Glucagon Without IV Access
Objective: Use glucagon when you cannot give IV dextrose and the patient cannot swallow safely. It can fail when the liver has no stored sugar. The patient still needs carbohydrate and a recheck. Your protocol card sets the amount.
Why this matters
Glucagon is for hypoglycemia when you cannot give IV dextrose and the patient cannot swallow safely. Picture a very low glucose, a seizure, and no IV. It is easy to keep searching for a vein while the brain is still without sugar.
Glucagon can fail if liver stores are empty. The patient still needs carbohydrate after they wake. Your protocol sets the milligrams and the device. This site does not list milligrams.
- Give it intramuscularly or intranasally, as your packaging says. This site does not list milligrams.
- Turn the patient if they vomit. Glucagon often causes nausea.
- After they wake, they still need carbohydrate. Glucagon used sugar stored in the liver.
Clinical sequence
- If the patient can protect the airway and swallow, oral glucose comes first. Glucagon is not the first drug for a talking patient who can swallow.
- No IV and no safe oral route: give glucagon intramuscularly or intranasally, as your packaging says. This site does not list milligrams.
- Turn the patient if they vomit. Glucagon often causes nausea. Recheck the glucose and mental status. If the glucose does not rise, keep working on an IV, or an IO if you are authorized.
- After they wake, they still need carbohydrate. Glucagon used glycogen stored in the liver. A starved patient, a patient with alcoholism, or a patient with liver failure may not rise at all.
Teaching points
- Best options: a protected airway plus oral glucose, or IV D10 titrated to effect. See the D10 and diabetic lessons.
- Glucagon is for when you cannot do those. It needs glycogen, stored sugar in the liver.
- Intranasal glucagon exists in some kits. Follow the device.
- Recheck the glucose and mental status. If glucagon fails, keep working on access.
Common errors
- Glucagon instead of oral glucose in a talking patient who can swallow.
- No recheck.
- Assuming every patient with alcoholism will respond.
Practice
One-minute check
With a partner: glucose 32, jaw clenched, no IV after two tries, and the protocol has intramuscular glucagon. Name the next two steps, including what you do after they wake.
Related: D10, Diabetic emergencies.
Sources & Further Study
Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.
- NASEMSO National Model EMS Clinical Guidelines (2022) — U.S. EMS model language. Your protocol still decides.
- ADA Standards of Care 2025 — Glucagon when IV dextrose is not available. Then give carbohydrate.
Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.
Check Your Understanding
Questions drawn only from this lesson. After you check, the key is highlighted. Education practice — not a certification exam.