Glucagon Dosing for Severe Hypoglycemia
The recommended dose of glucagon for treating severe hypoglycemia is 1 mg (1 mL) administered subcutaneously or intramuscularly for adults and pediatric patients weighing more than 25 kg or for pediatric patients with unknown weight 6 years and older, and 0.5 mg (0.5 mL) for pediatric patients weighing less than 25 kg or for pediatric patients with unknown weight less than 6 years of age. 1
Adult Dosing
- 1 mg (1 mL) injected subcutaneously or intramuscularly into the upper arm, thigh, or buttocks, or intravenously (IV administration only under medical supervision) 1
- If there has been no response after 15 minutes, an additional 1 mg dose may be administered using a new kit while waiting for emergency assistance 1
- Glucagon typically increases blood glucose levels within 5-15 minutes after administration 2, 3
Pediatric Dosing
- For children weighing more than 25 kg or with unknown weight 6 years and older: 1 mg (1 mL) injected subcutaneously or intramuscularly 1
- For children weighing less than 25 kg or with unknown weight less than 6 years of age: 0.5 mg (0.5 mL) injected subcutaneously or intramuscularly 1
- A repeat dose may be administered after 15 minutes if there is no response, using the same dosage as the initial administration 1
Administration Instructions
- Glucagon for injection is available in multiple formulations, including traditional reconstitution kits, pre-filled pens/syringes, and intranasal glucagon 2
- For traditional kits, the powder must be reconstituted with the supplied diluent immediately before use 1
- The reconstituted solution should be clear and colorless; do not use if cloudy or contains particulate matter 1
- Administer immediately after reconstitution 1
- Newer intranasal and ready-to-inject glucagon preparations are now available and preferred due to their ease of administration 3
Post-Administration Care
- Call for emergency assistance immediately after administering the dose 1
- Monitor blood glucose after glucagon administration to ensure adequate response 2
- 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
- Any episode of severe hypoglycemia requires reevaluation of the diabetes management plan 4
Important Clinical Considerations
- Glucagon should be prescribed for all patients at increased risk for clinically significant hypoglycemia 2, 3
- Caregivers, family members, and others in close contact with the patient should be trained on glucagon administration 2, 3
- Common side effects include nausea and vomiting 3
- 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
- Intranasal glucagon (3 mg) has been shown to be highly effective in treating insulin-induced hypoglycemia with success rates comparable to intramuscular glucagon (1 mg) 5