Recommended Glucagon Dosing for Hypoglycemia
For severe hypoglycemia, administer 1 mg glucagon for adults and children weighing >25 kg (or ≥6 years old), and 0.5 mg for children weighing ≤25 kg (or <6 years old), via subcutaneous, intramuscular, or intravenous routes. 1
Standard Dosing by Weight and Age
Adults and Larger Children
- 1 mg (1 mL) is the recommended dose for patients weighing more than 25 kg or age 6 years and older 1
- Can be administered subcutaneously, intramuscularly (upper arm, thigh, or buttocks), or intravenously 1
- If no response after 15 minutes, an additional 1 mg dose may be given using a new kit while waiting for emergency assistance 1
Pediatric Patients (Smaller Children)
- 0.5 mg (0.5 mL) is the recommended dose for children weighing less than 25 kg or younger than 6 years of age 1
- Same routes of administration apply (subcutaneous, intramuscular, or intravenous) 1
- If no response after 15 minutes, an additional 0.5 mg dose may be administered 1
Route Considerations and Expected Response
Route Selection
- No clinically significant difference exists between subcutaneous and intramuscular administration in terms of efficacy for raising blood glucose 2
- Intravenous administration produces higher initial plasma glucagon levels and a steeper rise in blood glucose during the first 5 minutes, but maximal glucose increase is similar across all routes 2
- In practice, subcutaneous or intramuscular routes are preferred in out-of-hospital settings due to ease of administration 1
Timeline for Response
- Blood glucose typically increases within 5-15 minutes after glucagon administration 3, 4, 5
- Recovery of consciousness after intramuscular glucagon averages 6.5 minutes, compared to 4.0 minutes with intravenous dextrose 6
- The slightly slower recovery with glucagon compared to IV dextrose is clinically acceptable given the ease of administration and lower risk of complications 6
Post-Administration Management
Immediate Follow-Up
- Call for emergency assistance immediately after administering the dose 1
- Monitor blood glucose every 15 minutes until levels exceed 70 mg/dL (3.9 mmol/L) 5
- Once the patient responds and can swallow safely, give 15-20 g of oral carbohydrates to restore liver glycogen and prevent recurrence 5, 1
- Follow with a meal or protein-containing snack 5
Common Side Effects
- Nausea and vomiting are common, particularly with standard doses 4, 5
- Lower doses (10 mcg/kg) result in smaller glycemic responses but less nausea, though this is primarily relevant for mini-dose glucagon protocols used for mild hypoglycemia 4
Alternative Formulations
Intranasal Glucagon
- 3 mg intranasal dose is now available and preferred by the American Diabetes Association due to ease of administration 4
- Shown to be noninferior to intramuscular glucagon, with >98% success rate in treating hypoglycemic events 7
- Does not require reconstitution and can be administered in less than one minute 7
- Particularly useful for caregivers uncomfortable with injections 7
Critical Clinical Pearls
Administration Technique
- Traditional glucagon kits require reconstitution: inject all liquid from the prefilled syringe into the powder vial, shake gently until completely dissolved, then withdraw and inject 1
- The reconstituted solution should be clear and colorless; discard if cloudy or contains particles 1
- Use immediately after reconstitution and discard any unused portion 1
Safety Considerations
- Never attempt oral glucose in a seizing or unconscious patient due to aspiration risk 5
- Do not delay glucagon administration to obtain intravenous access in prehospital or home settings 5
- Glucagon should be prescribed for all patients at increased risk for clinically significant hypoglycemia 3, 4
- Train caregivers, family members, and close contacts on glucagon administration 3, 4