Glucagon Administration Frequency for Recurrent Hypoglycemia
For severe hypoglycemia, administer glucagon as a single dose (1 mg for adults/children >25 kg or 0.5 mg for children <25 kg), and if there is no response after 15 minutes, a second dose may be given using a new kit while waiting for emergency assistance. 1
Initial Dosing Protocol
Standard single-dose administration:
- Adults and children ≥25 kg (or ≥6 years): 1 mg (1 mL) administered intramuscularly, subcutaneously, or intranasally 1, 2
- Children <25 kg (or <6 years): 0.5 mg (0.5 mL) administered intramuscularly or subcutaneously 1
- Glucagon typically increases blood glucose within 5-15 minutes after administration 3, 2
Repeat Dosing for Non-Response
If the patient fails to respond to the initial dose:
- A second dose of the same amount may be administered after 15 minutes using a new glucagon kit 1
- Call for emergency assistance immediately after the first dose, regardless of response 1
- Blood glucose should be monitored after administration to ensure adequate response 2
Critical Post-Administration Management
Once the patient responds and can swallow safely:
- Immediately provide oral carbohydrates to restore liver glycogen and prevent secondary hypoglycemia 1, 2
- Give starchy or protein-rich foods after the patient can swallow safely 2
- This step is essential because glucagon depletes hepatic glycogen stores 1
Important Clinical Considerations
Route selection matters in specific contexts:
- In the ICU setting with IV access available, IV dextrose is preferred over glucagon due to faster response time (1-3 minutes vs 8-21 minutes for recovery) 4, 5
- For out-of-hospital severe hypoglycemia without IV access, glucagon is the treatment of choice 2, 6
- Newer intranasal and ready-to-inject formulations are preferred over traditional reconstitution kits due to ease of administration and more rapid correction 2, 3
Common Pitfalls and Side Effects
Anticipate and manage expected adverse effects:
- Nausea and vomiting are common side effects, particularly with higher doses 3, 2
- Protect the airway before glucagon administration in patients with altered mental status 2
- If the patient does not respond adequately after two doses, switch to IV dextrose administration (20-40 mL of 50% glucose solution) 2
Long-Term Prevention Strategy
For patients with recurrent hypoglycemia:
- All insulin-treated individuals should be prescribed glucagon, even those on basal-only regimens 2
- Caregivers, family members, school personnel, and close contacts must be trained on glucagon administration 3, 2
- Consider continuous glucose monitoring (CGM) to detect and prevent hypoglycemia in high-risk patients 4
- Reevaluate the diabetes treatment plan with deintensification, simplification, or agent modification as appropriate 4
- Replace glucagon products when they reach their expiration date and store according to product instructions 3, 2