What is glucagon?

Glucagon is a hormone medicine used in diabetes management. It can be administered in non-emergency situations with mini-dosing to prevent “glycemic overshoot” or in emergencies when a diabetic is experiencing hypoglycemia and cannot take sugar orally. It comes in powder form and must be added to a solution in order to administer it. It raises the blood sugar by sending a signal to the muscles and liver (where glucose is stored in your body). Glucagon is the opposite of insulin.

When do you use glucagon?

In management – 

In cases of hypoglycemia (low blood sugar), glucagon allows the body to release sugar into the blood stream, so BGLs elevate to a safer range. Consult a physician to see if it would be helpful to use glucagon in glycemic overshoot prevention or if you have a history of hypoglycemia and thyroid problems.

In emergencies – 

If you are conscious but cannot consume sugar orally, you can self-administer glucagon. If you are unconscious, someone else will need to inject the glucagon into muscle. If hospitalized, the injection may be given intravenously. Always contact emergency services if glucagon is administered in an emergency situation.

What is the difference between glucagon and insulin?

Glucagon raises your blood sugar (treating hypoglycemia) while insulin lowers it (treating hyperglycemia or preventing it when taken before eating).

What can cause hypoglycemia?

  • Too much insulin causing an “insulin reaction”
  • Not eating when scheduled to eat
  • Being sick (excessive vomiting or diarrhea)
  • Excessive exercise

What are symptoms of hypoglycemia?

anxious feeling, behavior change similar to being drunk, blurred vision, cold sweats, confusion, cool pale skin, difficulty in concentrating, drowsiness, excessive hunger, fast heartbeat, headache, nausea, nervousness, nightmares, restless sleep, shakiness, slurred speech, and unusual tiredness or weakness.

According to the Mayo Clinic, untreated hypoglycemia will cause convulsions (seizures), unconsciousness and possibly death.

glucagon diagram

How to administer Glucagon:

1 – Check Glucagon expiration date. Do not use an expired Glucagon.

2 – Make sure your hands are clean.

3 – Open Glucagon. You will find a large syringe filled with liquid as well as a small bottle containing either a powder or a tablet. There will also be a page with instructions.

4 – Remove needle cap from syringe.

5 – Empty syringe into bottle with tablet / powder. It should start dissolving.

6 – Take syringe out and place to the side, but keep sterile.

7 – Gently swirl the vial containing the liquid and powder until it is dissolved.

8 – Using the same syringe, insert the needle into vial and draw out the mixed glucagon liquid. The general guidelines are to use half a syringe for Children 44 lbs. or less and a full syringe for those that weigh more than 44 lbs..

9 – Select area to inject glucagon and clean surface of skin. You should pick a large fleshy area such as thighs or buttocks, though an arm or the stomach works as well. Once you have identified the area, wipe with an alcohol swab.

10 – Insert needle of syringe fully into skin at a 90 degree angle. Once syringe is in, inject the glucagon liquid. It is best to do this as swiftly as possible, especially if the diabetic is having seizing and moving around. Try to keep the diabetic as steady as possible while you are injecting the glucagon.

11 – Once all liquid has been emptied, remove and safely discard the used syringe. If you have left over liquid in the vial from only using half a dose, this mixed liquid can be stored in the fridge for up to 24 hours, but no longer.

12Call your emergency care immediately. Turn the diabetic on his or her side, (glucagon may induce vomiting). Continue to monitor the diabetic while waiting for help to arrive. The glucagon, though fast acting, will take a few minutes (around 10-15) to take effect.

13 – You will need to continue to closely monitor blood sugars throughout the day after this, as a glucagon use will raise blood sugar substantially, but you will usually have an after effect of going low again. There is also a greater risk for another severe low for 24 hours after glucagon use. Because glucagon depletes the excess glucose storage in your system, some doctors recommend running your BGs a bit higher for a few days following glucagon use to help restore emergency sugars.

14 – Restock! After the ordeal is over and BGLs have returned to a safe range, don’t forget to restock. Glucagon is a MUST-HAVE medication for diabetics, so when the unexpected occurs, you’re prepared.

Possible side effects of glucagon:

  • nausea
  • vomiting
  • rash
  • itchy skin

If the following occur, a physician must be called immediately – 

  • difficulty breathing
  • unconsciousness

For additional manufacturing and device information for glucagon, visit Lilly (app available) or Novo Nordisk

Additional Reading:

How to Give Yourself an Insulin Shot

How to Give Someone an Insulin Shot

“I think We Saved Our Son’s Life Tonight” by Caitlin Edwards – a mother uses glucagon