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

Glucagon Dosing for Symptomatic Hypoglycemia

For symptomatic hypoglycemia, the recommended glucagon dose is 1 mg (1 mL) injected subcutaneously or intramuscularly for adults and pediatric patients weighing more than 25 kg or 6 years and older, while patients weighing less than 25 kg or under 6 years should receive 0.5 mg (0.5 mL). 1

Dosing Guidelines by Age and Weight

• Adults and children >25 kg or ≥6 years of age:

  • 1 mg (1 mL) administered subcutaneously or intramuscularly into the upper arm, thigh, or buttocks 1
  • If no response after 15 minutes, an additional 1 mg dose may be administered while waiting for emergency assistance 1

• Children <25 kg or <6 years of age:

  • 0.5 mg (0.5 mL) administered subcutaneously or intramuscularly into the upper arm, thigh, or buttocks 1
  • If no response after 15 minutes, an additional 0.5 mg dose may be administered while waiting for emergency assistance 1

Administration Routes and Formulations

• Glucagon can be administered via subcutaneous, intramuscular, or intravenous routes, with intravenous administration ONLY under medical supervision 1

• Multiple formulations are now available:

  • Traditional reconstitution kits (powder with diluent)
  • Pre-filled pens/syringes
  • Intranasal glucagon (3 mg fixed dose) 2, 3

• Intranasal glucagon (3 mg) has been shown to be noninferior to intramuscular glucagon and is easier to administer, making it a preferred option for caregivers 3, 4

Expected Response and Monitoring

• Glucagon typically increases blood glucose levels within 5-15 minutes after administration 5
• Blood glucose should be monitored after administration to ensure adequate response 2
• When the patient has responded to treatment and is able to swallow, oral carbohydrates should be given to restore liver glycogen and prevent recurrence of hypoglycemia 1

Important Clinical Considerations

• Glucagon should be prescribed for all patients at increased risk for clinically significant hypoglycemia 5
• Caregivers, family members, and others in close contact with the patient should be trained on glucagon administration 5
• Common side effects include nausea and vomiting; intranasal formulations may cause local irritation, rhinitis, or sneezing 3, 6

Special Situations

• For mild or impending hypoglycemia in children with type 1 diabetes during illness or poor oral intake, "mini-dose" glucagon may be considered:

  • Children ≤2 years: 20 mcg (0.02 mg)
  • Children >2 years: 10 mcg/kg or approximately 1 mcg per year of age up to 150 mcg (0.15 mg) 7

• There is no significant difference in efficacy between subcutaneous and intramuscular routes for glucagon administration, though intravenous administration (when performed by medical professionals) provides slightly faster initial glucose elevation 8

Storage and Replacement

• Care should be taken to replace glucagon products when they reach their expiration date 5
• Store according to specific product instructions to ensure safe and effective use 5