How to Give an Emergency Glucagon Injection to Treat Low Blood Sugar

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About 3 minutes

This information will teach you how to give an injection (shot) of glucagon to treat very low blood sugar in an emergency.

Very low blood sugar is sugar that is lower than 50 milligrams per deciliter (mg/dl). Glucagon will raise the blood sugar to safer levels.

Keep this resource to help you remember the steps on how to give the injection.

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About Low Blood Sugar (Hypoglycemia)

Your body uses sugar called glucose for energy. Glucose comes from the food that you eat. It’s stored in your liver and released into your bloodstream when needed. Your blood carries glucose to your cells so that your cells can use it for energy.

Low blood sugar means that there is too little glucose in your bloodstream. If your blood sugar drops too low, you can have symptoms such as:

• Sweating
• Shakiness
• Headaches
• Feeling faint
• A fast, forceful heartbeat
• Weakness

Without treatment, your blood sugar can keep going down. This can lead to symptoms such as:

• Poor coordination
• Confusion
• Not being able to eat or drink safely due to confusion
• Losing consciousness
• Having seizures

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About Your Glucagon Emergency Kit

Glucagon is a hormone made in your pancreas. It causes your liver to release sugar.

Because very low blood sugar is dangerous, it needs to be treated right away. Getting an injection of glucagon from your emergency kit will bring up your blood sugar quickly. You will feel better and be safer.

Figure 1. Glucagon emergency kit

Everything you need to give a glucagon injection is in the emergency kit. It includes a vial and syringe (see Figure 1). The vial has dry glucagon powder in it. The syringe is filled with a liquid to dilute the glucagon. The syringe will already have a needle attached.

Your caregivers should know how to give the glucagon injection, in case your blood sugar falls too low. After practicing in the hospital with your nurse, your caregivers should look at the kit and review how to give the injection.

The kit can be stored at room temperature. Look at the expiration date when you buy the kit. Write it on your calendar so that you can replace it when it is out of date.

When to use your glucagon emergency kit

You need glucagon if your blood sugar level is less than 50 mg/dl and you are:

• Unable to eat or drink safely because you’re confused or disoriented
• Unconscious
• Having seizures

If possible, someone will need to check your blood sugar level to make sure it’s low. This is because having high blood sugar can also make you unconscious. In that case, glucagon won’t help. Instead, get medical attention right away by calling 911. If you cannot find the blood glucose kit, and the person is showing the symptoms above, skip this step.

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How To Give a Glucagon Injection

1. Open the glucagon kit.
2. Flip off the cap of the vial containing the glucagon powder (see Figure 2)

   Figure 2. Opening the glass vial with the glucagon powder

3. Remove the cap covering the syringe needle.
4. Insert the needle into the rubber stopper on the top of the vial.
5. Push down on the syringe plunger to inject all of the fluid into the glucagon vial (see Figure 3).

   Figure 3. Injecting the diluting fluid into the glucagon vial

6. Without removing the needle from the vial, gently shake or roll the vial to mix it. The easiest way to do this is to hold the vial and syringe in one hand, with the vial on top and the syringe on bottom (see Figure 4). Mix until all the powder is completely dissolved. The solution should be clear and colorless.

   Figure 4. Mixing the glucagon powder with the diluting fluid

7. Draw up the glucagon into the syringe. To do this, hold the vial and syringe so that the vial remains on top and the tip of the syringe is towards the bottom of the vial (see Figure 5). Pull the plunger of the syringe back to draw the Glucagon into the syringe. Be sure to draw all of the medication in the vial into the syringe.

   Figure 5. Drawing the glucagon into the syringe

8. You will inject the glucagon into the person’s thigh or buttock. Clean the injection site with an alcohol swab. If you don’t have an alcohol swab, skip this step.
9. Insert the needle into the person’s skin in one quick motion at a 90 degree angle (straight up and down, see Figure 6). Use your thumb to push the plunger all the way down until all the medication is injected.

   Figure 6. Injecting the glucagon

10. When the syringe is empty, pull it straight out of the skin.
11. After injecting, turn the person onto their side. They may vomit after the injection and turning them on their side will keep them from choking.

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After Giving the Glucagon Injection

Call 911 after giving the injection.

Check your blood sugar, or have someone check it for you after the injection. It should rise to at least 70 mg/dl. Let the emergency medical personnel know the blood sugar result when they arrive.

An unconscious person will usually wake up within 15 minutes after the injection. Once the person is awake and able to drink, give them sips of fruit juice or regular soda. This will help restore the glucose in their liver and prevent the blood sugar from dropping again.

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Side Effects

Most people don’t have any side effects. Some people may have nausea and vomiting after getting glucagon.

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Last Updated

Saturday, April 22, 2023

Glucagon & Other Emergency Glucose Products

Medication and Treatments

Diabetes is a balancing act, especially when you take insulin or oral medications that lower blood glucose (blood sugar), especially sulfonylureas. If you do unplanned activity, skip a meal, or give yourself too much insulin, your blood glucose levels can dip and you quickly can develop low blood glucose.

Low blood glucose, also known as hypoglycemia, can cause you to have poor judgment or even lose consciousness. When you have severe hypoglycemia, it means you can’t swallow glucose-containing foods or drinks on your own to bring your levels back up.

When this happens, you’ll need to turn to glucagon.

Glucagon

Glucagon—a hormone that raises blood glucose levels—is used to treat severe hypoglycemia. Glucagon is taken as a spray into the nose or an injection administered under the skin.  

If you use insulin or a sulfonylurea to manage your diabetes, it’s a good idea to keep a glucagon kit with you in case of emergencies. You should also stash a second kit at work or in your car for extra security. Make sure your family, friends, and coworkers know how to use it in case of emergency. 

Check that you have an active prescription for glucagon. Before buying glucagon, check the expiration date—it should have at least a year of shelf life remaining.

Researchers have worked hard to bring us a future where glucagon delivery isn’t a multistep process. They have developed glucagon products that require no mixing or injection. Their goal? A fast hypoglycemia treatment that lessens a caregiver’s stress during a tense emergency situation—and saves lives.

Glucagon products now available in the U.S. and Food and Drug Administration (FDA)-approved:

Nasal Powder

Eli Lilly and Co.’s powder glucagon uses a device similar in size to a typical nasal spray to drive powdered glucagon into your nose, where it’s absorbed into the bloodstream.

This is a fast, one-step process. Because it’s needle-free, it may be less scary for caregivers and easier to deliver correctly. Like current treatments, nasal glucagon can be given to an unconscious person. 

Pre-Mixed, Shelf-Stable Pen

Xeris Pharmaceuticals’ device works similarly to EpiPens and other pens prefilled with medicines, such as insulin and type 2 injectable drugs. The device will contain a stable form of glucagon that’s already dissolved into liquid.

Because the glucagon is premixed, the caregiver simply removes the cap and injects it into the person with severe hypoglycemia. The pen pushes glucagon into the system as quickly as a glucagon kit.

How to administer mixed glucagon

A caregiver needs to:

1. Remove the seal from the vial of powder and the needle cover from the syringe.
2. Insert the needle into the vial and push the plunger to empty the saline into the powder.
3. Gently roll or swirl the vial to dissolve the powder into the liquid until it is clear.
4. Draw the solution back into the syringe.
5. Inject into the outer mid-thigh or arm muscle of the person with severe hypoglycemia.
6. Turn the person on his or her side in case of vomiting, a common side effect.

But remember, these are general rules, and you should always follow the manufacturer’s instructions for how to safely administer their glucagon. If you have further questions, be sure to contact your doctor. 

Proper insulin administration is the key to successful diabetes management!

Diabetes is one of the most common diseases of our time. An increasing number of people are receiving insulin therapy to compensate for carbohydrate metabolism. New insulin preparations are constantly being developed in an attempt to improve treatment outcomes. In the pursuit of innovation, fundamental principles such as the correct insulin therapy technique are often forgotten. But no matter how first-class qualities insulin possesses, if the drug is administered incorrectly, they are all leveled.

What are the main aspects of correct insulin therapy technique?
1. Selecting the correct needle length
2. Selecting the right injection site
3. Correct rotation of injection sites
4. Regular change of needles

Insulin must be administered subcutaneously, when injected into the muscle, the drug is absorbed into the blood faster, thereby causing a sharp, sometimes inexplicable, decrease in blood glucose (hypoglycemia). The main reason for intramuscular insulin administration is the use of needles longer than 6 mm.

A person may not be aware that they are injecting insulin into a muscle. The main signs of intramuscular injections are:
– bleeding from the injection site
– hematoma at the injection site
– Pain during injection.

Needles for syringe pens with a length of 4 mm are recognized as the safest for adults and children, injections with needles of this length are the most painless and comfortable. The 4 mm needle should be inserted at a 90° angle to the skin surface, the injection is performed without a skin fold. Needles with a length of 5 and 6 mm can also be used. When using 6 mm needles, to avoid the risk of intramuscular injection of insulin, it is necessary to collect a skin fold or insert the needle at an angle of 45 ° to the skin surface.

Recommended for injection: abdomen, anterior thighs, buttocks.

It is necessary to know the boundaries of the areas for insulin administration and use the entire available surface area of ​​the skin within these areas:
The abdominal area – retreating 2-3 cm to the right and left of the navel (injections around the navel are unacceptable!), 1 cm below the last ribs, not reaching 1 cm to the lateral surface of the abdomen, 1 cm above the pubic symphysis.
The thigh area is the upper lateral third of both thighs.
Buttock area – the upper quadrants of both buttocks.

The shoulder area is not recommended for self-administration of insulin due to the high risk of intramuscular injections (a thin layer of subcutaneous fat in this area).

Rotation of injection sites is essential for a correct insulin therapy technique! The harmful practice of injecting insulin in the same place, such as around the navel, is very common. The lack of change of injection sites leads to the formation of lipohypertrophy – a complication of injection therapy. Lipohypertrophy is an overgrowth of subcutaneous adipose tissue in response to needle trauma and looks like a tumor-like formation in a place where insulin injections are constantly performed.

The action of insulin when injected into an area of ​​lipohypertrophy is unpredictable and can lead to both hypoglycemia (very rapid absorption) and an apparent lack of insulin action (insulin is not absorbed).
So, in order to avoid the risk of developing lipohypertrophy, it is necessary to use the entire surface area of ​​the skin available for injections and constantly alternate injection sites. It is necessary to retreat at least 1 cm from the site of the previous injection (finger width).

Do not forget – after inserting the needle under the skin and pressing the plunger button, it is necessary to count up to 10 while holding the button of the syringe pen (when using some types of syringe pens, up to 5 – see instructions), so that the entire dialed dose of insulin is delivered by appointment.

Remember that the needle is changed after each injection!

Compliance with these simple rules is the key to the successful use of insulin to compensate for diabetes.

Prepared by: Head of the Diabetes Center V. V. Kalugina

How to give an emergency glucagon injection to correct low blood sugar

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Time to read:
Approximately 3 min.

This information will teach you how to give an emergency injection (shot) of glucagon to correct very low blood sugar.

Very low blood sugar is considered to be below 50 milligrams per deciliter (mg/dL). Glucagon raises blood sugar to a safer level.

Use this resource to review all the steps involved in performing an injection.

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Information about low blood sugar (hypoglycemia)

Glucose is one of your body’s sources of energy. Glucose is found in the foods you eat. It accumulates in the liver and is released into the bloodstream as needed. Blood carries glucose to all cells of the body, supplying them with energy.

When blood sugar is low, there is not enough glucose in the bloodstream. If your blood sugar drops too low, you may experience the following symptoms:

• sweating
• shiver;
• headache;
• feeling of faintness;
• rapid, increased heartbeat.
• weakness;

Without treatment, the drop in blood sugar may continue. This can lead to symptoms such as:

• impaired coordination of movements;
• confusion;
• inability to safely eat or drink due to confusion;
• loss of consciousness;
• convulsive seizures.

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Information about the Glucagon Emergency Kit

Glucagon is a hormone produced by the pancreas. Under its action, sugar is released from the liver into the bloodstream.

Since very low blood sugar is dangerous, this condition requires immediate treatment. An injection of glucagon from an emergency kit quickly raises blood sugar levels. You will feel better and your condition will be safer.

Figure 1 Glucagon Emergency Kit

In the kit you will find everything you need to inject glucagon in an emergency. It includes a vial and a syringe (see Figure 1). The vial contains glucagon in the form of a dry powder. The syringe is filled with liquid to dilute glucagon. The needle is already on the syringe.

Your caregivers should know how to give you a glucagon injection if your blood sugar drops too low. After training in the hospital with a nurse, your caregivers should learn how to use the kit and give injections.

The kit can be stored at room temperature. Check the expiration date of the kit when purchasing. Make a note on your calendar to replace the kit after its expiration date.

When to use the emergency glucagon injection kit

Glucagon is given when blood sugar drops to less than 50 mg/dl and when:

• inability to safely eat or drink due to confusion and disorientation;
• loss of consciousness;
• convulsive seizures.

If possible, have someone check your blood sugar to make sure it’s low. This is necessary because high blood sugar can also cause you to pass out. In this case, glucagon will not help. Instead, seek medical attention by calling 911. If you cannot find a blood glucose kit and the person has the symptoms described above, skip this step.

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How to inject glucagon

1. Open the glucagon injection kit.
2. Remove the cap from the vial of glucagon powder (see Figure 2).

   Figure 2. Opening a glass vial of powdered glucagon

3. Remove the cap from the syringe needle.
4. Poke the rubber stopper at the top of the bottle with a needle.
5. Press down on the plunger of the syringe to inject all of the liquid into the glucagon vial (see Figure 3).

   Figure 3. Injection of the dilution liquid into the vial of glucagon

6. Without removing the needle, gently shake or roll the vial between your palms to mix the contents. The easiest way to do this is to hold the vial and syringe in the same hand so that the vial is higher and the syringe is lower (see Figure 4). Mix until the powder is completely dissolved. The solution should be clear and colorless.

   Figure 4. Mixing glucagon powder with dilution liquid

7. Draw glucagon into the syringe. To do this, hold the vial and syringe so that the vial remains higher and the tip of the syringe points towards the bottom of the vial (see Figure 5). Pull the plunger to draw glucagon into the syringe. Be sure to draw all the medicine from the vial into the syringe.

   Figure 5. Drawing glucagon into a syringe

8. Glucagon must be injected into a person’s thigh or buttock. Wipe the injection site with an alcohol-soaked swab. If you don’t have an alcohol-soaked swab, skip this step.
9. In one quick motion, insert the needle into the skin at a 90-degree angle (moving straight up and down, see Figure 6). Press the plunger with your thumb and lower it all the way until you have injected all of the medicine.

   Figure 6. Administration of glucagon

10. When the syringe is empty, withdraw the needle from the skin by moving vertically upwards.
11. After the injection, turn the person on their side. After the injection, he may vomit, so you need to turn the person on his side so that he does not choke.

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After your glucagon injection

After your injection, call 911.

Check your blood sugar or have someone do it after your injection. It should rise to at least 70 mg/dL. When the ambulance arrives, inform them of your blood sugar results.

The person usually regains consciousness 15 minutes after the injection. When the person is awake and able to drink, give them a few sips of fruit juice or plain soda. This will help restore glucose levels in the liver and prevent blood sugar from falling again.

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Side effects

Most people do not experience any side effects. Some people may experience nausea and vomiting after administration of glucagon.

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