What is the recommended dose of glucagon (glucagon) for treating hypoglycemia?

From the Guidelines

The recommended dose of glucagon for treating severe hypoglycemia is 1 mg for adults and children weighing 25 kg (55 lbs) or more, and 0.5 mg for children weighing less than 25 kg. Glucagon is administered by injection, either subcutaneously, intramuscularly, or intravenously, and should be given when a person with diabetes is unconscious, having seizures, or unable to safely consume oral carbohydrates. After administration, the patient should be placed in the recovery position, and emergency services should be called. Once the person regains consciousness (usually within 10-15 minutes), they should consume oral carbohydrates to prevent recurrence of hypoglycemia, as glucagon's effects are temporary. Glucagon works by stimulating the liver to release stored glucose into the bloodstream and inhibiting insulin secretion, thereby raising blood glucose levels. It's essential to note that glucagon kits have expiration dates and should be stored according to manufacturer instructions, typically at room temperature 1.

Some key points to consider when treating hypoglycemia include:

• Glucose (15–20 g) is the preferred treatment for conscious individuals with hypoglycemia, although any form of carbohydrate that contains glucose may be used 1.
• If SMBG shows continued hypoglycemia 15 minutes after treatment, the treatment should be repeated 1.
• Glucagon should be prescribed for all individuals at increased risk of clinically significant hypoglycemia, defined as blood glucose <54 mg/dL (3.0 mmol/L), so it is available should it be needed 1.
• Hypoglycemia unawareness or one or more episodes of severe hypoglycemia should trigger reevaluation of the treatment regimen 1.

It's crucial to prioritize the patient's safety and well-being when treating hypoglycemia, and to follow the recommended guidelines for glucagon administration and treatment.

From the FDA Drug Label

1. 2 Dosage in Adults and Pediatric Patients for Using the Glucagon Emergency Kit for Low Blood Sugar to Treat Severe Hypoglycemia 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 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 dose of glucagon for treating hypoglycemia is:

• 1 mg (1 mL) for adults and pediatric patients weighing more than 25 kg or for pediatric patients with unknown weight 6 years and older, injected subcutaneously or intramuscularly into the upper arm, thigh, or buttocks, or intravenously.
• 0.5 mg (0.5 mL) for pediatric patients weighing less than 25 kg or for pediatric patients with unknown weight less than 6 years of age, injected subcutaneously or intramuscularly into the upper arm, thigh, or buttocks, or intravenously. If there is no response after 15 minutes, an additional dose of the same amount may be administered using a new kit while waiting for emergency assistance 2.

From the Research

Recommended Dose of Glucagon for Hypoglycemia

The recommended dose of glucagon for treating hypoglycemia is not explicitly stated in the provided studies as a single, unified recommendation. However, the following points can be considered:

• According to 3, intranasal glucagon is administered as a 3-mg dose, which has been shown to be noninferior to intramuscular glucagon.
• The study 4 mentions the use of 1 mg glucagon injected intramuscularly, subcutaneously, or intravenously, but this is in the context of pharmacokinetics and bioavailability rather than a recommended dose for hypoglycemia treatment.
• There is no mention of a specific dose in 5, 6, or 7 that can be directly applied as a recommendation for glucagon dosage in hypoglycemia treatment.

Administration Routes and Efficacy

• Intranasal glucagon has been found to be effective in treating hypoglycemia, with studies indicating its noninferiority to intramuscular glucagon 5, 3.
• The choice between intranasal and intramuscular/subcutaneous administration may depend on the specific situation, such as the availability of administration routes, patient preference, and the severity of hypoglycemia.
• Intravenous administration of glucagon results in higher initial plasma glucagon levels and a steeper rise in glycemia but does not differ from intramuscular or subcutaneous routes in terms of maximal increase in blood glucose levels 4.

Considerations for Use

• Glucagon is underutilized in the treatment of severe hypoglycemia 7, suggesting a need for better education and understanding of its use.
• The ease of administration, particularly of intranasal glucagon, can facilitate faster treatment of hypoglycemia 3.
• Factors such as nausea, vomiting, and local adverse events should be considered when administering glucagon 3.