Editor’s Note: This content has been verified by Marina Basina, MD, a Clinical Associate Professor at Stanford University. She’s a clinical endocrinologist and researcher with a focus on diabetes management and diabetes technology. Dr. Basina is an active member of multiple medical advisory boards and community diabetes organizations, and she is on the Beyond Type 1 Science Advisory Council. 

What is glucagon?

Besides being a hormone that occurs naturally in the body, glucagon is also an emergency medicine used when a person with diabetes is experiencing hypoglycemia and cannot take sugar orally or in non-emergency situations with mini-dosing to prevent “glycemic overshoot.” It comes in powder form and must be added to a solution in order to administer it. Once injected, it raises the blood sugar by sending a signal to the muscles and liver (where glucose is stored in your body).The effect of glucagon is opposite of the effect of insulin, raising blood sugar instead of lowering it.

What is the difference between glucagon and insulin?

In people with a fully functional pancreas, insulin and glucagon work in tandem to keep blood sugars stable. Insulin lowers blood sugar, while its partner, glucagon, releases the body’s glucose reserves from the liver to raise blood sugars.

When do you use glucagon?

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.

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.

How to store glucagon?

When not in use, (ie still in powder form) the glucagon kit should be stored at room temperature. Do not freeze or refrigerate and keep away from direct sunlight. If using for mini-dosing, mixed glucagon can be stored in the refrigerator for 24 hours.

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
  • unusual tiredness or weakness

Untreated hypoglycemia will cause convulsions (seizures), unconsciousness and possibly death.

glucagon diagram

Glucagon demo from athlete Robin Arzon

How to administer Glucagon:

1 – Make sure your hands are clean.

2 – 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.

3 – Remove needle cap from syringe.

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

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

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

7 – 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.

8 – 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.

9 – 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.

10 – 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.

11 – Call 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.

12 – 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.

13 – 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. Use your expired glucagon for practice on an orange as well!

Possible side effects of glucagon:

  • nausea
  • vomiting
  • rash
  • itchy skin

If the following occur, call your physician immediately:

  • difficulty breathing
  • unconsciousness

For additional manufacturing and device information for glucagon, visit Lilly or Novo Nordisk

The Future of Glucagon

Many believe that the next phase for glucagon is to create a stable, aqueous form of glucagon. Since glucagon is used in emergency situations to treat severe hypoglycemia, it needs to be intuitive, quick, and easy to use. However, the only form that you can currently find glucagon in is in a powder form, which requires multiple steps to dilute and then inject. Arecor has developed a prototype of a stable, aqueous form of glucagon that is currently in preclinical development.

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