Understanding Severe Hypoglycemia
Hypoglycemia, or low blood sugar, occurs when glucose levels in the blood drop too low, typically below 70 mg/dL [1.10.2, 1.3.5]. While mild cases can be treated by consuming fast-acting carbohydrates, severe hypoglycemia is a medical emergency where the brain is deprived of the glucose it needs to function [1.3.4, 1.3.5]. This condition is defined as a state where an individual requires assistance from another person to recover [1.2.5]. It can lead to confusion, loss of consciousness, and seizures [1.3.1]. In a study of U.S. veterans hospitalized with diabetes, 2.2% experienced severe hypoglycemia (blood glucose <54 mg/dL) [1.10.1]. Glucagon is a hormone naturally produced by the pancreas that raises blood glucose levels by signaling the liver to release stored glucose [1.2.2, 1.2.4]. A glucagon emergency kit contains a synthetic version of this hormone to counteract a severe hypoglycemic event [1.2.2].
When to Administer Glucagon
A glucagon emergency kit should be used immediately when a person with diabetes is experiencing symptoms of severe low blood sugar and is unable to safely swallow food or drink [1.2.4, 1.3.1]. The key indicators for using glucagon are:
- Loss of consciousness or unresponsiveness: The person cannot be woken up [1.2.1, 1.2.4].
- Seizures or convulsions: The person is experiencing uncontrollable body movements [1.3.1, 1.3.2].
- Inability to swallow: The person is conscious but too confused, disoriented, or nauseous to safely eat or drink a sugar source [1.3.1, 1.2.5].
- Lack of response to oral glucose: Attempts to treat with sugary drinks or food have failed and the person's condition is worsening [1.3.1].
Family, friends, and coworkers of individuals at risk should be trained to recognize these symptoms and know how to administer glucagon [1.2.4, 1.2.5]. In an emergency, it is better to give glucagon than to hesitate; it is a safe medication even if given unnecessarily [1.9.2].
Types of Glucagon Emergency Kits and Administration
Modern glucagon kits are designed for easier use than older versions. The main types available include nasal glucagon, pre-filled syringes or auto-injectors, and traditional kits that require mixing [1.8.1, 1.8.3].
Nasal Glucagon (Baqsimi)
This form is a dry powder sprayed into the nose. It does not need to be inhaled and is effective even if the person has a cold or is congested [1.5.3, 1.5.4].
- Remove the device from its shrink-wrapped tube [1.5.3].
- Insert the tip gently into one of the person's nostrils until your fingers touch their nose [1.5.1, 1.5.2].
- Push the plunger firmly all the way in. The dose is complete when the green line on the plunger disappears [1.5.1, 1.5.3].
Auto-Injectors and Pre-filled Syringes (Gvoke, Zegalogue)
These devices contain a stable, pre-mixed liquid glucagon and are similar in function to an EpiPen [1.4.1, 1.8.3].
- Remove the cap from the device [1.4.1, 1.4.4].
- Choose an injection site, such as the outer thigh, lower abdomen, or upper arm [1.4.1, 1.4.4].
- Push the pen firmly against the skin and hold for the time specified in the instructions (e.g., 5 seconds for Gvoke HypoPen) until the indicator shows the injection is complete [1.4.3, 1.4.4].
Traditional Injectable Kits
These kits require mixing a powder with a sterile liquid before injection [1.4.1].
- Remove the cap from the powder vial and the needle cover from the syringe [1.4.2].
- Inject all the liquid from the syringe into the powder vial [1.4.2].
- Swirl the vial gently until the powder dissolves and the solution is clear [1.4.1].
- Draw the entire solution back into the syringe [1.4.1].
- Inject the full dose into the muscle of the outer thigh, buttock, or arm [1.4.2, 1.6.5].
| Feature | Nasal Glucagon (Baqsimi) | Auto-Injector (Gvoke) | Traditional Kit |
|---|---|---|---|
| Form | Nasal Powder [1.8.5] | Pre-mixed Liquid Injection [1.8.5] | Powder & Liquid for mixing [1.4.1] |
| Administration | Sprayed into one nostril [1.5.1] | Injected into thigh, arm, or abdomen [1.4.4] | Injected into muscle after mixing [1.4.2] |
| Ease of Use | Very high; no needles, no mixing [1.8.2] | High; pre-filled and ready to use [1.8.1] | Lower; requires manual mixing [1.8.2] |
| Needle Involved | No [1.8.3] | Yes (auto-injector) [1.8.3] | Yes (manual syringe) [1.4.2] |
Actions to Take After Administering Glucagon
The work is not finished after the dose is given. Taking the right steps afterward is crucial for safety and recovery.
- Call 911 Immediately: Always seek emergency medical help right after administering glucagon, regardless of the person's response [1.6.1, 1.6.4].
- Position the Person: Turn the individual onto their side. Glucagon can cause vomiting, and this position helps prevent choking [1.2.1, 1.6.2].
- Wait for a Response: A person will typically wake up within 15 minutes [1.2.1, 1.2.3]. If there is no response after 15 minutes, a second dose may be given if available [1.5.5, 1.2.1].
- Provide Sugar: As soon as the person is awake and able to swallow safely, give them a fast-acting source of sugar like fruit juice or non-diet soda. This should be followed by a long-acting carbohydrate and protein snack, such as crackers with cheese or a sandwich, to prevent another drop in blood sugar [1.2.1, 1.6.4].
- Monitor Blood Sugar: Check the person's blood sugar levels frequently in the hours following the event [1.2.1].
- Store and Replace: Store glucagon kits at room temperature (68°F to 77°F), protected from light, and note the expiration date [1.9.1, 1.9.3, 1.9.4]. Replace any used kit immediately so you are prepared for a future emergency [1.6.1].
Conclusion
A glucagon emergency kit is a non-negotiable safety tool for many people with diabetes, particularly those on insulin [1.2.5]. Knowing when and how to use it can be life-saving. The primary trigger for its use is a severe hypoglycemic episode where the individual cannot self-treat by swallowing sugar [1.2.1]. Modern options like nasal sprays and auto-injectors have made administration much simpler and faster for caregivers in a high-stress situation [1.8.2]. Educating family, friends, and colleagues on recognizing severe hypoglycemia and using the kit correctly is a vital part of a comprehensive diabetes management plan [1.2.4]. Following up with emergency services and providing supplemental nutrition after administration ensures the person's safety and stabilizes their recovery [1.6.1, 1.6.4].
For more information from an authoritative source, you can visit the American Diabetes Association.
