Fasting-acting glucagon may be needed for severe hypoglycemia. You may not be able to self-treat, so friends, family, colleagues, or caregivers may need to know how to administer glucagon.

Severe low blood sugar can quickly become a medical emergency, and it may require quick treatment to make sure it doesn’t become life threatening.

Glucagon is a hormone that can quickly raise blood sugars and get you back to a safe place.

Since glucagon is most often used for severe hypoglycemia, it’s those who help care for people with diabetes who are typically the ones who administer the rescue glucagon in these emergency situations.

Glucagon is an emergency medical solution for people diabetes. It’s used to treat severely low blood sugar in all types of diabetes.

Since 2019, there are several newer, ready-to-use products available that make glucagon use much easier than it had traditionally been for those with diabetes. These glucagon options come in a few different basic forms:

  • Xerisa ready-to-use auto-injector rescue pen
  • an easy-to-use prefilled syringe
  • an older mix-and-inject kit

Historically, there was an older mix-and-inject glucagon kit.

These were introduced in the 1960s, with a red plastic kit by Eli Lilly and an orange plastic kit by Novo Nordisk. Both have now been discontinued in the United States and abroad, in 2023 and Summer 2024 respectively.

With each of these above-mentioned types of glucagon currently avaiable, more than 1 company makes different products.

Aside from these injectable options, Eli Lilly also has a nasal glucagon version called Baqsimi, which is a fast-acting powder that comes in a dispenser that you use much like a Flonase dose up the nose.

In the event of severe hypoglycemia, you may not be able to give yourself an injection.

It’s a good idea to teach those closest to you what hypoglycemia looks like, where you keep your glucagon, and how to administer it.

This type of ready-to-use injection doesn’t require much in the way of preparation.

But don’t open the pouch until you’re ready to administer the glucagon. It must be discarded if you open it but don’t use it.

Here’s how to administer glucagon with a prefilled auto-injector rescue pen:

  1. Open the pouch and make sure the medication looks clear and almost colorless. If it’s cloudy or has visible particles, don’t use it.
  2. If alcohol is available, clean the injection site.
  3. Inject into the skin of the lower abdomen, thigh, or upper arm.
  4. Hold for 5 seconds, then release.
  5. Turn the person on their side.

With the prefilled syringe, the process is similar to the above steps using the plastic rescue pen. But there are a few distinct differences involved with using a syrinve that you can see and isn’t self-contained inside the injector device.

  1. Remove the prefilled syringe from the foiled pouch
  2. Make sure the medication looks clear and almost colorless. If it’s cloudy or has visible particles, don’t use it.
  3. If alcohol is available, clean the injection site.
  4. Inject into the skin of the lower abdomen, thigh, or upper arm.
  5. Push the plunger down as far as it will go to quickly inject all of the liquid solution into the skin.
  6. Push the plunger down as far as it will go to quickly inject all the liquid solution into the skin, or roughly 10 seconds. Do not pull back on the plunger rod or lift the syringe from the skin before finishing the injection.
  7. Once fully injected, pull the syringe directly up from the skin and put aside, to dispose of the needle in a sharps container after the medical emergency.
  8. Turn the person on their side.

The novel nasal version of glucagon is unique in how it’s delivered. It comes as a powder inside an intranasal device, which you use to dispense the medication up into the nose.

  1. Unbob and unseal the wrapper and take the dispenser out of the yellow plastic case.
  2. Hold the dispenser between your two big fingers and thumb, but don’t yet push the plunger.
  3. Gently insert the tip of the tube up into one nostril until your fingers are touching the bottom of the nose.
  4. Squeeze the plunger all the way until the green line disappears.
  5. There isn’t a need to inhale the medication for it to be absorbed and start working.

These were the only glucagon options starting in the 1960s.

Both Eli Lilly and Novo Nordisk made a plastic kit, colored red and orange respectively. They included a syringe and vial with crystalized glucagon, in which you had to mix in a multiple step process before injecting the fast-acting glucagon.

Eli Lilly discontinued its red glucagon kit in 2023 and Novo Nordisk did the same with its orange kit in 2023. With these having a 24-month shelf life, they will gradually phase out as expiration dates go by.

With this type of glucagon kit, you have to premix the medicine before you inject it. Even so, it should only take a minute or two. Here are the basic steps:

  1. Open the kit. Remove the cap from the vial of powder and the cap from the syringe.
  2. Insert the needle into the rubber stopper on the vial.
  3. Push the plunger on the syringe to inject the liquid into the powder.
  4. Keeping the needle in the vial, flip so that the vial is on top.
  5. Gently swirl until all the powder is dissolved and the solution is totally clear.
  6. With the vial still on top, pull the plunger out of the syringe back and draw all the liquid into it.

Now you’re ready to inject the medicine into the thigh, buttock, or upper arm. Here are the steps:

  1. Clean the injection site with an alcohol swab, if available.
  2. Insert the needle straight into the skin (not at an angle), quickly and in one motion.
  3. Using your thumb, push the plunger all the way until all the medicine has been injected.
  4. Remove the needle by pulling straight out.
  5. If you have an alcohol swab, press it against the injection site.
  6. Turn the person onto their side in case they vomit.

If you mix the medicine, but don’t use it, throw it away. Mixed medicine can’t be used later.

What not to do

When someone is experiencing hypoglycemia and is losing consciousness, it’s a life threatening situation.

Call 911 if you don’t know what to do, or if there’s no glucagon available. If the person stops breathing and has no pulse, perform CPR.

In the meantime, do not:

  • try to put food or fluids in their mouth because this can lead to choking.
  • inject insulin because they already have low blood sugar, and this will lower it even more
  • use expired glucagon

With modern glucagon products, it’s much easier than ever to administer glucagon for severe low blood sugar.

This 2020 research review pointed to many benefits of these modern versions, citing one earlier usability study in particular that found 88% people successfully used a new auto-injector pen compared to only 31% when using the traditional glucagon syringe kits.

A 2023 study suggested that people with type 1 diabetes are more often getting access to these newer rescue pen versions and more easily learning to use them.

However, the research also found that healthcare professionals haven’t fully adopted these newer glucagon options, but as more people have access to these ready-to-use versions, it may improve diabetes care and emergency response to hypoglycemia.

Glucagon starts working within minutes, but it can take 5 to 20 minutes for the glucagon to take effect and show visible signs that it’s working.

If possible, check to see if their blood sugar level is at least 70 milligrams per deciliter (mg/dL).

Once the person who was unconscious is awake and alert enough, help them consume some carbohydrates. The glucagon may boost their blood sugar quickly, but it wonn’t last for long.

It’s important to get more stable carbohydrates into their system, with food such as a peanut butter sandwich.

If the person hasn’t regained consciousness within 15 to 20 minutes and help hasn’t arrived, you can give a second dose of glucagon, if available. If the person stops breathing, perform CPR.

Consulting healthcare team

People who’ve experienced a severe low requiring glucagon should consider consulting their healthcare team as quickly as possible.

Their care team can discuss what may have caused the severe hypoglyemia and whether any changes are needed for the person’s diabetes care plan.

People may experience side effects after taking glucagon. These might include:

  • nausea
  • vomiting
  • irritation at the injection site
  • headache
  • rapid heartbeat

Other side effects may include allergic reaction symptoms, which can include:

  • hives
  • skin rash
  • difficulty breathing
  • loss of consciousness

Glucagon doesn’t need refrigeration. Room temperature is best.

While the different glucagon products have varying expiration dates, many are shelf-stable and can be used for 12 to 24 months. Check the label before using and don’t use any expired glucagon.

Avoid storing it where young children can get to it. Make sure that people who can administer the medication know where you keep it.

Consider storing glucagon where you spend a lot of time, including:

  • home
  • school or dorm
  • work
  • homes of friends and relatives you visit often

Keep in mind that glucagon should not be exposed to extreme temperatures or direct sunlight. But there may be circumstances where you can carry a kit in your car, backpack, or satchel.

Glucagon is a potentially lifesaving treatment for people with diabetes who experience severe hypoglycemia. This is a prescription product that’s available in an auto-injector rescue pen, a prefilled syringe version, and a nasal powder inhaler version.

Earlier glucagon kits came in a plastic container with a syringe and glass vial, required a multi-step process to mix the powder and liquid before using it. However, those glucagon mix kits were both discontinued in 2023 and 2024.

To prepare for emergencies, teach those closest to you how to recognize hypoglycemia and administer glucagon.