School Information for Florida

Recommendation of the Diabetes Advisory Council:

Using Glucagon as an Emergency Response for Reversing Hypoglycemia for Children and Young Adults in the School Setting

Background
Glucagon, a pancreatic hormone, is used for the treatment of severe hypoglycemia (very low blood sugar).  Untreated severe hypoglycemia can lead to permanent brain damage and thus, is considered a medical emergency requiring immediate treatment.  This severe degree of hypoglycemia, characterized by loss of consciousness and often seizures, excludes other treatments, which require oral administration.  Therefore, an intramuscular glucagon injection is the most efficient rapid treatment.

Other treatment includes the intravenous injection of glucose.  This treatment demands medical professionals in attendance, whereas glucagon can be administered intramuscularly by anyone capable of administering insulin.  Should glucagon be administered to a child who does not have a low blood glucose (an example might be a seizure for another reason) there is very little risk of harm.  It is always safe to assume in a crisis that the glucose is low.  Glucagon will not raise the blood sugar to harmful levels.

Position
Clearly, the recognition of hypoglycemia before it progresses to such a severe level, where glucose containing foods, glucose tablets, or glucose gel can be administered orally to the still-conscious child is the preferred treatment modality. Glucagon is reserved for situations where other treatments cannot be used due to unconsciousness and/or seizures. 

Monitoring of blood glucose is essential for maintaining good health. Children with diabetes should be monitored by adults familiar with the symptoms of hypoglycemia. Children with diabetes should be able to test blood glucose at all times in the school setting.  Children with diabetes and their authorized diabetes care providers should also have access to glucose containing foods whenever needed or requested.  Prevention of severe hypoglycemia is of the utmost importance.

In spite of careful attention, the infrequent need for glucagon will arise. Those who are responsible for the health of a child during school and/or day care must be able to provide this needed service. Individuals in the school setting should have training and written instructions available on glucagon preparation and injection. The identity of these authorized diabetes care providers should be documented in the student’s health record. Ideally, more than one individual needs to be identified so that coverage is assured.