Glucagon Emergency Kit Prescription Recommendations
Order at least 2 glucagon emergency kits for any patient at increased risk of severe hypoglycemia, with kits strategically placed in multiple locations where the patient spends significant time. 1
Rationale for Multiple Kits
The American Diabetes Association guidelines explicitly state that glucagon should be prescribed for all individuals at increased risk of severe hypoglycemia, with caregivers and family members instructed on administration. 1 However, the guidelines emphasize a critical practical consideration: glucagon kits must be available where the patient actually experiences hypoglycemia, which can occur in multiple settings.
Strategic Placement Locations
- Primary home location (bedroom, kitchen, or main living area) 1
- Workplace or school (for patients who spend significant daytime hours away from home) 1
- Caregiver's home (if the patient regularly stays with family members or partners) 1
- Vehicle or travel bag (for patients who travel frequently, though temperature stability must be considered) 2
Minimum Recommendation: Two Kits
At minimum, prescribe 2 kits to ensure:
- One kit remains at the primary residence 1
- One kit is available at the secondary most-frequented location (work, school, or caregiver's home) 1
- Backup availability if one kit is expired or used 1, 2
Additional Considerations for Higher-Risk Patients
For patients with hypoglycemia unawareness, previous severe hypoglycemia episodes, or those living alone, consider prescribing 3-4 kits to maximize coverage across all relevant locations. 1, 3, 4
Critical Expiration Management
The American Diabetes Association specifically warns that "care should be taken to ensure that glucagon kits are not expired." 1 This necessitates:
- Annual prescription renewal at minimum, regardless of whether kits have been used 1
- Proactive replacement 1-2 months before expiration to prevent gaps in coverage 2
- Patient education on checking expiration dates every 3-6 months 1
Who Requires Glucagon Kits
According to current guidelines, glucagon should be prescribed for: 1
- All patients on any insulin regimen (basal, bolus, or mixed) 1, 5
- Patients on sulfonylureas who meet high-risk criteria (age ≥65, previous severe hypoglycemia, CKD, hypoglycemia unawareness) 1
- Any patient with documented Level 3 (severe) hypoglycemia requiring external assistance for recovery 1, 4
- Patients with hypoglycemia unawareness regardless of medication regimen 1, 4
Caregiver Training Requirements
The guidelines emphasize that glucagon administration is not limited to healthcare professionals—family members, roommates, school personnel, childcare providers, and coworkers should all receive instruction. 1 This multi-person training requirement further supports having multiple kits available, as different caregivers may be present in different locations.
Common Pitfall to Avoid
Do not prescribe only one kit assuming it can be carried everywhere. Research demonstrates that glucagon emergency kits are significantly underutilized (only 3% prescription rate in one ED study), partly due to accessibility issues when hypoglycemia occurs. 6 Multiple kits eliminate the risk of the kit being in the wrong location during an emergency.
Newer Formulation Considerations
While traditional glucagon emergency kits require reconstitution (taking 97 seconds on average), newer ready-to-use formulations (autoinjectors, nasal glucagon) reduce administration time to approximately 27 seconds. 7, 8 If prescribing newer formulations, the same multi-kit strategy applies, though the simplified administration may improve actual use rates. 7, 9