Wait 20 minutes before repeating glucagon if there's no response.

How long should you wait to repeat glucagon if there is no response?

• A. 10 minutes
• B. 15 minutes
• C. 20 minutes
• D. 30 minutes

Answer: (C)

In the context of administering glucagon, if there is no response, it is generally recommended to wait for approximately 15 to 20 minutes before considering a repeat dose. The preferred timeframe is 20 minutes, as this allows adequate time for the initial dose to be effective in increasing blood glucose levels. Glucagon is a hormone that stimulates the liver to release stored glucose, which can be critical in treating severe hypoglycemia. However, the timing is equally important; waiting too long could lead to further deterioration in the patient's condition, while administering it too frequently can increase risks of side effects. Therefore, after an initial dose with no response, waiting 20 minutes before repeating glucagon ensures that the administration is both safe and effective.

Glucagon timing in the field: when 20 minutes matters

When an EMS call lands with a patient in severe hypoglycemia, every minute can feel oversized. Glucagon isn’t a magic wand, but it’s a powerful ally: it nudges the liver to release stored glucose, giving the brain something to work with when there’s little or no sugar circulating in the blood. But what happens if the first dose doesn’t spark a quick turnaround? How long should you wait before repeating it? The answer you’ll hear in many EMS protocols is simple, practical, and grounded in real-world physiology: wait about 20 minutes before considering a repeat dose.

Here’s the thing: waiting isn’t a lazy pause. It’s a careful space to let the first dose do its job. Glucagon starts a cascade—signaling liver cells to release glucose and raising blood glucose levels. That process isn’t instant. It takes a bit of time for the hormone to circulate, for the liver to respond, and for the patient’s symptoms to improve. If you jump to a second dose too soon, you risk unnecessary side effects and you may miss important clues about how the patient is responding. On the flip side, waiting too long can allow the patient’s condition to deteriorate further. That balance—enough time for the medicine to work, but not so long that you miss a window—is what the 15-to-20 minute rule is all about. In many guidance documents, the preferred window is 20 minutes because it gives a clear, consistent target for action in the field.

Why commonly 15 to 20 minutes? A quick biology refresher helps explain the rationale. After an IM (intramuscular) or SC (subcutaneous) injection, glucagon hits the bloodstream and signals the liver to release stored glycogen as glucose. The exact timing depends on factors like how well blood flow is working to the injection site, the patient’s underlying liver stores, and their overall physiology at that moment. In practice, you’ll likely see improvements in mental status, responsiveness, and sometimes measurable blood glucose within a window that centers around 20 minutes. If there’s no discernible improvement by then, many protocols encourage you to reassess and consider the next step, which may include a repeat dose if allowed by local guidelines or a transition to alternate therapy.

Let me explain how this plays out on the street

First, the setup matters. You administer the initial glucagon dose as indicated by your protocol—usually IM or SC. Then you monitor closely. Look for signs that glucose is starting to move the needle: the patient becoming more awake, able to speak, or showing clearer orientation. A quick blood glucose check, if you have a meter and the scene allows, provides a numeric anchor to your assessment. But even without a meter, responsive signs—eye contact, follow-through with commands, improving breathing pattern—are meaningful.

Second, the clock is your ally, not your enemy. After that first dose, give the body the estimated 15-to-20 minute window to respond. If the patient improves at any point in that interval, great—you’ve got a sign that the rescue is working and you can adjust your care accordingly. If there’s no improvement by the 20-minute mark, you’ll need to act based on your protocol and clinical judgment.

Third, plan for the possibility of a second dose. In many EMS systems, a second dose of glucagon can be given if there is still a lack of response after the 20-minute window, especially if the patient remains unable to protect their airway or isn’t waking up adequately. The key is to follow your local guidelines and communicate with medical control if you’re unsure. If a second dose is given and there’s still no response, that’s a signal to escalate care—consider establishing IV access if it hasn’t been done, arrange for rapid transport to a higher level of care, and prepare for alternative glucose administration (such as IV dextrose) if you’re trained and authorized to deliver it.

What to do in the field, in practical terms

• Administer the initial dose as directed. IM or SC injections are common routes, depending on your system’s protocol.

• Observe for gradual improvement. Don’t assume no change equals failure—some patients wake up more slowly than others.

• Check blood glucose if you can, but don’t delay transport while you wait for a meter reading. Immediate transport with life-saving measures beats getting stuck on one metric.

• If after about 20 minutes there’s no improvement, consult your protocol. If permitted, you may administer a second glucagon dose. If not, move forward with escalation—this could mean setting up IV access if you’re equipped to do so, or preparing for rapid transport to a facility where IV dextrose or hospital-level care is available.

• Watch for side effects. Nausea and vomiting can occur with glucagon. Ensure airway protection and be ready to manage vomiting or aspiration risk, especially if the patient isn’t fully alert.

• Reassess continually. Glucose control is dynamic, and patient status can shift quickly. Recheck breathing, mental status, and skin color. Keep your team informed—clear communication prevents confusion on a busy scene.

A common scenario, a clear takeaway

If you’re faced with a question that presents options like A) 10 minutes, B) 15 minutes, C) 20 minutes, D) 30 minutes, the medically supported stance is C) 20 minutes. That window captures the practical moment when you should consider a repeat dose after an initial administration, assuming the patient hasn’t shown meaningful improvement yet. It’s not about chasing perfection; it’s about giving the body time to respond while staying vigilant for signs of deterioration that require a swift pivot to the next level of care.

This isn’t just about numbers on a sheet. It’s about staying calm, reading the room, and knowing when to press forward and when to pause. In the chaos of a hypoglycemic emergency, a 20-minute rule can be a steady compass.

Common-sense pitfalls to avoid

• Don’t assume no response equals failure too early. Some patients wake up gradually or show improvement in small, early signs that aren’t immediately dramatic.

• Don’t wait indefinitely. If protocols call for a 20-minute window, respect it. Prolonged delays can worsen outcomes, especially in patients who are unresponsive or unable to protect their airway.

• Don’t skip monitoring. Glucose management isn’t a one-and-done action. Reassess vitals, mental status, airway, and safety repeatedly.

• Don’t overlook transport. Glucagon is a bridge to definitive care. Get the patient to a setting where continuous monitoring and more definitive treatment are available.

Where this sits in the bigger picture

Glucagon is one tool in the EMS toolkit for severe hypoglycemia. Its timing is a reminder that pharmacology works best when we’re patient enough to let it do its job, but proactive enough to act when it doesn’t. The 20-minute window isn’t a rigid mandate; it’s a practical guideline that fits the way people respond in real life. In the field, you’ll blend science with situational awareness: how the scene looks, how the patient responds, and what your protocol allows. That blend—technique, timing, and teamwork—defines effective emergency care.

A quick, human note about the numbers

Sometimes students ask, “Why not 15 minutes or 30?” The honest answer is that the literature and protocols reflect a balance between giving the drug time to work and not letting hunger for improvement turn into a delay that risks patient safety. The 15–20 minute range gives you a reliable anchor without turning every call into a clock-watching exercise. In practice, you’ll adapt to the patient in front of you, and that adaptation—grounded in solid timing—keeps you nimble and confident.

If you’re ever unsure, here’s a simple mental model you can carry: administer, observe, clock the window, decide on the next step. It’s almost like a mini-patient-care routine you can run through without panicking. And yes, a calm rhythm matters when the scene around you is loud and fast.

Closing thoughts: the essence of timing and care

The 20-minute rule for repeating glucagon isn’t about memorizing a fact in isolation. It’s about understanding the why behind the action. Glucagon’s job is to prompt the liver to release glucose, and timing is essential to keep the patient from slipping further. By holding the line for a full, patient-centered window and then deciding on a repeat dose or escalation, you’re balancing risk and benefit in a way that saves brain function and life.

If you ever encounter a clinical scenario or a quiz question that asks you to pinpoint the moment to act again, remember the telltale sign: no meaningful response after a 20-minute window. That’s your cue to reassess, consider a second dose if your protocol allows, and escalate as needed. In the end, the goal is simple and powerful: keep the patient safe, stabilize the situation, and get them to a place where complete recovery can begin.