Glucagon Dosing for Severe Hypoglycemia in a 2-Year-Old
For a 2-year-old child with severe hypoglycemia, the recommended dose is 0.5 mg (not 1 mg) of glucagon administered subcutaneously or intramuscularly. 1
Weight-Based Dosing Guidelines
The FDA-approved dosing for glucagon in young children is stratified by weight and age 1:
- Children weighing less than 25 kg OR children younger than 6 years of age: 0.5 mg (0.5 mL) dose 1
- Children weighing more than 25 kg OR children 6 years and older: 1 mg (1 mL) dose 1
Since a typical 2-year-old weighs approximately 12-14 kg (well below 25 kg), the appropriate dose is 0.5 mg, not 1 mg. 1
Alternative Weight-Based Dosing from Guidelines
The American Diabetes Association guidelines provide an alternative dosing strategy of 30 mcg/kg subcutaneously up to a maximum dose of 1 mg, which will increase blood glucose levels within 5-15 minutes 2. However, the FDA label takes precedence and clearly specifies 0.5 mg for children under 25 kg or under 6 years of age. 1
Administration and Expected Response
Glucagon should be administered as soon as severe hypoglycemia is recognized 1:
- Blood glucose typically increases within 5-15 minutes after administration 2, 3, 4
- If there is no response after 15 minutes, an additional 0.5 mg dose may be administered using a new kit while waiting for emergency assistance 1
- Once the child responds and can swallow, give oral carbohydrates to restore liver glycogen and prevent recurrence 1
Formulation Considerations
Newer intranasal and ready-to-inject glucagon preparations are preferred over traditional reconstitution kits due to ease of administration 2, 4:
- Intranasal glucagon (3 mg) is available and effective across all pediatric age groups, including children as young as 4 years 5, 6
- Pre-filled pens and syringes eliminate reconstitution errors and reduce administration time 2
Important Safety Considerations
Nausea and vomiting are common side effects of glucagon administration 2, 4:
- Lower doses (10 mcg/kg) result in less nausea compared to higher doses (20-30 mcg/kg), though blood glucose levels at 20 minutes are not significantly different 2
- The standard 0.5 mg dose for young children balances efficacy with tolerability 1
Critical Pitfalls to Avoid
- Never administer insulin to a child experiencing hypoglycemia 2
- Do not use the adult 1 mg dose in children under 25 kg or under 6 years of age 1
- Ensure caregivers are trained on glucagon administration and know where it is stored 2, 3, 4
- Replace glucagon when it reaches expiration date and store according to product instructions 2, 3, 4
Prescription Requirements
All children with diabetes treated with insulin should be prescribed glucagon 2, 3, 4. Family members, childcare providers, and school personnel should receive training on recognition of severe hypoglycemia and proper glucagon administration 2, 4.