Is 1mg of glucagon appropriate for severe hypoglycemia?

Glucagon Dosing for Severe Hypoglycemia

The recommended dose of glucagon for severe hypoglycemia (blood glucose of 35 mg/dL) is 1 mg administered subcutaneously or intramuscularly, which is the appropriate dose for adults and pediatric patients weighing more than 25 kg or for pediatric patients with unknown weight who are 6 years and older. 1

Dosing Guidelines

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

Administration Instructions

• Glucagon for injection is for subcutaneous, intramuscular, or intravenous injection (administer intravenously ONLY under medical supervision) 1
• Using the supplied prefilled syringe, inject all the liquid into the vial containing glucagon powder and shake gently until completely dissolved 1
• The reconstituted solution should be clear and colorless; do not use if cloudy or contains particulate matter 1
• Immediately after reconstitution, inject the solution subcutaneously or intramuscularly 1
• Newer intranasal and ready-to-inject glucagon preparations are now available and preferred due to their ease of administration resulting in more rapid correction of hypoglycemia 2, 3, 4

Expected Response and Monitoring

• Glucagon typically increases blood glucose levels within 5-15 minutes after administration 5, 6
• Blood glucose should be monitored after glucagon administration to ensure adequate response 5
• When the patient has responded to treatment and is able to swallow, give oral carbohydrates to restore liver glycogen and prevent recurrence of hypoglycemia 1, 2

Important Clinical Considerations

• Glucagon should be prescribed for all patients at increased risk for clinically significant hypoglycemia 2, 5
• Caregivers, family members, school personnel, and others in close contact with the patient should be trained on glucagon administration 2
• Glucagon is effective in treating hypoglycemia only if sufficient hepatic glycogen is present; patients in states of starvation, with adrenal insufficiency, or chronic hypoglycemia may not have adequate levels of hepatic glycogen for glucagon to be effective 1
• Nausea and vomiting are common side effects of glucagon administration 6

Storage and Replacement

• Care should be taken to replace glucagon products when they reach their expiration date 2, 5
• Store glucagon according to specific product instructions to ensure safe and effective use 2, 5

Common Pitfalls and Caveats

• Glucagon is contraindicated in patients with pheochromocytoma, insulinoma, known hypersensitivity to glucagon or excipients, and glucagonoma when used as a diagnostic aid 1
• Glucagon has been historically underutilized due to the lack of confidence or ability to administer in emergency situations 7, 8
• Traditional glucagon kits required reconstitution immediately prior to injection, which was cumbersome in emergency situations; newer formulations have addressed this issue 4, 9
• Hypoglycemia unawareness or one or more episodes of severe hypoglycemia should trigger reevaluation of the treatment regimen 2