Administration of Glucagon via Injection

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Considerations:

Low blood sugar in children with diabetes can have varied symptoms. These can include but are not limited to:

  • nervousness,
  • shakiness,
  • weakness,
  • extreme hunger,
  • slight nausea,
  • dizziness,
  • headache,
  • blurred vision,
  • fast heartbeat and/or
  • feeling tired.
  • Based on the student’s diabetes medical management plan/health care provider’s order, low blood sugar is treated with some type of quick-acting oral sugar, such as candy, icing/cake frosting tubes, and/or juice.
  • Severe low blood sugar symptoms include disorientation, unconsciousness, and seizures. If not treated promptly it could lead to death.
  • Glucagon is a medication used in emergency situations when the student is unresponsive or unable to swallow because of very low blood sugar.
  • Given that when a student is having symptoms of severe low blood sugar, it can be a stressful situation, it is highly recommended that you familiarize yourself with the student’s emergency plan beforehand.
  • The school nurse or other qualified health care professional must review the glucagon procedure with staff to ensure that they have the skills to perform this emergency medication administration.
  • Store the diabetes medical management plan/health care provider’s order and glucagon in a location that is easily accessible during a severe blood sugar event.
  • Be sure that staff members who have regular contact with the student know where the medication is stored.
    • If the student self-carries their glucagon be sure to communicate with the student to know where they store their medication.
  • The school nurse should develop a plan to systematically check the expiration date on medication to ensure medication is not expired.
  • Remember to keep the student’s health care information confidential.

Supplies: 

  • Glucagon kit
  • Alcohol wipe
  • Gauze or cotton ball
  • Gloves
  • Diabetes Medical Management Plan
  • Individualized Healthcare Plan (IHCP)
  • Healthcare provider’s order
  • Parent/Guardian authorization form
Procedure Download
Skill Competency Download

Procedure:

  1. Identify that symptoms of a severe low blood sugar reaction are present and that based on the student’s diabetes emergency plan, medication needs to be given
  2. Call for assistance
  3. Ask that another school staff person call 911 or emergency medical services
  4. If able, move the student to a lying position
  5. Explain the procedure to the student at his/her level of understanding
  6. Check the six rights of medication administration and the order to be sure it is:
    1. For the right student
    2. The right medication
    3. The right dose
    4. Being given at the right time
    5. Being given by the right route
    6. Being given for the right reason
  7. Be sure to check the medication to ensure that it has not expired
  8. Ensure proper documentation of parent/guardian authorization to administer medication
  9. Review student’s allergy status
  10. Wash your hands, if possible
  11. Assemble supplies and place on a clean surface
  12. Review the six rights once again while checking the glucagon to be sure it is:
    1. For the right child
    2. The right medication
    3. The right dose
    4. Being given at the right time
    5. Being given by the right route
    6. Being given for the right reason
  13. Be sure to check the medication to ensure that it is not expired
  14. Put on gloves, if gloves are not available, continue with the procedure
  15. Remove the glucagon vial and syringe containing the liquid or diluent from the case
  16. Remove the cap from the glucagon vial
  17. Remove the cap from the syringe
  18. Do not remove the plastic clip from the syringe, as this may allow the push rod to come out of the syringe
  19. Insert the needle tip in the center top of the rubber stopper on the vial and slowly push the diluent from the syringe into the vial
  20. Gently swirl the vial with the syringe still in the vial until the solution is clear (this takes about 10-15 seconds)
    • Do not use if the solution is cloudy or if you see particles in the solution
  21. Turn the vial upside down, being sure that the needle does not fall out of the vial
  22. Pull the solution into the syringe, by pulling back on the plunger, as you withdraw the ordered amount of glucagon solution
    • Do not pull the plunger out of the syringe
  23. Check the syringe for air bubbles
  24. If you see air bubbles, tap the syringe until the bubbles rise to the top of the syringe
    • If this method does not work to remove the air bubbles, push the dose back into the vial and pull back on the plunger again to withdraw the ordered amount of glucagon
  25. Once all the air bubbles have been removed, take the syringe out of the vial
  26. Identify the location (buttock, thigh, or arm) for the injection
  27. If you have an alcohol wipe, cleanse the injection site
  28. Insert the needle into the skin at a 90-degree angle
  29. Slowly inject the solution
  30. Once all the solution has been injected, remove the needle
  31. Put the used syringe in the carrying case
  32. Close the carrying case to avoid a possible needle stick injury
  33. Apply pressure using the alcohol wipe and gently massage injection site
  34. If the student is not lying on their side, move the student to a side-lying position because vomiting often follows the injection of glucagon
  35. If needed, ask another person for assistance
  36. If alone with student, and you have not already called 911 or emergency medical service, do so now
  37. Monitor the student’s arousal, pulse and respirations and for potential seizure
  38. If the student begins to seize, clear the area of anything hard or sharp, to prevent injury
  39. Place something soft under the student’s head and time the seizure
  40. If breathing stops, move the student onto their back
  41. Begin rescue breaths
  42. If breathing and heartbeat stop, begin CPR
  43. Stay with the student until EMS arrives
  44. As soon as the individual is awake and able to swallow, give the individual a fast-acting source of sugar (such as fruit juice)
  45. Once rescue squad arrives, inform them of medication administered, including type of medication, dose and time
  46. Send along glucagon kit along with used dose
  47. Dispose of all used materials in proper receptacles
  48. Remove gloves and wash hands
  49. Follow up with the parent or guardian and healthcare provider, as needed
  50. Document medication administration in the student’s medication administration log

References

American Diabetes Association. (n.d.). Hypoglycemia (low blood sugar). Retrieved June 2, 2023, from https://diabetes.org/healthy-living/medication-treatments/blood-glucose-testing-and-control/hypoglycemia

American Diabetes Association. (n.d.). Medications and treatments. Glucagon and other emergency glucose products. Retrieved June 2, 2023, from https://diabetes.org/healthy-living/medication-treatments/glucagon-other-emergency-glucose-products#:~:text=Glucagon%E2%80%94a%20hormone%20that%20raises,you%20in%20case%20of%20emergencies

Centers for Disease Control and Prevention. (2022, January 2). Seizure first aid. Retrieved June 6, 2023, from https://www.cdc.gov/epilepsy/about/first-aid.htm

Fresenius Kabi. (2019, November). Summary of instructions for use. Glucagon emergency kit for injection, 1mg/ml. Retrieved June 2, 2023, from https://glucagonemergencykit.com/wp-content/uploads/2019/12/Glucagon_IFU_191122.pdf

Levitsky, L.L., & Misra, M. (2022). Hypoglycemia in children and adolescents with type 1 diabetes mellitus. In a J. I. Wolfsdorf (Ed.), UpToDate. Retrieved: June 2, 2023, from https://www.uptodate.com/contents/hypoglycemia-in-children-and-adolescents-with-type-1-diabetes-mellitus

National Association of School Nurses. (2022, June 15). School nursing evidence-based clinical practice guideline: Students with type 1 diabetes toolkit. Retrieved June 2, 2023, from https://cdn.fs.pathlms.com/HRuI7pAvQWiJPZdzH6i8

National Association of School Nurses. (2021). School nursing evidence-based clinical practice guideline: Students with type 1 diabetes. Silver Spring, MD: Author. Retrieved June 2, 2023, from https://learn.nasn.org/courses/37660

National Diabetes Education Program. (2016). Helping the student with diabetes succeed: a guide for school personnel. Retrieved June 2, 2023 from https://diabetes.org/sites/default/files/2020-02/NDEP-School-Guide-Full-508.pdf

National Library of Medicine. (2019). Glucagon injection. Retrieved June 2, 2023, from https://medlineplus.gov/druginfo/meds/a682480.html#:~:text=Glucagon%20can%20be%20injected%20with,and%20how%20to%20administer%20glucagon

Wyckoff, L. (2019). Students with diabetes. In Selekman, J. (Ed.), School nursing, a comprehensive text (3rd ed.). (pp. 575-602). Philadelphia PA.: F.A. Davis Co.

Page last reviewed: February 19, 2025

Page last updated: February 19, 2025

The information and materials presented in this Website are intended for informational purposes only and are not designed to diagnose or treat a health problem or disease, or assist in diagnosis or treatment of the same.  The information is not intended to substitute for, supplement or replace clinical judgment.  If there are any concerns or questions about or relating to a nursing or medical procedure, contact the individual’s healthcare provider.  The information provided on this Website is not intended to be a substitute for medical orders and persons without the proper education, training, supervision and/or licensure should not perform the procedures.