Can I administer glucagon (Glucagon) intramuscularly (IM) for severe hypoglycemia?

Glucagon Administration for Severe Hypoglycemia

Yes, glucagon can be administered intramuscularly (IM) for severe hypoglycemia and is an appropriate route of administration when a patient cannot take oral glucose. 1, 2, 3

Definition and Classification of Hypoglycemia

Hypoglycemia is classified into three levels:

• Level 1: Blood glucose <70 mg/dL but ≥54 mg/dL (mild)
• Level 2: Blood glucose <54 mg/dL (moderate)
• Level 3: Severe event with altered mental/physical status requiring assistance 2, 3

Treatment Algorithm for Hypoglycemia

For Conscious Patients (Levels 1-2)

1. Administer 15-20g of oral glucose or any carbohydrate containing glucose
2. Recheck blood glucose after 15 minutes
3. Repeat treatment if hypoglycemia persists
4. Once blood glucose normalizes, consume a meal or snack to prevent recurrence 2, 3

For Severe Hypoglycemia (Level 3)

1. First choice (if available): Intravenous glucose administration under medical supervision
2. When IV access unavailable: Glucagon administration via:
   • Intramuscular (IM) injection
   • Subcutaneous (SC) injection
   • Intravenous (IV) injection (under medical supervision only) 1, 3

Glucagon Dosing for Severe Hypoglycemia

• Adults and children >25 kg or ≥6 years with unknown weight: 1 mg (1 mL) IM, SC, or IV
• Children <25 kg or <6 years with unknown weight: 0.5 mg (0.5 mL) IM, SC, or IV 1, 3

If no response after 15 minutes, a second dose may be administered while waiting for emergency assistance 1.

Administration Instructions for IM Glucagon

1. Using the supplied prefilled syringe, inject all liquid into the vial containing glucagon powder
2. Shake gently until completely dissolved (solution should be clear and colorless)
3. Draw up the reconstituted solution (1 mg/mL)
4. Inject immediately into the upper arm, thigh, or buttocks muscle
5. Place patient in recovery position
6. Call for emergency assistance immediately after administering the dose
7. When patient regains consciousness, provide oral carbohydrates to restore liver glycogen and prevent recurrence 1, 3

Important Considerations

• Glucagon is effective only if sufficient hepatic glycogen is present; patients in states of starvation, adrenal insufficiency, or chronic hypoglycemia may not respond adequately 1
• Contraindicated in patients with pheochromocytoma, insulinoma, glucagonoma, or known hypersensitivity to glucagon 1
• Allergic reactions including generalized rash and anaphylactic shock have been reported 1
• Traditional glucagon kits require reconstitution which can be cumbersome in emergency situations 4, 5

Practical Implementation

• Prescribe glucagon to all patients on insulin regimens and consider for those taking sulfonylureas 3
• Train family members/caregivers on glucagon administration 2, 3
• Glucagon administration does not require a healthcare professional 2
• Ensure unexpired glucagon kits are available 2
• Consider newer formulations like intranasal glucagon or ready-to-use injectable solutions which may be easier to administer in emergency situations 4, 6, 7, 8

IM glucagon is an effective and appropriate treatment for severe hypoglycemia when oral glucose cannot be administered due to altered mental status or unconsciousness.