What is the appropriate dosing for Glucagon (Glucagon)?

From the Guidelines

Glucagon dosing should be initiated with a dose of 1-5 mg administered intravenously over 5 minutes, followed by an infusion of 5-15 mg/min, as indicated by 1.

Key Considerations

• For beta-blocker or calcium channel blocker overdose, a higher dose of 2-10 mg may be considered, with a maintenance infusion of 1-15 mg/h, as recommended by 1.
• Pediatric dosing is typically based on weight, with a dose of 0.05-0.15 mg/kg, as stated in 1.
• It is essential to anticipate vomiting and take necessary precautions, as glucagon can cause nausea and emesis, as noted in 1.
• The dose may need to be titrated to achieve the desired clinical response, and individual patient needs may vary, as emphasized in 1.

Administration

• Glucagon should be administered intravenously or intramuscularly, as indicated by 1.
• The dose can be repeated as necessary, with careful monitoring of the patient's response, as recommended by 1.

From the FDA Drug Label

The recommended dosage is 1 mg (1 mL) injected subcutaneously or intramuscularly into the upper arm, thigh, or buttocks, or intravenously If there has been no response after 15 minutes, an additional 1 mg dose (1 mL) of Glucagon for Injection may be administered using a new kit while waiting for emergency assistance. Pediatric Patients Weighing Less Than 25 kg or for Pediatric Patients with Unknown Weight Less Than 6 Years of Age:

• The recommended dosage is 0.5 mg (0. 5 mL) injected subcutaneously or intramuscularly into the upper arm, thigh, or buttocks, or intravenously.
• If there has been no response after 15 minutes, an additional 0.5 mg dose (0.5 mL) of Glucagon for Injection may be administered using a new kit while waiting for emergency assistance. The recommended diagnostic dose for relaxation of the stomach, duodenal bulb, duodenum, and small bowel is 0.2 mg to 0.5 mg administered intravenously or 1 mg administered intramuscularly; the recommended dose to relax the colon is 0.5 mg to 0.75 mg administered intravenously or 1 mg to 2 mg administered intramuscularly

The appropriate dosing for Glucagon (Glucagon) is as follows:

• Severe Hypoglycemia:
  • Adults and pediatric patients weighing more than 25 kg: 1 mg (1 mL) injected subcutaneously, intramuscularly, or intravenously
  • Pediatric patients weighing less than 25 kg: 0.5 mg (0.5 mL) injected subcutaneously, intramuscularly, or intravenously
• Diagnostic Aid:
  • Relaxation of the stomach, duodenal bulb, duodenum, and small bowel: 0.2 mg to 0.5 mg intravenously or 1 mg intramuscularly
  • Relaxation of the colon: 0.5 mg to 0.75 mg intravenously or 1 mg to 2 mg intramuscularly 2, 2

From the Research

Dosing Regimens for Glucagon

The dosing regimens for glucagon vary depending on the patient's age, weight, and severity of hypoglycemia.

• For children with type 1 diabetes, a mini-dose glucagon regimen can be used, where children ages ≤ 2 years receive 2 units (20 μg) of glucagon subcutaneously, and those ages > 2 years receive 1 unit/year of age up to 15 units (150 μg) 3.
• If the blood glucose does not increase within 30 minutes, the initial dosage can be doubled and given at that time 3.
• For adults with type 1 diabetes, 3 mg of nasal glucagon (NG) has been shown to be non-inferior to 1 mg of intramuscular glucagon (IMG) in treating insulin-induced hypoglycemia 4.
• In cases where glucagon is ineffective, a second dose can be administered 5.

Administration Routes

Glucagon can be administered through various routes, including:

• Subcutaneous injection: commonly used in children with type 1 diabetes 3.
• Intramuscular injection: used in adults with type 1 diabetes 4.
• Nasal administration: a novel drug-device combination product that delivers glucagon dry powder through nasal administration, shown to be effective and well-tolerated in adults with type 1 diabetes 4.

Efficacy and Safety

The efficacy and safety of glucagon have been evaluated in several studies, with results showing that:

• Glucagon is effective in increasing blood glucose levels in patients with hypoglycemia 3, 5, 4.
• Mini-dose glucagon is safe and effective in managing children with type 1 diabetes during episodes of impending hypoglycemia 3.
• Nasal glucagon is as efficacious and well-tolerated as intramuscular glucagon for the treatment of insulin-induced hypoglycemia in adults 4.