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Questions and Answers
When should glucagon be prepared for administration?
When should glucagon be prepared for administration?
What is the proper method for administering glucagon?
What is the proper method for administering glucagon?
What should you not do when preparing glucagon?
What should you not do when preparing glucagon?
What is a common side effect of glucagon administration?
What is a common side effect of glucagon administration?
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What should be done with unused glucagon solution?
What should be done with unused glucagon solution?
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What is the correct first step in administering glucagon?
What is the correct first step in administering glucagon?
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What is a characteristic of glucagon as a medication?
What is a characteristic of glucagon as a medication?
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What is the most serious emergency problem related to blood sugar control?
What is the most serious emergency problem related to blood sugar control?
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Which symptom is classified as severe hypoglycemia?
Which symptom is classified as severe hypoglycemia?
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What is the best intervention for mild hypoglycemia?
What is the best intervention for mild hypoglycemia?
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Which of the following is NOT a common cause of hypoglycemia?
Which of the following is NOT a common cause of hypoglycemia?
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When should a person check blood sugar after initial treatment for hypoglycemia?
When should a person check blood sugar after initial treatment for hypoglycemia?
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What condition is typically treated with insulin injections?
What condition is typically treated with insulin injections?
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Which symptom is a mild indicator of hypoglycemia?
Which symptom is a mild indicator of hypoglycemia?
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What should be done if blood sugar is not in an acceptable range after rechecking the first time?
What should be done if blood sugar is not in an acceptable range after rechecking the first time?
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Study Notes
Training Protocol for Emergency Glucagon Providers
- The protocol is for emergency glucagon providers, like paramedics.
- The provider is from Cedar Mountain Fire Rescue, Transylvania County EMS.
- Glucagon is available in 1 mg/vial.
Training Pre-Requisites
- Providers must reasonably expect responsibility for someone at risk for hypoglycemia.
- This usually involves a person with diabetes.
- The person being trained must be at least 18 years old.
Objectives
- Initial training or retraining covers:
- An overview of diabetes.
- Recognition of symptoms.
- Factors leading to hypoglycemia.
- Glucagon administration.
- Necessary follow-up treatment.
Protocol (Adult Diabetic)
- Blood glucose analysis is a key procedure.
- Blood glucose ≤69 mg/dl and symptomatic, with no venous access, requires glucagon (1-2 mg IM) repeated in 15 minutes if needed.
- If blood sugar is 70-249 mg/dl, consider oral glucose solutions (juices / food).
- Glucose ≥ 80 mg/dl = monitor and reassess until blood glucose is ≥ 80 mg/dl.
- If condition changes, exit to the appropriate protocol(s).
- Blood glucose ≥ 250 mg/dl requires a normal saline bolus (500 mL IV/10).
Overview of Diabetes
- Diabetes is a chronic, lifelong disease.
- It affects how the body uses food.
- The pancreas produces insulin.
- Insulin allows glucose to enter cells for energy production.
- In diabetes, this system doesn't function correctly.
- Glucose builds up in the bloodstream.
- Insulin must often be replaced with injections.
Overview of Diabetes - Type 1 and 2
- Type 1: The pancreas produces no insulin. Treated with insulin shots or pump, usual type in children and young adults, no prevention, lifelong condition.
- Type 2: Not enough insulin produced or the person doesn't respond to insulin. May be treated orally and/or with insulin, more common in adults.
Hyperglycemia (High Blood Sugar)
- Symptoms include increased thirst, frequent urination, increased hunger, weight loss, irritability, flushed/dry skin, nausea/vomiting, weakness/fatigue.
Complications
- High blood sugar can cause long-term complications, such as blindness, kidney/nerve damage, heart disease.
- Controlling blood sugar levels is crucial.
Balance
- Diabetes management involves balancing food intake, insulin, and physical activity.
- Physical/emotional stress and illness can disrupt this delicate balance.
Hypoglycemia (Low Blood Sugar)
- The most serious "emergency" problem related to blood sugar control.
- It develops quickly and requires early detection and immediate attention.
Common Causes of Hypoglycemia
- Too much diabetes medication.
- Changes in meal/snack times.
- Insufficient food intake.
- Skipping/incomplete meals/snacks.
- Increased physical activity/exercise.
- Alcohol consumption without eating.
Symptoms of Hypoglycemia
- Mild: Hunger, sweating, feeling shaky, feeling nervous.
- Moderate: Headache, behavior changes, blurred/double vision, crabbiness/confusion, drowsiness, weakness, difficulty talking.
- Severe: Unresponsive (including being unable or unwilling to take oral feedings), loss of consciousness, seizure activity.
Intervention for Mild/Moderate Hypoglycemia
- Treat immediately with a fast-acting sugar:
- Fruit juice (4-8 ounces)
- Regular soda (6 ounces)
- Sugar packets/table spoon in water (3/1)
- Chewable glucose tablets (3-4)
- Glucose gel (1 dose)
- Honey (1 tablespoon)
- Hard candy (2-4 pieces)
15 Minute Rule
- Following initial treatment, observe and recheck blood sugar in 15 minutes.
- Repeat fast-acting carbohydrate if blood sugar level is not within the acceptable range.
- Offer an extra snack if a meal is an hour or more away.
Treatment For Severe Hypoglycemia
- Prepare to treat with glucagon if:
- The person is unwilling or unable to take treatment.
- The person does not improve after the second treatment.
- Symptoms worsen to the point where the person cannot swallow.
- Loss of consciousness or seizures occur.
Glucagon
- A hormone, similar to insulin, produced by the pancreas.
- Acts on the liver, converting glycogen to glucose.
- Safe and relatively free from adverse reactions.
- No human overdose cases reported.
- May cause nausea and vomiting.
Glucagon Emergency Kit
- Contains:
- Glucagon powder.
- Special diluting fluid.
- Syringe or vial.
- Prescriptions may be needed for individual patients.
Glucagon: Storage and Handling
- Store at room temperature (59° - 86°).
- Do not mix until needed.
- Discard unused portions.
- Glucagon solution should be clear and have a water-like consistency.
- Check expiration dates regularly.
- Inject into fatty tissue or muscle (arm/thigh).
Glucagon - Dosages
- Manufactured in 1 mg vials.
- The person's healthcare provider determines the dose.
Intervention/Severe Hypoglycemia (cont.)
- If the person is unconscious but breathing and has a pulse, assume severe hypoglycemia.
- Cut/clamp insulin tubing (if on insulin pump).
- Obtain the glucagon emergency kit.
- Prepare and administer glucagon.
To Prepare Glucagon
- Put on gloves.
- Remove the flip-off seal from the powdered glucagon.
- Remove the needle cover from the syringe.
- Do not remove the plastic clip from the syringe.
- Insert the needle into the powdered glucagon vial.
- Push the plunger to inject the liquid into the powdered glucagon.
Prepare Glucagon (cont.)
- Leave the needle on the syringe in the vial.
- Gently shake the bottle until the powder dissolves.
- Withdraw the appropriate amount of medication.
Administer Glucagon (cont.)
- Insert the needle into the loose skin/muscle of the upper arm or thigh.
- Administer all the medication.
- Carefully withdraw the needle at the same angle, without releasing the person's limb.
- Discard the needle according to OSHA Bloodborne Pathogen Standards.
Administer Glucagon (cont.)
- If a person is combative or having a seizure, get assistance from another provider.
Glucagon Administration Video
- Visual demonstration of administering glucagon.
Care of the Person
- Position the person on their side.
- Monitor for absent pulse/breath, or seizures.
- Improvement usually seen within 10-15 minutes.
- A person might be unresponsive for other reasons.
Care of the Person (cont.)
- If the person responds and can swallow, feed a fast-acting sugar source (e.g., clear sugar-containing liquids).
- Follow up with longer-acting sources (e.g., carbohydrates and proteins)
- Seek consultation from a medical provider.
Follow Up
- Emergency responders decide if transport to medical facility is needed.
- The person or caregiver seeks consultation to prevent future episodes.
- Dispose of any glucagon remaining from the EMS supply.
Unsolved Questions (ONS)
- Unsolved questions in the video.
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Description
This quiz covers the training protocol for emergency glucagon providers, focusing on the administration of glucagon to individuals at risk for hypoglycemia. It includes important information about diabetes recognition, symptoms, and necessary follow-up treatments. Ideal for paramedics and emergency responders.
