GVOKE HypoPen (Administration of Injectable Glucagon)

Emergency Intervention, Endocrine

Discussion: Just in Time Learning

 

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.

Supplies:

  • GVOKE Hypopen
  • Gloves
  • Health care provider’s order/Diabetes Medical Management Plan and student’s Individualized Health Care Plan (IHCP)
  • Parent/Guardian authorization form
  • Alcohol wipe
  • Gauze or cotton ball

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. Review the six rights of medication administration to be sure it is:
    1. The right student
    1. The right medication
    1. The right dose
    1. Being given at the right time
    1. Being given by the right route
    1. Being given for the right reason
  7. Check the medication expiration date
  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. The right student
    1. The right medication
    1. The right dose
    1. Being given at the right time
    1. Being given by the right route
    1. Being given for the right reason
  12. Put on gloves; if gloves are not available continue with the procedure
  13. Tear open pouch at the dotted line and carefully remove the GVOKE HypoPen
  14. Look at the liquid medicine through the viewing window. It must be clear and colorless, or a pale yellow
    1. Do not use if the liquid contains lumps, flakes, or particles
    1. Do not inject if the solution is not visible in the viewing window
  15. Identify the location (stomach, thigh, or upper arm) for the injection
  16. Remove any clothing covering the injection site
    1. NOTE: GVOKE Hypopen cannot be administered through clothing
  17. If you have an alcohol wipe, cleanse the injection site
  18. Pull the red needle cap straight off the device
    1. Do not put your thumb, fingers, or hand on or near the needle guard or needle opening to help prevent accidental needle sticks
  19. Push and hold the GVOKE HypoPen straight down against the injection site
  20. Listen for a “Click”
  21. Hold the device down and count slowly to 5
  22. When the injection is complete, the viewing window will be red
    1. Do not lift up the GVOKE HypoPen until the injection is complete
  23. Once complete, lift the device straight up from the injection site
    1. The yellow needle guard will lock over the needle
  24. If the student is not lying on their side, move the student to a side-lying position because vomiting often follows the injection of glucagon
  25. If needed, ask another person for assistance
  26. If alone with student, and you have not already called 911 or emergency medical service, do so now
  27. Monitor the student’s arousal, pulse and respirations and for potential seizure
  28. If the student begins to seize, clear the area of anything hard or sharp, to prevent injury
  29. If breathing stops, move the student onto their back
  30. Begin rescue breaths
  31. If breathing and heartbeat stop, begin CPR
  32. As soon as the individual is awake and able to swallow, give the individual a fast-acting source of sugar (such as fruit juice)
  33. Once rescue squad arrives, inform them of medication administered, including type of medication, dose and time
  34. Send along glucagon kit along with used dose
  35. Dispose of all used materials in proper receptacles
  36. Remove gloves and wash hands
  37. Follow up with the parent or guardian and health care provider, as needed
  38. Document medication administration in the student’s medication administration log

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. (2022, January 2). Seizure first aid. Retrieved June 6, 2023, from https://www.cdc.gov/epilepsy/about/first-aid.htm

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

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 J. Selekman, Shannon, R.A., Yonkaitis, C.F. (Eds.). School nursing, a comprehensive text (3rd ed., pp. 575-602). Philadelphia PA.: F.A. Davis Co.

Xeris Pharmaceuticals, Inc. (2023, April). Instructions for use Gvoke HypoPenTM (glucagon injection) auto-injector for subcutaneous use. Retrieved June 5, 2023, from https://gvokeglucagon.com/pdf/instructions-for-use-gvoke-hypopen.pdf

________________________________________

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

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 February 21, 2024
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