When should glucagon be considered as a treatment option for a patient?

When to Consider Giving a Patient Glucagon

Glucagon should be prescribed to all patients taking insulin and should be considered for patients taking sulfonylureas who are at high risk for hypoglycemia, to treat severe hypoglycemic episodes when the patient cannot take oral carbohydrates. 1

Primary Indications for Glucagon Administration

Severe Hypoglycemia

• Severe hypoglycemia (characterized by cognitive impairment requiring assistance from another person)
• Patient unable or unwilling to consume carbohydrates orally 1
• Blood glucose typically <70 mg/dL (<3.9 mmol/L) 2

High-Risk Populations Who Should Have Glucagon Available

1. All patients taking insulin (even those on basal-only regimens) 2
2. Patients taking sulfonylureas or glinides who meet criteria for high hypoglycemia risk 2
3. Patients with history of severe hypoglycemia episodes 2
4. Patients with hypoglycemia unawareness 2

Dosing Guidelines

Adults and Children ≥25 kg (or ≥6 years with unknown weight):

• 1 mg injected subcutaneously or intramuscularly into upper arm, thigh, or buttocks 3
• If no response after 15 minutes, an additional 1 mg dose may be administered while awaiting emergency assistance 3

Children <25 kg (or <6 years with unknown weight):

• 0.5 mg injected subcutaneously or intramuscularly 3
• May repeat after 15 minutes if no response 3

Administration Considerations

Preferred Formulations

• Newer formulations are preferred due to ease of use: 1
  • Nasal glucagon
  • Single-dose auto-injector glucagon
  • Dasiglucagon pens
  • These are easier to use than traditional glucagon kits, which facilitates training 2

Important Precautions

Contraindications

• Pheochromocytoma (may stimulate catecholamine release) 4
• Insulinoma (may cause hypoglycemia after initial glucose rise) 4
• Known hypersensitivity to glucagon 4
• Glucagonoma when used as a diagnostic aid 4

Reduced Efficacy Situations

• Glucagon is effective only if sufficient hepatic glycogen is present 4
• May be ineffective in patients with:
  • States of starvation
  • Adrenal insufficiency
  • Chronic hypoglycemia
  • Impaired liver function 1
  • These patients should be treated with glucose instead 4

Patient Education and Preparation

Family/Caregiver Training

• Family members and close associates of persons using insulin should be trained in glucagon administration 2
• Training should include:
  • Storage requirements
  • Administration technique
  • Recognition of severe hypoglycemia
  • When to call emergency services 1

Institutional Settings

• Correctional institutions and similar settings should train staff to recognize and treat hypoglycemia 2
• Staff should have immediate access to glucagon for intramuscular injection 2
• Patients at risk for hypoglycemia should be identified and monitored 2

Follow-up After Glucagon Administration

• Monitor blood glucose after administration
• If hypoglycemia persists after 15 minutes, repeat dose while awaiting emergency assistance 4
• Once patient is alert, provide oral carbohydrates to prevent recurrent hypoglycemia 2
• Replace glucagon products when they reach expiration date 1

By following these guidelines, healthcare providers can ensure appropriate use of glucagon to effectively manage severe hypoglycemia and potentially life-threatening situations in patients with diabetes.