What is the recommended dose of glucagon (Glucagon) for treating hypoglycemia in adults and children?

Glucagon Dosing for Hypoglycemia

For severe hypoglycemia, administer 1 mg (1000 mcg) of glucagon intramuscularly, subcutaneously, or intranasally for adults and children weighing more than 25 kg (or age ≥6 years), and 0.5 mg (500 mcg) for children weighing less than 25 kg (or age <6 years). 1, 2

Standard Dosing Protocol

Adults and Larger Children

• Administer 1 mg (1 mL) via IM, SC, or intranasal route for patients weighing >25 kg or age ≥6 years 1, 2
• If no response after 15 minutes, an additional 1 mg dose may be administered using a new kit while waiting for emergency assistance 1
• The maximum single dose is 1 mg regardless of age or weight in this population 2

Younger/Smaller Children

• Administer 0.5 mg (0.5 mL) via IM, SC, or intranasal route for children weighing <25 kg or age <6 years 1, 2
• If no response after 15 minutes, an additional 0.5 mg dose may be administered using a new kit while waiting for emergency assistance 1

Alternative Dosing for Specific Situations

• For insulin excess as an adjunct to glucose: 0.03 mg/kg up to maximum of 1 mg; may repeat every 15 minutes up to a total of 3 doses if needed 3

Route Selection and Formulation Preferences

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 2

• Intranasal glucagon (3 mg dose) is noninferior to IM glucagon and can be administered in less than 1 minute 4, 5
• Traditional IM/SC glucagon requires reconstitution and takes 1-4 minutes to administer, with risk of incomplete dosing 5
• All routes (IM, SC, intranasal) are effective, but IV dextrose is preferred when IV access is available due to faster response time (1-3 minutes vs 8-21 minutes for recovery) 6

Expected Response and Monitoring

• Glucagon typically increases blood glucose within 5-15 minutes after administration 2, 7, 6
• Recovery of normal consciousness occurs at approximately 6.5 minutes with IV glucagon versus 4.0 minutes with IV dextrose 8
• Blood glucose should be monitored after administration to ensure adequate response 2

Critical Post-Administration Management

Immediately after the patient responds and can swallow safely, provide oral carbohydrates to restore liver glycogen and prevent recurrence of 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

When Glucagon May Be Insufficient

If the patient does not respond adequately to the initial dose, switch to IV dextrose administration with an initial dose of 20-40 mL of 50% glucose solution 2

• In the ICU setting with IV access available, IV dextrose is preferred over glucagon from the outset 2, 6
• For out-of-hospital severe hypoglycemia without IV access, glucagon remains the treatment of choice 6

Important Safety Considerations

Airway Protection

• Protect the airway before glucagon administration in patients with altered mental status or central nervous system depression 2, 6
• Nausea and vomiting are common side effects, particularly with higher doses 2, 7, 6

Common Pitfalls to Avoid

• Do not underdose—use the full recommended dose based on weight/age criteria 1
• Do not delay calling for emergency assistance—call immediately after administering glucagon 1
• Do not use if the reconstituted solution is cloudy or contains particulate matter 1
• Never administer insulin to individuals experiencing hypoglycemia 2

Who Should Be Prescribed Glucagon

All individuals treated with insulin—even basal-only regimens—should be prescribed glucagon 2, 7, 6

• Glucagon may also be considered for persons taking sulfonylureas who meet criteria for high hypoglycemia risk 2
• Family members, roommates, school personnel, childcare professionals, and coworkers should be trained on glucagon administration 2, 7, 6

Storage and Replacement

• Replace glucagon products when they reach their expiration date 2, 7
• Store according to specific product instructions to ensure safe and effective use 2, 7