Gvoke Administration

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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 child’s individual health plan (also known as diabetes action plan or diabetes emergency plan), low blood sugar is treated with some type of quick acting oral sugar, such as candy, icing, 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 child 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.
  • Your school nurse or other licensed health care professional must review the glucagon procedure with you to ensure that you have the skills to perform this emergency medication administration.
  • Store the diabetes emergency plan 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.
  • Remember to keep health care information confidential.

Supplies: 

  • Gvoke Hypopen
  • Gloves
  • Medication order

 procedure download  skill competency

This video was developed in partnership with the Wisconsin Department of Public Instruction
  1. Identify that symptoms of a severe low blood sugar reaction are present and that based on the child’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 child at his/her level of understanding
  6. Check the medication and the order 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
  7. Be sure to check the medication to ensure that it has not expired
  8. Wash your hands, if possible
  9. Quickly review the five rights once again while checking the Gvoke HypoPen 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
  10. Be sure to check the medication to ensure that it is not expired
  11. Put on gloves
  12. Tear open pouch at the dotted line and carefully remove the GVOKE HypoPen
  13. Look at the liquid medicine through the viewing window. It must be clear and colorless, or a pale yellow
  14. Identify the location (stomach, thigh, or upper arm) for the injection
  15. Cleanse the injection site with an alcohol wipe
    • NOTE: GVOKE Hypopen cannot be administered through clothing
  16. Pull the red needle cap straight off the device
  17. Push and hold the GVOKE HypoPen straight down against the injection site. Listen for a “Click”
  18. Hold the device down and count slowly to 5
  19. When the injection is complete, the viewing window will be red
  20. Lift the device straight up from the injection site. The yellow needle guard will lock over the needle
  21. 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
  22. If needed, ask another person for assistance
  23. If alone with student, and you have not already called 911 or emergency medical service, do so now
  24. Monitor the student’s arousal, pulse and respirations
  25. If breathing stops, move the student onto their back
  26. Begin rescue breaths
  27. If breathing and heartbeat stop, begin CPR
  28. As soon as the individual is awake and able to swallow, give the individual a fast-acting source of sugar (such as fruit juice)
  29. Once rescue squad arrives, inform them of medication administered, including type of medication, dose and time
  30. Send along glucagon kit along with used dose
  31. Dispose of all used materials in proper receptacles
  32. Remove gloves and wash hands
  33. Follow up with the parent or guardian and healthcare provider, as needed
  34. Document medication administration in the student’s medication administration log

References:

American Diabetes Association. (2015). Hypoglycemia (low blood sugar). Retrieved April 15, 2020, from http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/hypoglycemia-low-blood.html.

Levitsky, L.L., & Misra, M. (2020). Hypoglycemia in children and adolescents with type 1 diabetes mellitus. In a J. I. Wolfsdorf (Ed.), UpToDate. Retrieved April 16, 2020.

National Association of School Nurses. (2016). Diabetes management in the school setting (Position Statement). Silver Spring, MD: Author. Retrieved May 1, 2020, from https://www.nasn.org/advocacy/professional-practice-documents/position-statements/ps-diabetes.

National Association of School Nurses. (2017). Medication administration in schools (Position Statement). Silver Spring, MD: Author. Retrieved May 1, 2020, from https://www.nasn.org/nasn/advocacy/professional-practice-documents/position-statements/ps-medication.

National Association of School Nurses. (2019). Nursing delegation in the school setting (Position Statement). Silver Spring, MD: Author. Retrieved May 1, 2020, from https://www.nasn.org/nasn/advocacy/professional-practice-documents/position-statements/ps-delegation.

National Diabetes Education Program. (2016). Helping the student with diabetes succeed: A guide for school personnel. Retrieved April 23, 2020, from https://www.niddk.nih.gov/-/media/Files/Health-Information/Health-Professionals/Diabetes/health-care-professionals/NDEP-School-Guide-Full-508.pdf?la=en&hash=96CB5BC79927D61084D4EAEF5577FCFC.

Xeris Pharmaceuticals, Inc. (2020). Gvoke HypoPenTM (glucagon injection). Instructions for use. Retrieved March 15, 2021 from https://www.gvokeglucagon.com/pdf/instructions-for-use-gvoke-hypopen.pdf

Page last updated: July 15, 2021