Glucagon When There Is No IV
Objective: Use glucagon as a bridge when there is no IV and no safe oral route — and know it can fail in empty liver glycogen.
Why This Is Hard
The glucose is 28, they are seizing, and the IV is not happening. Crews keep fishing a vein while the brain cooks. ADA: treat symptomatic hypoglycemia. Glucagon is a field option when IV dextrose is not available.
- IM or IN per your packaging. This site does not publish milligrams.
- Turn them when they vomit. Glucagon makes people sick.
- After they wake, they still need carbohydrate. Glucagon used liver stores.
Field Rules (Education)
- Best: protected airway plus oral glucose, or IV D10 titrated. See D10 and diabetic lessons.
- Glucagon when you cannot do those. It needs glycogen. Starved, alcoholic, or liver-failure patients may not bump.
- IN glucagon exists in some kits. Follow the device.
- Recheck glucose and mentation. Failure means keep working the IV or IO if authorized.
Field Pitfalls
- Glucagon instead of a perfectly good oral glucose in a talking patient.
- No recheck.
- Assuming alcoholics always respond.
Practice
60-second drill
Partner: glucose 32, clenched, no IV after two tries, protocol has IM glucagon. Next two steps including 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; protocol still wins
- ADA Standards of Care 2025 — glucagon when IV dextrose is not available; then carbohydrate
Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.
Check Your Understanding
Street decisions from this lesson only. After you check, the key is highlighted. Education practice — not a certification exam.