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Treating severe lows with Glucagon

If your child's mild to moderate low blood sugar (hypoglycemia) is not treated quickly, it can become severe and treatment with Glucagon may be needed. Severe low blood sugar may cause your child to lose consciousness. If your child is physically unable to eat or drink a rapid-acting source of sugar (glucose), they will need a Glucagon injection. You or another trained adult will need to give it to them.

What is Glucagon?

Glucagon is a potentially lifesaving treatment for insulin coma or insulin reaction resulting from severe low blood sugar. If your child takes insulin, many healthcare providers suggest keeping Glucagon on hand. Glucagon is a medicine that's different from insulin. It works by telling the liver to release sugar (glucose) into the bloodstream to quickly bring the blood sugar level back up.

Be prepared

The possibility of severe low blood sugar and of giving your child a Glucagon injection can be scary. It is very important that you understand how to recognize severe low blood sugar and that you—and any other adult who may need to help your child in an emergency—are able to give a Glucagon injection if needed. Download a Lilly Glucagon brochure and watch a tutorial to learn more about Glucagon and how to give an injection in case of severe low blood sugar.

Your child may be in the care of lots of people besides you throughout the day. This list could include teachers, coaches, after-school activity leaders, school bus drivers, school nurses, babysitters, grandparents and other extended family members, and friends. These people should be educated about low blood sugar and how to give a Glucagon injection in case of a severe low blood sugar emergency. A medical ID bracelet or necklace indicating that your child has type 1 diabetes and takes insulin is recommended.

Select Safety Information for Glucagon

Glucagon should not be used if your child has pheochromocytoma or if your child is allergic to Glucagon. Make sure you tell your child's healthcare provider if your child has been diagnosed with or has been suspected of having an insulinoma as Glucagon should be used cautiously in this situation. You and anyone who may need to help your child during an emergency should become familiar with how to use Glucagon before an emergency arises. Read the Information for the User provided in the kit. Make sure that your relatives or close friends know that if your child becomes unconscious, medical assistance must always be sought. If your child is unconscious, Glucagon can be given while awaiting medical assistance. Warning: Your child may be in a coma from severe hyperglycemia (high blood glucose) rather than hypoglycemia. In such a case, they will not respond to Glucagon and require immediate medical attention. Tell your child's doctor about all of their medical conditions and prescription and over-the-counter drugs.

Lilly Glucagon Emergency Kit

The Lilly Glucagon Emergency Kit is small and portable, keeps all the items needed to administer Glucagon, and comes in a bright red case that is easy to recognize. Ask your child's healthcare provider about prescribing more than one Lilly Glucagon Emergency Kit for severe low blood sugar. That way, you can have one at home, at school, and wherever else your child spends time.

It's important that Lilly Glucagon Emergency Kits are in the places where they might be needed, that those who might need to administer Glucagon know where the kits are located, and that the kits are not expired. It's also important that you and any other adults who might need to help your child in a severe low blood sugar emergency are familiar with how to use the Lilly Glucagon Emergency Kit before an emergency rises.

Instructions for using Glucagon

Review these instructions so you can feel more comfortable about giving a Glucagon injection. You can also watch a tutorial to learn how to give an injection of Glucagon. Keep in mind that these are not full instructions. For complete instructions on how to give a Glucagon injection, please see the Information for the User.

  1. Flip off the seal from the vial of Glucagon powder.
  2. Remove the needle cover from the syringe. DO NOT REMOVE THE PLASTIC CLIP FROM THE SYRINGE, as this may allow the push rod to come out of the syringe.
  3. Insert the needle into the rubber stopper on the vial, then inject the entire contents of the syringe into the vial of Glucagon powder.
  4. Remove the syringe from the vial, then gently shake the vial until the liquid becomes clear. Glucagon should not be used unless the solution is clear and of a water-like consistency.
  5. Insert the same syringe into the vial and slowly withdraw all of the liquid. In patients weighing less than 44 pounds, withdraw half the liquid (0.5 mark on the syringe).
  6. Inject Glucagon immediately after mixing. The usual injection site is the top of the thigh. Inject the Glucagon and then withdraw the needle. Press an alcohol swab against the injection site.
  7. Turn the child on his/her side. When an unconscious person awakens, he/she may vomit.

    Call 911 immediately after administering Glucagon. If the child does not awaken within 15 minutes, you may administer a second dose of Glucagon, if previously instructed by the child's healthcare provider to do so.

    As soon as the child is awake and able to swallow, give them a fast-acting source of sugar (such as fruit juice) followed by a snack or meal containing both protein and carbohydrates (such as cheese and crackers, or a peanut butter sandwich).
  8. Discard any unused reconstituted Glucagon.

Remember to notify the child's healthcare provider that an episode of severe low blood sugar has occurred.

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Important Safety Information for Humalog

What is the most important information I should know about Humalog?

  • Do not change the insulin you use without talking to your healthcare provider. Doses of oral antidiabetic medicines may also need to change if your insulin is changed.
  • Test your blood sugar levels as your healthcare provider instructs.
  • When used in a pump, do not mix Humalog with any other insulin or liquid.

Who should not take Humalog?

  • Do not take Humalog if your blood sugar is too low (hypoglycemia) or if you are allergic to insulin lispro or any of the ingredients in Humalog.

Before using Humalog, what should I tell my healthcare providers?

Tell your healthcare providers:

  • About all of your medical conditions, including liver, kidney, or heart problems.
  • If you are pregnant or breastfeeding.
  • About all the medicines you take, including prescription (especially ones commonly called TZDs [thiazolidinediones]) and non-prescription medicines, vitamins, and herbal supplements.

How should I use Humalog?

  • Humalog is a rapid-acting insulin. Take Humalog within fifteen minutes before eating or right after eating a meal.
  • Always make sure you receive the correct type of Humalog from the pharmacy.
  • Do not use Humalog if it is cloudy, colored, or has solid particles or clumps in it.
  • Do not mix Humalog with insulin other than NPH when using a syringe. Do not mix or dilute Humalog when used in a pump.
  • Inject Humalog under your skin (subcutaneously). Never inject into a vein or muscle. Change (rotate) your injection site with each dose. Make sure you inject the correct insulin and dose.
  • Depending on the type of diabetes you have, you may need to take Humalog with a longer-acting insulin or with oral antidiabetic medicines.
  • If you forget to take your dose of Humalog, your blood sugar may go too high (hyperglycemia), which can lead to serious problems like loss of consciousness (passing out), coma, or even death.
  • Your insulin dose may need to change because of illness, stress, other medicines you take, change in diet, or change in physical activity or exercise.

What are the possible side effects of Humalog?

  • Low blood sugar is the most common side effect. There are many causes of low blood sugar, including taking too much Humalog. It is important to treat it quickly. You can treat mild to moderate low blood sugar by drinking or eating a quick source of sugar right away. If severe, low blood sugar can cause unconsciousness (passing out), seizures, and death. Symptoms may be different for each person. Be sure to talk to your healthcare provider about low blood sugar symptoms and treatment.
  • Severe life-threatening allergic reactions (whole-body reactions) can happen. Get medical help right away if you develop a rash over your whole body, have trouble breathing, have a fast heartbeat, or are sweating.
  • Reactions at the injection site (local allergic reaction) such as redness, swelling, and itching can happen. If you keep having skin reactions or they are serious, talk to your healthcare provider. Do not inject insulin into a skin area that is red, swollen, or itchy.
  • Skin may thicken or pit at the injection site (lipodystrophy). Do not inject insulin into skin with these types of changes.
  • Other side effects include low potassium in your blood (hypokalemia), and weight gain.
  • Serious side effects can include:
    • - swelling of your hands and feet
    • - heart failure when taking certain pills called thiazolidinediones or “TZDs” with Humalog. This may occur in some people even if they have not had heart problems before. Tell your healthcare provider if you have shortness of breath, swelling of your ankles or feet, or sudden weight gain, which may be symptoms of heart failure. Your healthcare provider may need to adjust or stop your treatment with TZDs or Humalog.
  • These are not all of the possible side effects. Ask your healthcare providers for more information or for medical advice about side effects.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

How should I store Humalog?

  • Unopened Humalog should be stored in a refrigerator and can be used until the expiration date on the carton or label.
  • Humalog should be stored away from light and heat. Do not use insulin if it has been frozen.
  • Opened vials should be kept at room temperature or in a refrigerator. Opened cartridges or prefilled pens should be kept at room temperature.
  • Once opened, Humalog vials, prefilled pens, and cartridges should be thrown away after 28 days.

Humalog is available by prescription only.

For additional information, talk to your healthcare providers and please click to access Full Prescribing Information and Patient Prescribing Information.

Please see Instructions for Use that accompany your pen.

HI CON ISI 29MAR2013

Humalog® and Humalog® KwikPen are registered trademarks of Eli Lilly and Company and are available by prescription only.

Humalog® KwikPen is a registered trademark of Eli Lilly and Company and is available by prescription only.

HumaPen® LUXURA is a registered trademark of Eli Lilly and Company. HumaPen® LUXURA HD is available by prescription only.

D-Tron® and D-Tronplus® are registered trademarks of Roche Diagnostics GmbH.

Other product names mentioned herein are the trademarks of their respective owners.

Important Safety Information for Glucagon

What is the most important information I should know about Glucagon?

  • Glucagon should not be used if you have pheochromocytoma or if you are allergic to Glucagon.
  • Make sure you tell your healthcare provider if you have been diagnosed with or have been suspected of having an insulinoma as Glucagon should be used cautiously in this situation.
  • You and anyone who may need to help you during an emergency should become familiar with how to use Glucagon before an emergency arises. Read the Information for the User provided in the kit.
  • Make sure that your relatives or close friends know that if you become unconscious, medical assistance must always be sought. If you are unconscious, Glucagon can be given while awaiting medical assistance.
  • Do not use the kit after the date stamped on the bottle label.
  • If you have questions concerning the use of this product, consult a doctor, nurse or pharmacist.

WARNING: YOU MAY BE IN A COMA FROM SEVERE HYPERGLYCEMIA (HIGH BLOOD GLUCOSE) RATHER THAN HYPOGLYCEMIA. IN SUCH A CASE, YOU WILL NOT RESPOND TO GLUCAGON AND REQUIRE IMMEDIATE MEDICAL ATTENTION.

Who should not use Glucagon?

Glucagon should not be used if you have pheochromocytoma or if you are allergic to Glucagon.

What should I tell my doctor before taking Glucagon?

Tell your doctor about all of your medical conditions and prescription and over-the-counter drugs. Tell your doctor if you have been diagnosed with or have been suspected of having pheochromocytoma or an insulinoma.

How should I use Glucagon?

  • Act quickly. Prolonged unconsciousness may be harmful.
  • Make sure your family and friends know to turn you on your side to prevent choking if you are unconscious.
  • The contents of the syringe are inactive and must be mixed with the Glucagon in the accompanying bottle immediately before giving injection. Do not prepare Glucagon for Injection until you are ready to use it.
  • Glucagon should not be used unless the solution is clear and of a water-like consistency.
  • The usual adult dose is 1 mg (1 unit). For children weighing less than 44 lbs (20 kg), give 1/2 adult dose (0.5 mg). For children, withdraw 1/2 of the solution from the bottle (0.5 mg mark on syringe). Discard unused portion.
  • You should eat as soon as you awaken and are able to swallow. Inform a doctor or emergency services immediately.

What is some important Information I should know about Low Blood Sugar (Hypoglycemia)?

  • Early symptoms of low blood sugar include: sweating, drowsiness, dizziness, sleep disturbances, palpitation, anxiety, tremor, blurred vision, hunger, slurred speech, restlessness, depressed mood, tingling in the hands, feet, lips, or tongue, irritability, lightheadedness, abnormal behavior, inability to concentrate, unsteady movement, headache, and personality changes. These symptoms may be different for each person and can happen suddenly.
  • If your low blood sugar is not treated, you may progress to severe low blood sugar that can include: disorientation, seizures, unconsciousness, and death
  • Low blood sugar symptoms should be treated with a quick source of sugar which should always be carried with you. If you do not improve or you are unable to take a quick source of sugar, you should be treated with Glucagon or with intravenous glucose at a medical facility.

What are the possible side effects of Glucagon?

  • Severe side effects are very rare, although nausea and vomiting may occur occasionally.
  • A few people may be allergic to Glucagon or to one of the inactive ingredients in Glucagon, or may experience rapid heart beat for a short while.
  • If you experience any other reactions which are likely to have been caused by Glucagon, please contact your doctor.

You are encouraged to report negative side effects of Prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

How should I store Glucagon?

  • Before dissolving Glucagon with diluting solution, store the kit at controlled room temperature between 20° to 25°C (68° to 77°F).
  • After dissolving Glucagon with diluting solution, use immediately. Discard any unused portion. Glucagon should be clear and of a water-like consistency at time of use.

For more safety information, please click to access Information for the User and Information for the Physician.

HI GLUC CON ISI 1NOV2013

The Glucagon design is a trademark of Eli Lilly and Company. Glucagon is available by prescription only.

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