Glucagon, and treating a low
Glucagon is the medicine someone else gives you in a severe low. How nasal and injectable glucagon work, and the 15 g, 15-minute rule.
This page is for the person with type 1 diabetes and, just as much, for the people around them. It covers glucagon — the rescue medicine for a severe low — and how to treat an ordinary low with fast sugar.
Glucagon: the medicine somebody else gives you
Glucagon reverses a severe low when the person can't swallow. That means the person with diabetes is never the one who uses it. It is given by whoever is with them — so family, friends, coworkers and roommates all need to know where it is and how it works.
A fair question to ask yourself honestly: do you know where your person's glucagon is right now?
Nasal, 3 mg. A puff into one nostril. No needle, no mixing, and it works even if they are unconscious — they don't need to breathe it in.
Injectable, 1 mg. Into the thigh, through clothing if you have to. Newer pens come ready to use instead of needing to be mixed.
After drinking, glucagon works less well. Glucagon tells the liver to release glucose. Alcohol stops the liver doing that. Past two drinks, call the ambulance rather than wait to see if glucagon works.
Everyone on insulin should have glucagon, in date, somewhere the people around them can find it — not buried in a drawer they don't know about.
Treating a low: 15 grams, 15 minutes
Below 3.9 mmol/L, Diabetes Canada says to take 15 g of fast-acting carbohydrate — preferably glucose or sucrose as tablets or dissolved in water, which work better than juice or gels.
Then
Wait 15 minutes at rest. Check again. Still under 3.9? Repeat.
Once you're back up, eat the meal that was due. If the meal is more than an hour away, have a snack with 15 g of carbohydrate and some protein.
What doesn't work
- Chocolate, cookies, cake — the fat slows the sugar down
- Milk, for the same reason
- Diet or zero drinks — they contain no sugar at all
- Glucose gel is slow; tablets are better
The diet drink mix-up is the one that catches families at the dinner table, where both cans look the same. If you're handing someone a drink for a low, check that it's the regular one.