What is glucagon?
Glucagon is a rescue medicine for a very low blood sugar. It raises blood sugar. It comes as a nose powder or a shot. A very low blood sugar can cause confusion, a seizure, or passing out. A person in that state cannot help themselves, so someone else gives the glucagon. Anyone can learn to give it. You do not need to be a nurse or a doctor.
Who is this visit for?
Adults 18 or older whom a clinician has told they have diabetes. You take insulin. Or you take a sulfonylurea or a meglitinide, and you are at high risk of a severe low. These are diabetes pills that can cause lows. Examples are glipizide, glyburide, glimepiride, repaglinide, and nateglinide. High risk means one of these: a low in the last 6 months that needed another person's help or a reading under 54, lows you do not feel coming, kidney failure, memory problems, weight-loss surgery, often going without enough food, low income, unstable housing, or not enough insurance. The doctor decides. The doctor reads your answers and sends a prescription to your pharmacy. No exam or test is needed. This visit does not start, stop, or change any diabetes medicine. We do not send insulin.
Can I buy glucagon without a prescription?
No. Glucagon is not sold without a prescription, so you cannot buy it from a store shelf. Your own diabetes doctor can prescribe glucagon too. The American Diabetes Association says every person who takes insulin should have it. If you can ask your own doctor, ask first. Your insurance may prefer one product. Ask your pharmacy. If you already have glucagon that has not expired, you may not need another. A second one can help in a second place, such as work.
What does this visit add?
If this visit fits you, the doctor sends a prescription for glucagon nose powder, 3 mg (BAQSIMI). One box has 2 devices. Each device works one time. The doctor may choose a different glucagon, such as a shot in an auto-injector (GVOKE HypoPen) or a kit you mix. You pick it up at your pharmacy. You pay the pharmacy for the medicine. You also get a plain sheet to share with the people you live with. This visit can be a faster way to get a prescription if you have no easy way to ask your own doctor. It does not make glucagon cheaper.
When do I give glucagon, and when do I give fast sugar?
Give glucagon if the person is passed out or will not wake up, is having a seizure, or cannot swallow safely. If the person is confused, call 911 now, and give fast sugar while you wait if they can swallow. If the person is awake, not confused, and can swallow, give fast sugar first. The amount is 15 grams, or 5 to 10 grams with an insulin pump that adjusts insulin by itself unless the low came with exercise or after too big a meal dose of insulin, then 15 grams. Juice, regular soda, or glucose tablets work. Read the label to see how much that is. If in doubt, give 15 grams. If you take acarbose, use only glucose tablets or glucose gel. Juice and soda can work too slowly with acarbose. Wait 15 minutes. Then check the blood sugar with a meter or a CGM. Do not go by how the person feels. A reading of 70 or lower is low. If it is still low, give fast sugar again and wait 15 minutes. If it is still low after that, call 911 or go to the ER now. If there is no meter or CGM that works, or it gives no reading, go by the low signs instead. Give fast sugar again after 15 minutes if the low signs have not gone away. Call 911 or go to the ER now if the low signs have not gone away after fast sugar twice. The person who is low must not drive. Someone else drives, or call 911.
How do I use glucagon nose powder?
Show these steps to the people you live with, and tell them where you keep it. 1. Check. Is the person passed out, having a seizure, or unable to swallow? If yes, go to step 2. If the person is confused, call 911 now, and give fast sugar while you wait if they can swallow. If the person is not confused, give fast sugar in the amount given above under When to give it, and wait 15 minutes. Then check the blood sugar with a meter or CGM. If it is 70 or lower, give fast sugar again and wait 15 minutes. Check again. If it is still 70 or lower, call 911 or go to the ER now. If there is no meter or CGM that works, or it gives no reading, give fast sugar, wait 15 minutes, and give it again if the low signs have not gone away. If the low signs have not gone away after fast sugar twice, call 911 or go to the ER now. The person who is low must not drive. Someone else drives, or call 911. 2. Give. Take the device out of the tube. Do not push the plunger first. Put the tip in one nostril until your fingers touch the nose. Push the plunger all the way in. The dose is done when the green line is gone. The person does not need to breathe it in. It works even if the person has a cold. If your doctor sent a shot or a kit, follow the Instructions for Use in the box. 3. Call 911 right after the dose. If someone else is there, one person gives the glucagon while the other calls 911. 4. Turn the person on their side. A person who wakes up may throw up. 5. Wait 15 minutes. If the person does not respond, give a second dose from a new device, if you have one. Keep waiting for help. 6. When the person is awake and can swallow safely, give fast sugar, such as juice. Then give a snack, such as crackers with cheese or peanut butter. If the person takes acarbose, use only glucose tablets or gel. 7. Stay until help comes, even if the person wakes up. A low can come back. Never give insulin to a person who is having a low.
How do I keep glucagon ready?
Keep the nose powder in its tube until you need it. Do not open the tube early, because wet air can spoil it. Keep it at room temperature, up to 86°F (30°C). Do not leave it in a hot car. If the doctor sends a shot, do not put it in the fridge or freeze it. A kit you mix must not freeze either. Keep it away from children. Check the date on the box and replace it before it expires. Show the people around you where it is. After glucagon, get a new device right away. Tell your own doctor every time you use glucagon. Your diabetes medicine may need to change.
Can I use this visit if I am pregnant or breastfeeding?
Yes. You can still use this visit. Reports and small studies over many years have not found harm from glucagon in pregnancy. A breastfed baby is unlikely to be harmed. Tell the doctor who manages your diabetes.
When should I get care right away?
Read the lists from the top. If more than one fits, follow the first one. Call 911 or go to the ER now if a low blood sugar is happening now in you or someone near you, with confusion, a seizure, passing out, or trouble swallowing. If the person is passed out, is having a seizure, or cannot swallow, and you have glucagon, give it. Then call 911. If someone else is there, one person gives the glucagon while the other calls 911. If the person is confused, call 911 now, and give fast sugar while you wait if they can swallow. Call 911 or go to the ER now if the blood sugar is still 70 or lower on a meter or CGM after fast sugar twice, or if there is no meter or CGM that works, or it gives no reading, and the low signs have not gone away after fast sugar twice. The person who is low must not drive. Call 911 or go to the ER now if you have chest pain or pressure, or if glucagon was given in the last 24 hours and the person was not seen in an ER. Call 911 if, after glucagon, the person has a rash or hives, swelling of the face, lips, or tongue, trouble breathing, or feels faint. Call your own diabetes doctor or clinic today if you had a severe low in the last 24 hours that needed another person's help and you did not need glucagon or 911, or if you had more than one low blood sugar under 54 (a level 2 low) in the last month, or several low blood sugars in a week that you could treat yourself. If no doctor or clinic manages your diabetes medicine, see a doctor in person today for either of these. Do not wait for our reply.