Glucagon treatment for severe hypoglycemia Overview & FAQs
Authors: ADCES staff and reviewed by subject matter experts.
Glucagon is a hormone that helps regulate the body’s blood sugar levels. It is also produced by the pancreas and works in the opposing function of insulin. While insulin helps lower blood sugar levels, glucagon increases them by signaling the liver to release stored glucose into the bloodstream.
Synthetic forms of glucagon, discussed here, are used as a medicine to treat severe hypoglycemia in people with diabetes. It is typically given to individuals with diabetes who are unable to bring up their blood sugar levels with oral carbohydrates or who have become unconscious (or experiencing seizures) due to hypoglycemia. Glucagon only works if there are adequate glycogen stores because glucagon causes the liver to break down and release glycogen into the bloodstream to raise blood sugar. If a person has had previous bouts of hypoglycemia and has not replaced their glycogen stores, glucagon as an emergency medicine will not be able to work.
Ideally, a person with diabetes will never need to use glucagon, but if required, it can be lifesaving.
Those familiar with diabetes, especially Type 1, know severe hypoglycemia is a dangerous condition that can occur when blood sugar levels drop too low, often due to taking too much insulin or not consuming enough food to match an insulin dose. It can cause a wide range of symptoms including confusion, shakiness, dizziness, seizures, even loss of consciousness. In the most severe cases, it is life-threatening.
Glucagon in either injectable or inhaled form is used to treat severe hypoglycemia. It works by signaling the liver to convert stored glycogen into glucose and release it into the bloodstream. This raises blood sugar levels and helps to alleviate the symptoms of hypoglycemia. Glucagon can raise blood glucose 100 mg/dl on average. Often glucagon needs to be administered by another person since the symptoms accompanying an extreme hypo can make it difficult or impossible for the person with diabetes to do it themselves.
It's incredibly important (we’ll say this again in case anyone missed it, INCREDIBLY IMPORTANT) for people with diabetes who are at risk of severe hypoglycemia to have a glucagon kit (or better yet, more than one) on hand in case of emergency. Kits typically contain a dose of glucagon and instructions for administration. People with diabetes and their caregivers should be trained on how to properly use glucagon in the event of an emergency before an emergency situation occurs. Ideally, this training is provided by healthcare providers at diagnosis but this isn’t always possible. There are many online resources to help people with diabetes learn how to use their glucagon kit (see below).
There are currently two forms:
Both are equally effective but there are a number of factors that go into selection. Price, insurance coverage, personal preference of person with diabetes for method of delivery (prefilled syringe, injector pen, or inhalation), ease of use (based on the individual and/or caregiver) and level of experience of the person who will most likely be needed to administer an emergency dose.
This is a complex question because people’s experiences of low blood sugar differ by individual. It is important to help the person with diabetes know what the common symptoms of low blood sugar are and to guide them to educate those around them about these symptoms and the fact that signs of low blood sugar and when to treat with glucagon may vary by individual and over time. In addition, when one is experiencing hypoglycemia, the ability to reason is diminished. Educate the person with diabetes to know the early signs of low blood sugar, how to treat it, to carry a written copy of their Low Blood Sugar Care Plan with their diabetes supplies and to wear a medical identification bracelet, necklace or tattoo that identifies that they have diabetes.
Please note that any of the above signs may indicate the need for glucagon in an individual so education is key.
Below are links to the manufacturer’s instructions for use.
Gvoke Glucagon Prefilled Syringe
Zegalogue Glucagon Prefilled Syringe
Zegalogue Glucagon Autoinjector
What is the Shelf-Life and How Do I Store It?
Each Glucagon kit has an expiration date. Most kits usually last for 2 years after they are manufactured. Encourage the person to check the expiration date on their glucagon kit(s) on a regular schedule (for example before each visit with you) and request a new prescription if the kit is close to expiration.
Storage of the glucagon kit is an important piece of education. A glucagon kit should be kept in a location that is easy to access for the person and caregiver and be easily available in an emergency. Keeping one kit at home in the Emergency or Sick Day Kit is good practice. It is important that the person have a glucagon kit available with them when they are away from home with their emergency hypoglycemia supplies (glucose tabs, gel, or juice).
Can I use glucagon to treat mild hypoglycemia or just severe?
Currently glucagon is indicated for severe hypoglycemia only.
However, there is research being conduction on the use of glucagon in non-emergency situations for mild hypoglycemia. Mini-dosing might be recommended as part of sick day protocols or as a substitute for glucose. It is proposed that mini-doses may prevent the tendency to over-treat low blood sugars with too many carbs. In addition, glucagon is being studied for use in dual hormone pump therapy.
Here are two articles that look at mini-dose use of glucagon.
Nonaqueous, Mini-Dose Glucagon for Treatment of Mild Hypoglycemia in Adults With Type 1 Diabetes: A Dose-Seeking Study
Relationship between Optimum Mini-doses of Glucagon and Insulin Levels when Treating Mild Hypoglycaemia in Patients with Type 1 Diabetes - A Simulation Study
How much is Glucagon, does insurance cover it, are there any affordability programs to decrease costs?
The cost of Glucagon is dependent on an individual’s insurance. Savings cards are available from some manufacturers.
What are the side effects of glucagon?
Common side effects of glucagon differ slightly depending on if using nasal or injectable and may include nausea and vomiting. These side effects typically resolve on their own within a few hours.
Can expired glucagon be used?
No, the individual should always check the expiration date on the glucagon kit and replace expired kits. Expired glucagon may not work as effectively, which can have dire consequences.
Can glucagon be used in children?
Yes, glucagon can be used in children. See dosing guidelines in their full prescribing information.
Baqsimi nasal glucagon is approved for individuals 4 years and older
Gvoke is approved for individuals 2 years and older
Zegalogue is approved for individuals 6 years and older
Can I use glucagon if I am pregnant or breastfeeding?
Glucagon has not been studied extensively in pregnant or breastfeeding women.
Does Alcohol Affect Glucagon? How?
Yes! The liver will not be able to release glycogen if it is busy detoxifying alcohol. The liver will choose detoxifying over releasing glycogen even with the administration of glucagon. Intravenous glucose administration by a medical professional is required.
What should the patient and caregiver be concerned about after administering glucagon?
As Follow-up After Emergency Has Been Resolved
|Delivery Method||Nasal||Prefilled Syringe or Hypopen||Prefilled Syringe or Hypopen|
|Age Approved For||4||2||6|
Managing low blood sugar in Children
Managing low blood sugar in Adults
Low Blood Sugar Road Map This resource has:
|Show Pwd the different types of Glucagon - Nasal, Hypopen, or syringe and vial||Go over directions and share links from manufacturers||Discuss where to keep the glucagon kits|
|Go over the forms of identification that are available and what the Pwd would be interested in using: ID Card, bracelet, necklace, tattoo, etc.||Fill out the Low Blood Sugar Care Plan and go over at annual visit for updates||Discuss the information on the plan and who the Pwd thinks need to be told about the glucagon kit|
|Discuss any life or medication changes that will impact alteration in method of glucagon delivery, need, or additional education|
Discuss Emergency Diabetes Supply Kit and what is needed for safety and security.
|Discuss expiration date(s) or kit(s), different options for glucagon, and comfort level with Low Blood Sugar Care Plan including changes required due to new life circumstances|
Connected Insulin Device Certificate Program
Insulin Delivery Options Beyond an Insulin Pump
This site and its services do not constitute the practice of medical advice, diagnosis or treatment. Always talk to your diabetes care and education specialist or healthcare provider for diagnosis and treatment, including your specific medical needs. If you have or suspect that you have a medical problem or condition, please contact a qualified health care professional immediately. To find a diabetes care and education specialist near you, visit diabeteseducator.org.
ADCES and danatech curate product specifics and periodically review them for accuracy and relevance. As a result, the information may or may not be the most recent. We recommend visiting the manufacturer's website for the latest details if you have any questions.