No improvement in level of consciousness within 15 minutes — give IV dextrose (D50) and notify the provider.
Before you read
Test yourself first: 3 questions
Question 1 of 3
A nurse is preparing to give a client glucagon for severe hypoglycemia. Which statement about glucagon is accurate?
Answer: B. Glucagon raises blood glucose by stimulating glycogenolysis in the liver and is used for severe hypoglycemia when the client cannot safely take oral carbohydrate. Because it can cause vomiting, the client should be positioned on the side, and oral carbohydrate is given once the client is alert and able to swallow. Glucagon lowers, not raises, the need for insulin and is not an insulin substitute.
Question 2 of 3
A client is found unresponsive with a blood glucose of 38 mg/dL and no IV access. Which intervention does the nurse implement?
Answer: B. An unconscious hypoglycemic client cannot safely swallow, so oral carbohydrate is contraindicated due to aspiration risk. With no IV access, the nurse administers glucagon 1 mg IM or subcutaneously. If IV access were available, 25 to 50 mL of 50% dextrose IV push would be given. Glucagon may cause nausea, so the client is positioned to protect the airway.
Question 3 of 3
A nurse finds a client with diabetes who is taking insulin to be confused, diaphoretic, and shaky. The client is awake and able to swallow. Which action should the nurse take first?
Answer: B. The client is showing signs of hypoglycemia and is conscious and able to swallow, so the first action is to give a fast-acting oral carbohydrate, such as 15 grams of glucose (juice, glucose tablets). IV dextrose or glucagon is reserved for clients who cannot safely swallow. Checking glucose should not delay treatment of symptomatic hypoglycemia in an alert client.
Keep the streak going with more questions like these, each with a full rationale.
What is glucagon?
It works by stimulating the liver to break down stored glycogen into glucose (glycogenolysis). It is the go-to rescue for an unresponsive hypoglycemic patient who cannot safely take anything by mouth.
Key points to remember
- Used for severe hypoglycemia when the patient is unconscious or cannot safely swallow oral carbohydrate.
- Raises glucose by converting liver glycogen stores into glucose, so it is ineffective in patients with depleted glycogen (starvation, alcoholism, chronic illness).
- Available as IM, subcutaneous, IV, and intranasal (Baqsimi) routes.
- Vomiting is a common effect after the patient regains consciousness, so place them in a side-lying position to prevent aspiration.
- Effect is temporary; the patient must eat a complex carbohydrate plus protein once alert to prevent rebound hypoglycemia.
Nursing priorities
- Position the unconscious patient on their side to protect the airway because nausea and vomiting are common.
- Administer promptly via IM, subQ, or intranasal route for an unresponsive hypoglycemic patient.
- Recheck blood glucose 15 minutes after administration and repeat treatment if needed.
- Once the patient is alert and can swallow, give a complex carbohydrate with protein to sustain glucose.
Labs & values
Patient teaching
- Teach a family member or caregiver how and when to give the glucagon kit at home.
- Always call 911 after giving glucagon for an unconscious person.
- Turn the person on their side after the injection to prevent choking if they vomit.
- Replace the kit before its expiration date and store as directed.
- Give food (carbs plus protein) as soon as the person can swallow safely.
Red flags: report now
- No improvement in level of consciousness within 15 minutes — give IV dextrose (D50) and notify the provider.
- Aspiration risk from post-dose vomiting — never leave an unconscious patient supine.
- Ineffective in glycogen-depleted patients (chronic alcohol use, malnutrition) — IV glucose is required.
References
Clinical references for this topic
