vial until you see that the liquid inside looks clear.
Once we know our liquid is clear, we're going to put the syringe back in the top of the vial,
flip the syringe and vial upside down and withdraw the medication.
If your child is age five or younger, you will pull back to the first line that says 0.5 milligrams.
And if your child is age six or older, you will withdraw all of the medication to the 1.0
milligram line. If you see any large air bubbles in the syringe, flick the syringe to remove them.
Once there are no large air bubbles left, you are now ready to give this medication.
Next steps after giving glucagon.
If your child is unconscious, place them in the recovery position after giving glucagon.
When an unconscious person wakes up after receiving glucagon, they may vomit.
Stay with your child until they wake up or help arrives.
Once your child is awake, offer them small sips of a carbohydrate containing liquid, for example,
juice. If they tolerate the liquid, offer them a small carbohydrate snack, for example, crackers.
If your child is unable to eat or drink, recheck their blood sugar level and contact your diabetes
team through the urgent number provided. If the diabetes doctor on call cannot be reached and your
child is vomiting, go to the nearest hospital even if their blood sugar level has started to rise.
Once your child is awake, monitor their blood sugar level every hour for about three to
four hours. If your child does not wake within 15 minutes after giving glucagon, call 9-1-1.
Once your child is alert remember to notify your diabetes team right away that an episode of severe
hypoglycemia has occurred. They will work with you to reduce the insulin doses over the next 24 hours.
Later, examine what happened and determine how this can be prevented in the future.
Important points. Keep the glucagon kit somewhere that is easily accessible.
Bring this medication with you when travelling. Teach all caregivers and other family members,
such as older siblings, when and how to use this medication in case of a severe low blood sugar.
Thank you. We are here to help! If you have questions or need
further tips please contact your diabetes team.