Glucagon Dosage and Administration for Severe Hypoglycemia and Diagnostic Purposes
For severe hypoglycemia in adults, administer glucagon 1 mg subcutaneously, intramuscularly, or intravenously. For children, the dose is 30 mcg/kg subcutaneously to a maximum of 1 mg. 1, 2
Severe Hypoglycemia Treatment
Adult Dosing
- Unconscious/unable to take oral glucose: 1 mg glucagon via subcutaneous, intramuscular, or intravenous route 1, 3
- Blood glucose typically rises within 5-15 minutes after administration 1
- Newer formulations available:
Pediatric Dosing
- Standard dose: 30 mcg/kg subcutaneously to maximum of 1 mg 1
- Lower dose of 10 mcg/kg results in smaller glycemic response but with less nausea 1
- For children ≥4 years old, intranasal glucagon (3 mg) can be used regardless of weight 4
Administration Considerations
- Glucagon should be prescribed for all patients at risk of level 2 (<54 mg/dL) or level 3 (severe) hypoglycemia 1
- Family members, school personnel, caregivers should be trained on administration 1
- Traditional powder formulations require reconstitution before injection 1
- Newer ready-to-use formulations (intranasal, prefilled pens) are preferred due to faster administration and ease of use 1, 4
Diagnostic Uses of Glucagon
Diagnostic Testing Dosage
- 1 mg via intramuscular or intravenous route 3
- Used in various diagnostic procedures including:
- Radiologic examinations of the stomach, duodenum, small bowel
- Assessment of beta cell function
- Provocative testing for growth hormone deficiency
Administration for Diagnostic Purposes
- Administer as a single 1 mg dose before the procedure 3
- Available in diagnostic kits containing 1 mg single-dose vial with sterile water for injection 3
- Timing of administration depends on specific diagnostic procedure
Clinical Considerations
Efficacy
- Both IV dextrose and glucagon are effective for treating hypoglycemic coma 5
- Recovery of consciousness is slower with glucagon (6.5 min) compared to IV dextrose (4.0 min) 5
- Intranasal glucagon has >98% success rate in treating hypoglycemic events 4
Side Effects
- Common side effects include nausea and vomiting 1, 4
- Higher doses (standard 1 mg) associated with more gastrointestinal side effects than lower doses 1
Storage and Handling
- Replace glucagon products when they reach expiration date 1
- Store according to specific product instructions 1
- Check insurance coverage as providers may prefer specific glucagon products 1
Hypoglycemia Classification and Treatment Algorithm
| Level | Blood Glucose | Description | Treatment |
|---|---|---|---|
| 1 | <70 mg/dL and ≥54 mg/dL | Mild hypoglycemia | 15-20g oral glucose |
| 2 | <54 mg/dL | Moderate hypoglycemia | 15-20g oral glucose |
| 3 | Any level | Severe event with altered mental/physical state requiring assistance | Glucagon injection |
Special Considerations
- For conscious patients with hypoglycemia, oral glucose (15-20g) is preferred over glucagon 1, 2
- Mini-dose glucagon (off-label) can be used for mild or impending hypoglycemia in situations of poor oral intake 6
- Intranasal glucagon is administered in less than a minute in most scenarios, while IM glucagon takes 1-4 minutes 4
- Despite its effectiveness, glucagon remains underutilized in clinical practice 7
Remember that glucagon is only effective if the patient has adequate liver glycogen stores. Patients with alcoholism, starvation, or adrenal insufficiency may have limited response to glucagon treatment.