13. Mini-dose glucagon

What is Glucagon?

Glucagon is a hormone that increases the level of glucose in the blood. It allows stored sugar from the liver (glycogen) to be converted to glucose and then released into the blood stream. Glucagon is used to treat severe hypoglycaemia. However, very small doses of glucagon (mini-dose glucagon) given with an insulin syringe, can also be used to treat or prevent mild-moderate hypoglycaemia.

Mini-dose glucagon can be administered for the treatment of persistent mild hypoglycaemia or to prevent the blood glucose levels falling too low. It can be used when children are unwell with nausea and/or vomiting, or unable to eat.

When mini-dose glucagon might be used:

• When your child's blood glucose remains less than 4 despite repeated treatment with glucose or sweet drinks 

• Your child is unable to tolerate oral carbohydrate related to nausea and vomiting associated with illness. (see sick days module) 

• Your child is unable to eat or is refusing food

The dose of glucagon advised will depend on your child's age. 

• 2 units for ≤ 2 years of age

• Then 1 unit/year up to max dose of 15 units

For example with a 3 year old, the likely prescribed dose will be 3 units.

How to use mini-dose glucagon:

Mini-dose glucagon should only be given on the specific advice of a diabetes doctor. You will need the following:

• GlucaGen™ Hypokit which includes a syringe with sterile water and a glass vial/bottle containing glucagon powder

• Insulin syringe (preferably 30U syringe with 8mm needle)

To make up and administer mini-dose glucagon:

• Take the orange cap off the glass vial and the grey cap off the top of the syringe and inject all of the sterile water into the vial.

• Remove the needle and gently swirl the solution to mix.

• Remove cap from insulin syringe and insert into glucagon vial

• Draw back the prescribed dose

• Remove needle from the vial, and expel any bubbles (as shown in video)

• Administer Glucagon into the layer of fat in your child's buttocks or abdomen as you would administer insulin

You can read a transcript of this video here.

After giving mini-dose glucagon:

• Once mixed, the glucagon needs to be refrigerated, discarding the remaining amount after 24 hours.

• Test blood glucose levels after 15 minutes.

• If blood glucose level is still under 4mmol/L, call the doctor. It is possible that the doctor will advise a doubled glucagon mini-dose be given. Several doses of mini-dose glucagon can be given if required.

• Once blood glucose levels are 4 or above, give your child long-acting carbohydrates such as soup, toast or crackers or milk.

• If your child continues to be unwell with persistent nausea and/or vomiting see your GP for assessment and keep up sweet fluids every half an hour. See sick days module.

Let's go over the main points. Read through our fact sheet to make sure you know how and when mini-dose glucagon should be administered. Ready?

Think you've got it sorted now?

If you have read through the information above and watched the video, and you feel confident that you understand this topic and know how and when to administer mini dose glucagon, print off and fill in the evaluation form below (you might need to ask someone to print this off for you) and return to the nurse on your ward. If you have any questions, note them down on this form and your diabetes nurse specialist will discuss them with you.

Mini-dose glucagon: Evaluation

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