What is the recommended dose of glucagon (Glucagon) for hypoglycemia in an outpatient setting?

Glucagon Dosing in the Outpatient Setting

For severe hypoglycemia in the outpatient setting, administer 1 mg intramuscular or subcutaneous glucagon for adults and children weighing more than 25 kg (or age ≥6 years with unknown weight), and 0.5 mg for children weighing less than 25 kg (or age <6 years with unknown weight). 1

Standard Dosing Protocol

Adults and Larger Children

• Administer 1 mg (1 mL) glucagon via intramuscular or subcutaneous injection into the upper arm, thigh, or buttocks 1
• This dose applies to adults and pediatric patients weighing more than 25 kg, or for children age 6 years and older with unknown weight 1
• If no response occurs within 15 minutes, administer an additional 1 mg dose using a new kit while waiting for emergency assistance 1

Pediatric Patients (Smaller Children)

• Administer 0.5 mg (0.5 mL) glucagon via intramuscular or subcutaneous injection for children weighing less than 25 kg or age less than 6 years with unknown weight 1
• If no response within 15 minutes, give an additional 0.5 mg dose using a new kit while awaiting emergency help 1

Administration by Caregivers

Family members, roommates, school personnel, childcare professionals, correctional staff, and coworkers can and should administer glucagon—this is not limited to healthcare professionals 2, 3

• Inject into the upper arm, thigh, or buttocks immediately when severe hypoglycemia is recognized 1
• Call for emergency assistance immediately after administering the dose 1
• Never attempt oral glucose in an unconscious or seizing patient due to aspiration risk 2, 4

Post-Administration Management

Immediate Follow-Up

• Glucagon typically increases blood glucose within 5-15 minutes after administration 4, 3
• Once the patient regains consciousness and can safely swallow, immediately give 15-20 grams of oral fast-acting carbohydrates (glucose tablets, regular soft drink, or fruit juice) 2, 1
• Follow with a meal or protein-containing snack to restore liver glycogen and prevent recurrence 2, 1

Monitoring Protocol

• Check blood glucose every 15 minutes until levels exceed 70 mg/dL (3.9 mmol/L) 2, 4
• Target blood glucose >70 mg/dL but avoid overcorrection causing hyperglycemia 2, 4

Alternative Formulations

Newer intranasal and ready-to-inject glucagon preparations are now preferred over traditional reconstitution kits because they are easier to administer by untrained caregivers and result in more rapid correction of hypoglycemia 3

• Intranasal glucagon is administered as a 3 mg dose and has been shown to be noninferior to intramuscular glucagon, with 100% treatment success rates 5, 6
• Intranasal formulations can be administered in less than one minute, compared to 1-4 minutes for traditional intramuscular preparations 5

Patient Selection for Glucagon Prescription

All individuals treated with insulin—even basal-only regimens—should be prescribed glucagon 3

• Glucagon may also be considered for persons taking sulfonylureas who meet criteria for high hypoglycemia risk 3
• Train family members and caregivers on where the glucagon product is kept, when to administer it, how to administer it, and explicitly educate them to never administer insulin to individuals experiencing hypoglycemia 3

Common Pitfalls and Caveats

Expected Side Effects

• Nausea and vomiting are common side effects, particularly with higher doses 4, 5
• The airway must be protected before glucagon administration in patients with central nervous system depression 7

Situations Where Glucagon May Be Ineffective

• Glucagon is only effective if sufficient hepatic glycogen is present 1
• Patients in states of starvation, with adrenal insufficiency, or chronic hypoglycemia may not have adequate hepatic glycogen for glucagon to work—these patients should be treated with intravenous glucose instead 1

Storage Requirements

• Replace glucagon products when they reach their expiration date 3
• Store according to specific product instructions to ensure safe and effective use 3

Mini-Dose Glucagon (Off-Label)

For mild or impending hypoglycemia with impaired carbohydrate intake (such as gastroenteritis), mini-dose subcutaneous glucagon is an off-label option: children ≤2 years receive 20 mcg (2 units on insulin syringe), and those >2 years receive 10 mcg per year of age up to 150 mcg (15 units), with repeat dosing if blood glucose does not increase within 30 minutes 8, 9