Glucagon rescue - AbsoluteAstronomy.com

Glucagon rescue is the emergency injection of glucagon

Glucagon

Glucagon, a hormone secreted by the pancreas, raises blood glucose levels. Its effect is opposite that of insulin, which lowers blood glucose levels. The pancreas releases glucagon when blood sugar levels fall too low. Glucagon causes the liver to convert stored glycogen into glucose, which is...

in case of severe diabetic hypoglycemia

Diabetic hypoglycemia

Diabetic hypoglycemia is a low blood glucose level occurring in a person with diabetes mellitus. It is one of the most common types of hypoglycemia seen in emergency departments and hospitals...

. It is needed during seizures and/or unconsciousness by an insulin user who is unable at that point to help themselves. Glucagon will facilitate the release of stored glucose back into the bloodstream, raising the blood glucose level.

Rescue has been simplified by the development of the glucagon hypoglycemia rescue kit, consisting of:

biosynthetic human glucagon, in a freeze dried form within a vial,
a sturdy syringe, pre-filled with a sterile diluting solution, and
a conspicuous brightly-colored red or orange plastic storage box, which includes instructions.

At the first signs of hypoglycemia, an insulin user should treat it immediately by consuming carbohydrate to restore blood glucose to safe levels (thereby preventing progression to severe hypoglycemia). However, not all insulin users can feel and recognize the early signs, particularly when sleeping. This can quickly lead to an emergency resulting in unconsciousness, inability to swallow, seizures, and in extreme cases death. In the past, treatment consisted of intravenous delivery of dextrose (glucose) usually in the emergency room; however, the delay in treatment due to emergency response and transport to a medical facility is life threatening.

The glucagon rescue kit facilitates rapid rescue by a simple injection, which does not require medical expertise, and can be done quickly and easily outside of a medical facility.

Simplified instructions

The instructions for using the emergency glucagon rescue kit can be simplified to the four essential steps as shown in the pictures inside the box cover.

open the vial by breaking off the plastic cap from the glucagon vial,
inject the diluting solution into the vial of dry glucagon by first removing the cover from the syringe needle, and then injecting the diluting fluid from the syringe into the glucagon vial,
swirl or shake to mix by withdrawing the syringe from the vial and swirl or shake slowly by hand until the white glucagon powder is dissolved in the fluid,
inject the glucagon mixture by reinserting the needle back into the vial and drawing the glucagon mixture back into the syringe, and then injecting into the unconscious person's leg or abdomen muscle: the dosage is approximately half (Lilly kit: 500 µg; Novo Nordisk kit 0.5ml) for small children and approximately all (Lilly kit: 1000 µg; Novo Nordisk kit 1ml) for larger children and adults. Roll the unconscious person onto their side in case they vomit upon recovery, and then wait for the glucagon to take effect.

Controversial United States Instructions

**GLUCAGON RESCUE KIT INSTRUCTIONS:**

In addition to the simplified instructions on the case, the glucagon rescue kits sold in the United States contain a lengthy, small-print instruction sheet. The instructions are folded tightly into a flat roll and glued at one end. When the instructions are unrolled, they may be intimidating because of their length and small print.

The instructions are divided in half. The left half is intended for the pharmacist, while the right half in intended for the user of the kit. The instructions for the pharmacist ask that the paper roll be cut in half, and that only the user half be included with the kit. However, it is rare for the pharmacist to do this, so the entire instructions are likely to be received by the user. In this case, reading starting from the left margin at the top will tell the reader about the chemical formula for glucagon, its organic sequence, pharmacokenetics, pharmacodynamics, indications and contraindications, etc. before the time-critical usage instructions.

On the usage side, the instructions for giving the injection state that the injection site should be cleansed with an alcohol swab prior to injection, and then the alcohol swab should be pressed to the injection site when removing the needle. The swab is not included in the kit, nor is its use specified in the simplified directions. While its use is a sanitary practice, it is not critical to administering the life-saving medicine. However, potential rescuers may erroneously decide to postpone rescue and wait for emergency personnel because they are unprepared to give a sterile medical injection.

The kit has been carefully designed to facilitate rescue by lay persons by following the four simple steps depicted inside the cover. While the instruction sheet may be helpful to a pharmacist and in prior training for glucagon administration, the sheet discourages the actual and proper use of the product.

UK user instructions for glucagon rescue kit

These instructions come with the kit as supplied in the UK, and although expanded from the 4 necessary steps illustrated in instructional pictures inside the top cover of the glucagon rescue kit box, are still straightforward and less complicated to use than the US instructions, as detailed above. However, the kit has been carefully designed to facilitate rescue outside of a medical facility by non-medical personnel, and the 4 necessary steps, as illustrated inside the plastic box, should be clear enough not to require these additional instructions in the case of a medical emergency.
Link to instructions

Politics of Glucagon Rescue

Public awareness of other forms of life saving measures has increased dramatically in the past, such as:

artificial respiration (or "mouth to mouth")
CPR
the Heimlich Maneuver, etc.

However, despite public relations to increase the awareness of the life saving capability of glucagon rescue, it is still largely unknown by the general public. An unfortunate example is seen in public school policy and some teachers' union contracts in the U.S., which require that union teachers shall not be allowed to deliver glucagon or even be trained in administration of glucagon.
This can only be due to the ignorance of glucagon as a life saving measure, as it would obviously be absurd to prohibit training and delivery of CPR or any other life saving first aid in a public school.

Glucagon "Mini-dose" Instruction

The purpose of the "mini-dose" is to avoid an emergency condition that may require glucagon rescue. This might be needed in cases such as when a diabetic child is injected with insulin before breakfast, eats, and then vomits and cannot eat again: with the injected insulin working its way into the bloodstream and no carbohydrate to balance, there may soon be a hypoglycemic emergency.

To avoid severe hypoglycemia (or alternatively avoid a trip to the hospital for intravenous glucose), the glucagon from the emergency rescue kit can be used in a measured dose to maintain the blood glucose level. Instead of the glucagon emergency syringe and its large bore needle, a standard U-100 insulin syringe can be used. The recommended dose is:

ages 2 years and under: 2 units (20 µg)
age 2 to 15 years: 1 unit (10 µg) for each year of age (6 units for a 6 year old, etc.)
age 15 years and older: 15 units (150 µg)

The mini-dose treatment should be repeated as necessary to maintain blood sugar until food can be eaten.

Medical studies have shown that the mini-dose rescue is tolerated well and effective.

External links

"Glucagon Emergency Kit" from Eli Lilly and Company

"GlucaGen HypoKit" from Novo Nordisk

Vials of GlucaGen from Bedford Laboratories