Mini-dose glucagon information sheet

Contact details

Sydney Children’s Hospital, Randwick Diabetes Team

Telephone advice: 

  • Diabetes nurse educators 8.30am – 4.30pm available Monday to Friday via hospital switch board (02) 938 21111, pager 44051.
  • Ask to speak to the paediatric diabetes educators.
  • After hours advice is available weekdays 4.30-8pm and weekends/public holidays 8.30am-8pm via the hospital switch board on (02) 938 21111.
  • Ask to speak to the Endocrine Registrar on call. 

For urgent care, dial 000 for an ambulance. Tell the phone operator it’s a diabetes emergency. 

Introduction

Glucagon is a hormone that raises blood glucose (sugar) levels by releasing stored glucose from the liver. 

Glucagon can be given when blood glucose levels are low (hypoglycaemia), especially when unable to safely eat/drink foods with glucose/sugar (carbohydrates). Mini-dose glucagon can be used to temporarily increase glucose levels until the person is able to eat and drink again. 

  • Go to the emergency department if glucose levels stay below 5mmol/L or the person is still vomiting.
  • A full dose of intramuscular (IM) glucagon is urgently needed for severe hypoglycaemia (eg. not awake/unconscious or seizures). Do not use mini-dose glucagon.

Mini-dose glucagon

Low glucose levels in a person with type 1 diabetes can be a problem when they are sick. Mini-dose glucagon can be used:

  • During illness such as vomiting, diarrhoea or flu.
  • Difficult behaviour such as not eating food with glucose when planned.
  • When glucose levels are less than 5mmol/L. If unable to eat or drink food/fluids with glucose/sugar, the glucose level can quickly fall below 5mmol/L, especially if insulin has just been given.

Mini-dose glucagon can be given up to 3 times over 24 hours and usually has little or no side effects.  

Emergency treatment

Emergency glucagon by intramuscular injection

Under 5 years old = 0.5ml  

Over 5 years old = 1ml

You need to get a new emergency glucagon kit after it's been used. Glucagon kits are available at your local pharmacy with a script. If you don’ t have a script, this can be organised with your GP or diabetes team. 

Severe hypoglycaemia

If a person has severe hypoglycaemia (eg. not awake/unconscious or fitting), give glucagon as an intramuscular (IM) injection straight away using the syringe supplied in the orange emergency glucagon kit. Once awake and can swallow safely, encourage to eat/drink foods with glucose/sugar (eg. carbohydrates). 

If you are unsure about this, speak to your diabetes team for more training. 

Equipment

An orange box containing vial and syringe
The GlucaGen® HypoKit® orange box containing the vial of glucagon and a syringe of sterile water
3 syringes with different measuring units
30 or 50 unit insulin syringes: these are then used to draw up the mini dose glucagon once mixed with the water that comes in the kit
A small handheld device for monitoring glucose levels
BGL monitoring equipment: lancet device, glucometer and glucose strips

Medication instructions

Mini-dose glucagon is best done with telephone support from your diabetes team.

Call the SCH Diabetes team or go to the Emergency Department if: 

  • More than 3 vomits within 1-2 hours
  • Glucose level is less than 5 mmol/L after 3 doses of mini-dose glucagon in 24hrs
  • Not drinking at least 50-100ml/hr  
  • Not able to wee (eg. passed urine) within 4 hours
  • You are unsure of what to do 

Do not stop insulin (especially long-acting/basal insulin). Speak to your diabetes team about adjusting insulin doses during illness.

Dosage

1st Dose:  

  • Units = insulin syringe units
  • 2 years or younger = 2 units
  • 2years – 15 years = 1 unit for every year of age. For example, 4 years old = 4 units
  • 15 years or older =  maximum 15 units for first dose 

2nd and 3rd dose:

  • Only give if glucose levels remain less than 5mmol/L
  • Double the 1st dose = (Example: if 4 units was given for 1st dose, give 8 units)  
  • (Note: 1st dose based on age. Dose is doubled for 2nd/3rd dose to a maximum 30 units) 

Sick day usage

Once the glucagon is mixed with water, use an insulin syringe to draw up the dose based on age. Using the insulin syringe, give the glucagon in the fat layer where you would normally give insulin (eg. fat layer on the tummy or upper bottom). 

Check the blood glucose level (BGL) 30 minutes after giving glucagon, always double-check sensor glucose levels with a BGL when less than 3.9mmol/L. If BGL is in target (i.e. above 5mmol/L), give food and fluids with glucose/sugar such as carbohydrates to keep the glucose levels in range. Keep checking glucose levels every 30mins-1hr until stable. 

Low glucose levels after dosage

  • If the glucose level is still less than 5mmol/L after the first dose of mini-dose glucagon, give another dose 30mins later. If a 2nd/ 3rd dose is needed, double the amount of 1st dose.  

Example:

  • If 4yrs old, give 4 units of glucagon using an insulin syringe for 1st dose. If glucose levels are less than 5mmol/L in 30 minutes, double the 1st dose (eg. 8 units glucagon) for the 2nd/3rd dose. The maximum mini-dose glucagon is 30 units (Note: 1st dose based on age and doubled for 2nd/3rd dose minimum 30mins apart).  
  • If the glucose level is still less than 5mmol/L and you've already given 3 mini-doses of glucagon in a 24hr period, speak to your diabetes team or go to the Emergency Department for a review. 

Overdose information

In the case of an overdose or poisoning, call the NSW Poisons Information Centre on 13 11 26 (24 hour service).