Can You Give Glucagon Twice? Understanding Repeat Glucagon Doses
Yes, you can give glucagon twice if the first dose doesn’t raise the blood sugar levels sufficiently and the person remains unconscious after approximately 15 minutes. However, repeated doses should always be administered under medical guidance when possible.
What is Glucagon and Why is it Used?
Glucagon is a hormone that helps raise blood sugar levels. It’s essentially the opposite of insulin. When someone with diabetes experiences severe hypoglycemia (very low blood sugar), they may become unconscious or unable to swallow, making oral glucose administration impossible. In these situations, glucagon is administered as an emergency treatment. Glucagon works by stimulating the liver to release stored glucose into the bloodstream.
How Glucagon Works in the Body
Glucagon acts specifically on the liver. Here’s a simplified breakdown:
- Glucagon binds to receptors on liver cells.
- This binding triggers the breakdown of glycogen (stored glucose) into glucose.
- The newly released glucose is then released into the bloodstream.
- Blood glucose levels rise.
The effectiveness of glucagon depends on the amount of glycogen stored in the liver. If the liver’s glycogen stores are depleted (e.g., due to prolonged fasting, strenuous exercise, or alcohol consumption), glucagon may not be as effective.
Administering Glucagon: A Step-by-Step Guide
Glucagon is typically available as a powder that needs to be mixed with a liquid before injection. Here’s a general overview of the administration process:
- Prepare the injection: Follow the instructions included with the specific glucagon kit. This usually involves injecting the liquid into the vial containing the powder and gently rolling (not shaking) to mix.
- Draw up the medication: Draw the mixed glucagon solution into the syringe.
- Administer the injection: Inject the glucagon into the muscle (intramuscular injection), typically in the upper arm, thigh, or buttock.
- Monitor the person: After administering the glucagon, monitor the person closely. They should regain consciousness within 15 minutes. If they do not, a second dose may be considered.
- Call for medical help: Regardless of whether the person responds to glucagon, it’s crucial to call for emergency medical assistance immediately.
Situations Where Glucagon May Not Work
Several factors can affect glucagon’s effectiveness:
- Depleted Liver Glycogen Stores: As mentioned before, if the liver’s glycogen stores are low, glucagon might not work as well.
- Adrenal Insufficiency: In rare cases, adrenal insufficiency can impair the body’s ability to respond to glucagon.
- Expired Glucagon: Always check the expiration date on the glucagon kit. Expired glucagon may not be effective.
Considerations Before Giving a Second Dose of Glucagon
Before administering a second dose of glucagon, consider these points:
- Time Elapsed: Wait approximately 15 minutes after the first dose to assess the person’s response.
- Lack of Improvement: If there’s no noticeable improvement in the person’s level of consciousness or blood sugar readings (if available and safe to check), a second dose may be considered.
- Availability of Medical Assistance: If emergency medical services are en route, it might be best to consult with them before administering a second dose.
Potential Risks and Side Effects
While glucagon is generally safe, potential side effects include:
- Nausea and vomiting.
- Headache.
- Increased heart rate.
- Pain or redness at the injection site.
Rarely, more serious side effects can occur.
The Importance of Follow-Up Care
After a glucagon injection, it’s crucial to provide follow-up care. This includes:
- Monitoring blood sugar levels regularly.
- Ensuring the person eats a meal or snack once they are able to swallow.
- Investigating the cause of the hypoglycemic episode to prevent future occurrences.
Common Mistakes to Avoid
- Not Mixing the Glucagon Properly: Follow the instructions carefully to ensure the glucagon is properly mixed.
- Injecting Air: Be sure to remove any air bubbles from the syringe before injecting the glucagon.
- Delaying Medical Assistance: Always call for emergency medical help, even if the person responds to glucagon. Glucagon is a temporary fix, and underlying medical issues need to be addressed.
- Assuming the Person is Awake Enough to Eat Immediately: Even if someone regains consciousness, they may still be groggy or disoriented. Make sure they are fully alert and able to swallow safely before offering food or drink.
Glucagon Formulations
Glucagon is available in several formulations to help improve ease of administration. These include nasal glucagon and auto-injectors. Choosing the right option is important for those at risk of hypoglycemia.
| Formulation | Administration Route | Preparation Required | Pros | Cons |
|---|---|---|---|---|
| Traditional Glucagon | Intramuscular Injection | Mixing Required | Relatively inexpensive. Widely available. | Requires mixing. Intramuscular injection can be daunting for some. |
| Nasal Glucagon | Nasal | No Mixing Required | Easier to administer, especially for caregivers uncomfortable with injections. Can be used if unconscious. | May not be effective if the person has nasal congestion or a cold. More expensive than traditional glucagon. |
| Glucagon Auto-Injector | Intramuscular Injection | No Mixing Required | Pre-filled and ready to use. Easier to administer than traditional glucagon. | More expensive than traditional glucagon. |
Planning for Emergencies
Having a plan for hypoglycemia emergencies is essential. This plan should include:
- Keeping glucagon readily available.
- Educating family members and friends on how to administer glucagon.
- Wearing a medical identification bracelet or necklace.
- Regularly checking and monitoring blood glucose levels.
Frequently Asked Questions (FAQs)
Can you use glucagon more than twice?
While it’s generally acceptable to administer a second dose if the first doesn’t work and medical help isn’t immediately available, giving glucagon more than twice without medical supervision is not recommended. Repeated doses might not be effective, and any lack of response warrants immediate medical intervention. There may be another underlying medical issue preventing the glucagon from working.
What should I do if the person vomits after receiving glucagon?
Vomiting is a common side effect of glucagon. Turn the person on their side to prevent choking and aspiration. Monitor them closely, and call for medical assistance if the vomiting is persistent or severe.
How long does glucagon take to work?
Glucagon typically takes effect within 10-15 minutes. If there is no improvement in the person’s level of consciousness or blood sugar levels after 15 minutes, a second dose may be considered, but ensure you have contacted emergency services.
What if I accidentally inject myself with glucagon?
Accidental injection of glucagon is unlikely to cause serious harm in someone who does not have diabetes. However, it can cause a temporary increase in blood sugar levels, as well as the potential side effects mentioned earlier such as nausea and headaches. Monitor yourself for any adverse reactions. If you have concerns, contact a medical professional.
Can glucagon be given to children?
Yes, glucagon can be given to children experiencing severe hypoglycemia. The dosage may vary depending on the child’s weight and the type of glucagon kit. Consult with a healthcare professional for specific dosage instructions. Most glucagon kits include pediatric dosages.
What are the signs of hypoglycemia?
Symptoms of hypoglycemia can vary but may include: shakiness, sweating, dizziness, confusion, blurred vision, rapid heart rate, and loss of consciousness. It is important to know and recognize these symptoms.
Where should I store glucagon?
Store glucagon according to the manufacturer’s instructions, typically at room temperature and away from direct sunlight and moisture. Never store glucagon in the refrigerator or freezer.
Is glucagon a substitute for calling 911?
No. Glucagon is not a substitute for calling 911. It is a temporary measure to raise blood sugar levels until medical help arrives. Always call for emergency medical assistance, even if the person responds to glucagon.
Can you give glucagon twice if the first dose made them throw up?
If the person vomits immediately after the first dose, it’s unlikely that enough medication was absorbed. A second dose might be necessary, but make sure medical assistance is on its way. Consider alternate routes of administration such as nasal glucagon, if available.
What are the alternatives to glucagon if it is not available?
If glucagon is not available and the person is conscious and able to swallow, give them a fast-acting source of glucose, such as glucose tablets or juice. If the person is unconscious, do not attempt to give them anything by mouth as it could cause choking. Call for emergency medical help immediately.
How can I be sure I am administering glucagon correctly?
Practice with a trainer kit or dummy device (if available). Review the instructions that come with the glucagon kit carefully. Ask your healthcare provider or diabetes educator for a demonstration and clarification on any questions.
What is nasal glucagon and how is it different?
Nasal glucagon is a powder administered directly into the nose. It requires no mixing or injection, making it easier for some caregivers to administer. Unlike injected glucagon, nasal glucagon does not require the person to be able to breathe in deeply, which can be helpful if they are experiencing a seizure or severe confusion.