Sick day management: mini-dose glucagon 

Mini-dose glucagon is a very effective and safe treatment used in children who are hypoglycaemic: blood gluocse level (BGL) below 4 mmol/L and cannot tolerate or are refusing food due to nausea or vomiting. Glucagon works by sending a message to the liver to release stores of glucose which raises the blood glucose levels. Mini-dose glucagon can be given up to 3 times, after which medical help should be given.

You must not use mini-dose glucagon protocol if your child has severe hypoglycaemia – decreased consciousness or fitting – a full dose of glucagon is needed urgently.                      

Your Glucagon Hypokit should include:

 The GlucaGen® HypoKit® orange box containing the vial of glucagon and a syringe of sterile water

and

30 or 50 unit insulin syringes: these are then used to draw up the mini dose glucagon once mixed with the water that comes in the kit.  

Step 1 

Make up the mini dose Glucagon as follows:

• Open the orange box and remove the orange plastic cap from the bottle of white powder (glucagon) and the needle guard from the syringe containing sterile water.
• Inject all the water in the syringe into the glucagon vial through the bulls eye in the top of the bottle.
• Remove the needle and keep the syringe in case it is later needed.
• Using an insulin syringe, draw up the required glucagon dose using the table below.
• Give the mini dose glucagon as you would an insulin injection.

When glucagon has been mixed with water,  it can be stored in the fridge and used for the next 24 hours.

Dosing guide: 

Step 2

Recheck BGL in 30 minutes.

• If BGL is 5.5 mmol/L or higher and your child is able to drink small amounts of sweetened fluids, continue sick day management as per guidelines. 
• If BGL is less than 5.5 mmol/L AND your child is still unable to tolerate small amounts of sweetened fluids or food, give double the dose of mini dose glucagon previously given e.g. if you gave 4 units for the first dose, you would now draw up 8 units in a new syringe.   

Step 3

Recheck BGL in 30 minutes.

• If BGL remains below 5.5 mmol/l give a third dose. The dose to give is the same as the 2nd dose (double your first dose).
  As per the example in step 2, if you gave 4 units for the first dose, 8 units in the second dose, this third dose would be 8 units again.
• Continue to offer small amounts of sweetened fluids and food and refer to sick day management guidelines.
• Monitor BGL’s hourly if BGL is maintained above 5.5 mmol/L 

Call your treating medical team or present to the emergency department (if outside the hours of 7am - 9pm Monday - Friday), if the following occur:

• Your child vomits 3 times within a few hours.
• Your child’s BGL is less than 5.5 mmol/L after 3 doses of mini dose glucagon.
  
• You are unsure what to do.

The Royal Children's Hospital (RCH) Sick day service phone number 9345 5522 ask for the 'Diabetes sick day call' 7am – 9pm Monday – Friday (for patients of the RCH). 

Page updated November 2024