Administration of Nasal Glucagon – BAQSIMI™

Pursuant to Sec. 5 CSR 20-200.300. Training of School Employees in the Care Needed for Students with Diabetes–Training of school employees in the care needed for students with diabetes shall take place prior to the commencement of each school year, or as needed when a student with diabetes is newly enrolled at a school or a student is newly diagnosed with diabetes, but in no event more than thirty days following such enrollment or diagnosis.  The school nurse or another health care professional with expertise in diabetes shall promptly provide follow-up training and supervision as needed.  Coordination, delegation, and supervision of care shall be performed by a school nurse or other qualified health care professional.

Considerations:

• Low blood sugar in children with diabetes can have varied symptoms. These can include but are not limited to:
  • nervousness,
  • shakiness,
  • weakness,
  • extreme hunger,
  • slight nausea,
  • dizziness,
  • headache,
  • blurred vision,
  • fast heartbeat and/or
  • feeling tired.
• Based on the student’s Diabetes Medical Management Plan/health care provider’s order, low blood sugar is treated with some type of quick-acting oral sugar, such as candy, icing/cake frosting tube, and/or juice.
• Severe low blood sugar symptoms include disorientation, unconsciousness, and seizures. If not treated promptly it could lead to death.
• Glucagon is a medication used in emergency situations when the student is unresponsive or unable to swallow because of very low blood sugar.
• Given that when a student is having symptoms of severe low blood sugar, it can be a stressful situation, it is highly recommended that you familiarize yourself with the student’s emergency plan beforehand.
• The school nurse or other qualified health care professional must review the glucagon procedure with staff to ensure that they have the skills to perform this emergency medication administration.
• Store the Diabetes Medical Management Plan/health care provider’s order and glucagon in a location that is easily accessible during a severe blood sugar event.
• Be sure that staff members who have regular contact with the student know where the medication is stored.
  • If the student self-carries their glucagon be sure to communicate with the student to know where they store their medication.
• The school nurse should develop a plan to systematically check the expiration date on medication to ensure medication is not expired.
• Remember to keep the student’s health care information confidential.

Important storage information:

• Do not remove the shrink wrap or open the tube until you are ready to give the medication
  • If the tube has been opened, BAQSIMI could be exposed to moisture
    • This could cause the medication to not work as expected

Supplies:

• Baqsimi
• Gloves
• Health care provider’s order/Diabetes Medical Management Plan and and student’s Individualized Health Care Plan (IHCP)
• Parent/Guardian authorization form
• Bulb syringe, if available
  
  NOTE: Student personal health information (PHI) shown on forms in this video is fictitious.

Procedure for medication administration:

1. Identify that symptoms of a severe low blood sugar reaction are present and that based on the student’s Diabetes Medical Management Plan/health care provider’s order, emergency medication needs to be given
2. Call for assistance
3. Ask that another school staff person call 911 or emergency medical services
4. If able, move the student to a lying position
5. Explain the procedure to the student at their level of understanding
6. Check the six rights of medication administration to ensure that it is:

1. For the right student
2. The right medication
3. The right dose
4. Being given at the right time
5. Being given by the right route
6. Being given for the right reason

7. Ensure that the medication has not expired
   1. If medication is expired do not administer, call 911 or emergency medical services
8. Review the student’s allergy status
9. Ensure proper documentation of parent/guardian authorization to administer medication
10. Wash your hands, if possible
11. Review the six rights again to ensure that it is:

1. For the right student
2. The right medication
3. The right dose
4. Being given at the right time
5. Being given by the right route
6. Being given for the right reason

12. Put on gloves, if gloves are not available, continue with procedure
13. Look into the child’s nostrils to determine if there is fluid or mucus in the nostrils
14. If drainage or mucus is present, use a bulb syringe to remove it
    1. If bulb syringe is not available, medication can still be administered if drainage or mucus is present
15. Remove the shrink wrap by pulling on the red stripe
16. Open the lid and remove the device from the tube
    1. Caution—do not push the plunger until ready to give the dose
17. Use your free hand to hold the crown of the head stable
18. Hold the device between your fingers and thumb
19. Do not push the plunger yet
20. Insert tip gently into one nostril until your finger(s) touch the outside of the nose
21. Push plunger firmly all the way in
    1. Dose is complete when the green line disappears
22. Remove the device
23. If the student is not lying on their side, move the student to a side-lying position because vomiting often follows the administration of glucagon
24. If needed, ask another person for assistance
25. If alone with student, and you have not already called 911 or emergency medical service, do so now
26. Monitor the student’s arousal, pulse, and respirations and for potential seizure
27. If the student begins to seize, clear the area of anything hard or sharp, to prevent injury
28. If breathing stops, move the student onto their back
29. Begin rescue breaths
30. If breathing and heartbeat stop, begin CPR
31. As soon as the individual is awake and able to swallow, give the individual a fast-acting source of sugar (such as fruit juice)
32. Once rescue squad arrives, inform them of medication administered, including type of medication, dose and time
33. Send along BASQIMI used dose
34. Dispose of all used materials in proper receptacles
35. Remove gloves and wash hands
36. Follow up with the parent or guardian and health care provider, as needed
37. Document medication administration in the student’s medication administration log

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References:

American Diabetes Association. (n.d.). Hypoglycemia (low blood sugar). Retrieved June 2, 2023, from https://diabetes.org/healthy-living/medication-treatments/blood-glucose-testing-and-control/hypoglycemia

American Diabetes Association. (n.d.). Medications and treatments. Glucagon and other emergency glucose products. Retrieved June 2, 2023, from https://diabetes.org/healthy-living/medication-treatments/glucagon-other-emergency-glucose-products#:~:text=Glucagon%E2%80%94a%20hormone%20that%20raises,you%20in%20case%20of%20emergencies

Centers for Disease Control and Prevention. (2024, May 15). First Aid for Seizures. Retrieved January 7, 2025, from https://www.cdc.gov/epilepsy/first-aid-for-seizures/

Diabetic care may be provided to students, when, trained personnel to be on site. Missouri Revisor of Statutes 167.809. (2013). https://revisor.mo.gov/main/OneSection.aspx?section=167.809

Eli Lilly and Company. (2020). Baqsimi-glucagon powder. Retrieved June 5, 2023, from https://uspl.lilly.com/baqsimi/baqsimi.html#ug

Eli Lilly and Company. (2020). How to use BAQSIMI . Retrieved April 15, 2020, from  https://www.baqsimi.com/how-to-use-baqsimi.

Levitsky, L.L., & Misra, M. (2022). Hypoglycemia in children and adolescents with type 1 diabetes mellitus. In a J. I. Wolfsdorf (Ed.), UpToDate. Retrieved: June 2, 2023, from https://www.uptodate.com/contents/hypoglycemia-in-children-and-adolescents-with-type-1-diabetes-mellitus

National Association of School Nurses. (2022, June 15). School nursing evidence-based clinical practice guideline: Students with type 1 diabetes toolkit. Retrieved June 2, 2023, from https://cdn.fs.pathlms.com/HRuI7pAvQWiJPZdzH6i8

National Association of School Nurses. (2021). School nursing evidence-based clinical practice guideline: Students with type 1 diabetes. Silver Spring, MD: Author. Retrieved June 2, 2023, from https://learn.nasn.org/courses/37660

National Diabetes Education Program. (2016). Helping the student with diabetes succeed: a guide for school personnel. Retrieved June 2, 2023 from https://diabetes.org/sites/default/files/2020-02/NDEP-School-Guide-Full-508.pdf

Plan to be submitted by parent or guardian of student with diabetes — review by school. Revisor of Statutes 167.806. (2013). https://revisor.mo.gov/main/OneSection.aspx?section=167.806

Training of school employees, content, requirements. Revisor of Statutes 167.803. (2013). https://revisor.mo.gov/main/OneSection.aspx?section=167.803&bid=8398&hl=.

Training of school employees in the care needed for students with diabetes. Missouri Secretary of State: Code of State Regulations. Division 20–Division of learning services. Chapter 200–Office of college and career readiness. (2022).https://www.sos.mo.gov/cmsimages/adrules/csr/current/5csr/5c20-200.pdf

Wyckoff, L. (2019). Students with diabetes. In Selekman, J. (Ed.), School nursing, a comprehensive text (3rd ed.). (pp. 575-602). Philadelphia PA.: F.A. Davis Co.

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Acknowledgment of Reviewers:

Angie Bulmahn, MSN, RN, NCSN
School Nurse Specialist
Missouri Department of Health and Senior Services

Marjorie Cole, MSN, RN, FASHA
State School Nurse Consultant
Missouri Department of Health and Senior Services

Renee Falkner, BSN, RN
School Nurse Supervision Specialist | Therapylog

Debra Funk, BSN, RN
Director of Practice
Missouri State Board of Nursing

Katherine Park, DNP, RN, NCSN
Nationally Certified School Nurse, Pierremont Elementary
Adjunct Professor, Maryville University School of Nursing

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Page last updated January 7, 2025
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