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What to do
When a Diabetic Person is Unconscious

• Remain calm.  You can do this!
   
• Act quickly. Prolonged unconsciousness may be harmful and blood glucose can continue to drop quickly even over a matter of minutes.   
   
• Yell specifically for someone by name (or point and say "you") to call 911, don't just randomly say "someone" call 911.

When to give glucagon

DO NOT USE glucagon kits after the expiration date stamped on the container. Call 911 if glucagon is expired or cannot be given for any reason whatsoever.

Milder cases of hypoglycemia should be treated quickly by giving fast sugars by mouth -- don't wait -- because blood glucose can drop rapidly and sharply and a person can lose consciousness in only a matter of minutes.  They will then need to be injected with glucagon.

Give glucagon  if:

• the person is unconscious
   
• the person is unable to eat sugar or a sugar-sweetened product
   
• the person is having a seizure or convulsions, or
   
• repeated administration of sugar or a sugar-sweetened product such as a regular soft drink or fruit juice does not improve the patient's condition. 

Glucagon will only work when injected under the skin into muscle or  into fatty tissue.

How to Prepare Glucagon for Injection

The contents of the syringe are inactive. You must mix the contents of the syringe with the  glucagon in the accompanying bottle before giving injection. Do not prepare Glucagon for Injection until you are ready to use it.

Turn patient on his/her side to prevent patient from choking and:

          Flip off Top                     Inject all liquid                 Swirl bottle gently
          from bottle;                   from syringe into              until dry glucagon is
          wipe rubber                   bottle                              dissolved and clear
          stopper with                                                         like water
          alcohol swab

1. Remove the flip-off seal from the bottle of glucagon. Wipe rubber stopper on bottle with alcohol swab.  
    
2. Remove the needle protector from the syringe. DO NOT REMOVE THE PLASTIC CLIP FROM THE SYRINGE.  
    
3. Inject the entire contents of the syringe into the bottle of glucagon.
    
4. Remove syringe from the bottle.  
    
5. Swirl bottle gently until glucagon dissolves completely.

GLUCAGON SHOULD NOT BE USED UNLESS THE SOLUTION IS CLEAR AND OF A WATER-LIKE CONSISTENCY.  IF YOU CANNOT INJECT GLUCAGON FOR ANY REASON IMMEDIATELY CALL 911.

How to Draw Glucagon into the Syringe

1. Using the same syringe, hold bottle upside down and, making sure the needle tip remains in solution.
    
2. Gently withdraw all of the solution (1 mg mark on syringe) from bottle.  
    
3. The plastic clip on the syringe will prevent the rubber stopper from being pulled out of the syringe; however, if the plastic plunger rod separates from the rubber stopper, simply reinsert the rod by turning it clockwise.  
    
4. The usual adult dose is 1 mg (1 unit). For children weighing less than 44 lb (20 kg), give 1/2 adult dose (0.5 mg).  
    
5. For children, withdraw 1/2 of the solution from the bottle (0.5 mg mark on syringe).

Note:  You can also use any syringe used to inject insulin to also inject glucagon.

DISCARD UNUSED PORTION

How to Inject Glucagon

Inject glucagon the same way that you inject insulin.  You can inject into the fat or muscle (fat is preferred, but don't worry - just get it under the skin). THERE IS NO DANGER OF OVERDOSE.

Using the following directions, inject glucagon IMMEDIATELY after mixing:

1. Cleanse injection site on buttock, arm, or thigh with alcohol swab.  
    
2. Insert the needle into the loose tissue under the cleansed injection site, and inject all (or ½ for children weighing less than 44 lb) of the glucagon solution. Inject just as you would insulin.
    
3. Apply light pressure at the injection site, and withdraw the needle. Press an alcohol swab against the injection site. 
    
4. Turn the patient on his/her side. When an unconscious person awakens, he/she may vomit. Turning the patient on his/her side will prevent him/her from choking.
    
5. Call 911, but don't leave the person alone if at all possible. 

FEED THE PERSON AS SOON AS HE/SHE AWAKENS AND IS ABLE TO SWALLOW. Give them a fast-acting source of sugar (such as a regular soft drink or fruit juice) and a long-acting source of sugar (such as crackers and cheese or a meat sandwich).  

If the person does not awaken within 15 minutes, give another dose of glucagon if paramedics have not arrived yet.

A doctor should ALWAYS be notified whenever severe hypoglycemic reactions occur.

What to do After Injecting Glucagon

• Keep person on their side; glucagon can cause vomiting
• Do not leave the person if at all possible
• Call 911 if necessary, then call parents
• Feed the person as soon as they are able to eat
• If person does not revived in 15 minutes give another shot of glucagon
• Watch for reactions to glucagon shots

Severe side effects are very rare but a few people may be allergic to one of the inactive ingredients in glucagon.  Other side effects may include:

• rapid heartbeat
• nausea and vomiting
• feeling "hungover" 

If you experience any reactions which are likely to have been caused by glucagon, contact your doctor immediately.

If the person does not respond to glucagon

WARNING   THE PATIENT MAY BE IN A COMA FROM SEVERE HYPERGLYCEMIA (HIGH BLOOD GLUCOSE) RATHER THAN HYPOGLYCEMIA. IN SUCH A CASE, THE PATIENT WILL NOT RESPOND TO GLUCAGON AND REQUIRES IMMEDIATE MEDICAL ATTENTION IN A HOSPITAL!

Islets of Hope Publication TRE-1-2006-fr  (excerpts from complete publication)

Other related publications available include:

TRE-1-2006 (Complete Version) How to Prepare & Inject Glucagon
HG-1-2006 Hypoglycemia

This information may be used and distributed freely.  We do ask that you reference www.IsletsofHope.com.