Nasal Administration of Glucagon

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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: 

  • Baqsimi
  • 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 Baqsimi 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. Look into the child’s nostrils to determine if there is fluid or mucus in the nostrils.
  13. If drainage or mucus is present, use a bulb syringe to remove it
  14. Remove the Shrink Wrap by pulling on the red stripe
  15. Open the lid and remove the device from the tube
    1. Caution—do not push the plunger until ready to give the dose
  16. Use your free hand to hold the crown of the head stable
  17. Hold the device between your fingers and thumb
  18. Do not push the plunger yet
  19. Insert tip gently into one nostril until your finger(s) touch the outside of the nose
  20. Push plunger firmly all the way in
    1. Dose is complete when the green line disappears
  21. Remove the device
  22. 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
  23. If needed, ask another person for assistance
  24. If alone with student, and you have not already called 911 or emergency medical service, do so now
  25. Monitor the student’s arousal, pulse and respirations
  26. If breathing stops, move the student onto their back
  27. Begin rescue breaths
  28. If breathing and heartbeat stop, begin CPR
  29. As soon as the individual is awake and able to swallow, give the individual a fast-acting source of sugar (such as fruit juice)
  30. Once rescue squad arrives, inform them of medication administered, including type of medication, dose and time
  31. Send along glucagon kit along with used dose
  32. Dispose of all used materials in proper receptacles
  33. Remove gloves and wash hands
  34. Follow up with the parent or guardian and healthcare provider, as needed
  35. 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.

Lilly. (2020). How to use BAQSIMI. Retrieved April 15, 2020, from  https://www.baqsimi.com/how-to-use-baqsimi.

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.

Page last updated: March 15, 2021