My daughter has never required stitches, but our endo and pediatrician have said, when in doubt, give the stress dose (if one of them can't be reached). The same is for the IM. My endo does not expect a call first before I inject, she said not to delay. However, I have her beeper and can page an endo on call if necessary-and I have. I always call when I give the IM, for further instructions or just for reassurance. Good luck.