From the FDA Drug Label
Severe Hypoglycemia: 1 mg single-dose vial of Glucagon for Injection with a 1 mL single-dose syringe of Sterile Water for Injection, USP (Glucagon Emergency Kit for Low Blood Sugar) Adults and Pediatric Patients Weighing More Than 25 kg or for Pediatric Patients with Unknown Weight 6 Years and Older: - The recommended dosage is 1 mg (1 mL) injected subcutaneously or intramuscularly into the upper arm, thigh, or buttocks, or intravenously Lack of Efficacy in Patients with Decreased Hepatic Glycogen: Glucagon for Injection is effective in treating hypoglycemia only if sufficient hepatic glycogen is present. Patients in states of starvation, with adrenal insufficiency or chronic hypoglycemia may not have adequate levels of hepatic glycogen for Glucagon for Injection to be effective. Patients with these conditions should be treated with glucose.
Management of Hypoglycemia in Non-Diabetic Patients:
- The recommended dosage of Glucagon for Injection for severe hypoglycemia is 1 mg (1 mL) injected subcutaneously or intramuscularly into the upper arm, thigh, or buttocks, or intravenously for adults and pediatric patients weighing more than 25 kg or for pediatric patients with unknown weight 6 years and older.
- Glucagon for Injection is effective in treating hypoglycemia only if sufficient hepatic glycogen is present.
- Patients with decreased hepatic glycogen should be treated with glucose. 1
From the Research
Management of hypoglycemia in non-diabetic patients should focus on treating immediate symptoms while identifying and addressing the underlying cause, with the most recent evidence from 2023 suggesting that the Whipple triad should be used to confirm hypoglycemia before pursuing further diagnostic workup 2. For acute hypoglycemia, consuming 15-20 grams of fast-acting carbohydrates such as glucose tablets, 4 ounces of fruit juice, 1 tablespoon of honey, or 8 ounces of milk is recommended, followed by a more substantial snack containing protein and complex carbohydrates once blood glucose begins to rise. Some key points to consider in the management of hypoglycemia in non-diabetic patients include:
- Identifying the underlying cause, which may include medications, alcohol consumption, critical illness, hormone deficiencies, or rare conditions like insulinoma
- Using the Whipple triad to confirm hypoglycemia, which includes low levels of plasma glucose, signs or symptoms that would be expected with low levels of plasma glucose, and improvement in those signs or symptoms when the level of plasma glucose increases 2
- Administering intravenous dextrose or glucagon injection for unconscious patients or those unable to swallow safely
- Considering the role of glucagon, catecholamines, and growth hormone in human glucose counterregulation, as well as the effects of somatostatin and combined alpha- and beta-adrenergic blockade on plasma glucose recovery and glucose flux rates after insulin-induced hypoglycemia 3
- Evaluating the patient's history, medications, and underlying comorbid conditions to determine the cause of hypoglycemia, and using supervised tests such as a 72-hour fast or mixed-meal test to recreate the situation under which the patient is likely to experience symptoms 2.
Overall, the management of hypoglycemia in non-diabetic patients requires a comprehensive approach that takes into account the underlying cause, the patient's medical history, and the most recent evidence-based guidelines. The most recent and highest quality study, published in 2023, provides the best evidence for the management of hypoglycemia in non-diabetic patients, and should be prioritized in clinical decision-making 2.