Intramuscular Glucagon for Hypoglycemia Treatment
Intramuscular (IM) glucagon is strongly recommended for the treatment of severe hypoglycemia in patients who are unable or unwilling to consume carbohydrates by mouth. 1, 2
Indications for Glucagon Use
- Glucagon is indicated for treatment of hypoglycemia in people unable to consume carbohydrates orally, particularly those with altered states of consciousness, coma, seizures, or disorientation 1
- All individuals treated with insulin or who are at high risk of hypoglycemia should be prescribed glucagon, as appropriate glucagon prescribing is currently very low in clinical practice 1
- Severe hypoglycemia requires treatment with glucagon or intravenous glucose, especially when the patient cannot take glucose orally 1
Administration Guidelines
- Glucagon can be administered via subcutaneous, intramuscular, or intravenous routes, though intravenous administration should only be performed under medical supervision 2
- For adults and pediatric patients weighing more than 25 kg or ≥6 years with unknown weight, the recommended IM dose is 1 mg 2
- For pediatric patients weighing less than 25 kg or <6 years with unknown weight, the recommended IM dose is 0.5 mg 2
- A glucagon dose of 30 mcg/kg subcutaneously to a maximum dose of 1 mg will increase blood glucose levels within 5–15 minutes 1
- If there is no response after 15 minutes, an additional dose may be administered while waiting for emergency assistance 2
Efficacy and Response
- Intramuscular glucagon typically increases blood glucose levels within 5-15 minutes after administration 1, 3
- While IM glucagon is slightly slower than intravenous dextrose (9.0 vs 3.0 minutes to restore consciousness), it remains effective for treating severe hypoglycemia 4
- Blood glucose should be monitored after glucagon administration to ensure adequate response 3
Formulations and Practical Considerations
- Traditional glucagon was dispensed as a powder requiring reconstitution prior to injection, which was cumbersome 1, 5
- Newer formulations include intranasal and ready-to-inject glucagon preparations, which are now preferred due to their ease of administration resulting in more rapid correction of hypoglycemia 1
- Care should be taken to replace glucagon products when they reach their expiration date and to store according to specific product instructions 1, 3
Education and Training
- Those in close contact with patients at risk (family members, roommates, school personnel, childcare professionals, correctional institution staff) should be instructed on glucagon use 1
- It is essential that caregivers be explicitly educated to never administer insulin to individuals experiencing hypoglycemia 1
- An individual does not need to be a healthcare professional to safely administer glucagon 1
Special Settings
- In correctional institutions, staff should have glucagon for intramuscular injection available to treat severe hypoglycemia without requiring transport of the hypoglycemic patient to an outside facility 1
- Security staff who supervise patients at risk for hypoglycemia should be educated in emergency response protocols for recognition and treatment of hypoglycemia 1
Important Clinical Considerations
- After glucagon administration and patient recovery, oral carbohydrates should be given to restore liver glycogen and prevent recurrence of hypoglycemia 2
- Lower doses of glucagon (10 mcg/kg) result in a smaller glycemic response but are associated with less nausea than higher doses 1
- Patients with impaired awareness of hypoglycemia are at higher risk for severe episodes and may particularly benefit from glucagon availability 1
Alternative Options
- While intranasal glucagon has shown similar efficacy to IM/SC glucagon in resolving hypoglycemia 6, intramuscular administration remains a well-established and effective route for glucagon delivery 2, 4
- For conscious patients with hypoglycemia, oral glucose (15-20g) should be the first-line treatment 1