Glucagon Infusion Preparation
For continuous glucagon infusion in severe hypoglycemia, reconstitute the 1 mg glucagon powder with the supplied diluent to create a 1 mg/mL solution, then dilute this to the desired concentration (typically 1 mg in 100-250 mL of D5W or normal saline) for IV administration under medical supervision only. 1
Reconstitution Process
- Insert the entire contents of the prefilled syringe (diluent) through the rubber stopper into the vial containing glucagon powder 1
- Swirl gently (do not shake vigorously) until the powder is completely dissolved and no particles remain 1
- The reconstituted solution should be clear and water-like in consistency—if cloudy or containing particulate matter, discard and do not use 1
- The reconstituted concentration is 1 mg/mL glucagon 1
Dilution for Continuous Infusion
While the FDA label primarily addresses bolus dosing, continuous infusions in hospital settings typically follow these principles:
- Use the reconstituted 1 mg/mL solution immediately after preparation 1
- For continuous IV infusion, dilute in compatible IV fluids (D5W or normal saline) to achieve desired infusion rate 2
- Standard dilution protocols in critical care often use 1 mg glucagon in 100-250 mL of IV fluid, though this must be determined by the treating physician based on clinical needs
Critical Administration Points
- Glucagon for continuous IV infusion must ONLY be administered under direct medical supervision in a monitored setting 1
- Use immediately after reconstitution—glucagon is biochemically unstable in liquid form and any unused portion must be discarded 1, 3
- Traditional glucagon powder formulations have major stability limitations, which is why newer ready-to-use preparations (intranasal, prefilled pens) are now preferred for emergency use 2, 3
Post-Administration Management
- Once the patient responds and can safely swallow, immediately provide oral carbohydrates to restore liver glycogen and prevent recurrence of hypoglycemia 4, 1
- Monitor blood glucose closely as the effects of glucagon are temporary and hypoglycemia may recur 2
Important Caveats
Continuous glucagon infusion is rarely used in modern practice—it is primarily reserved for specific scenarios like refractory hypoglycemia from sulfonylurea overdose or insulinoma management in hospitalized patients. For severe hypoglycemia treatment, IV dextrose (20-40 mL of 50% glucose solution) is the preferred initial therapy in medical settings 4, with glucagon reserved for situations where IV access is unavailable or as adjunctive therapy.
The complexity of reconstitution and instability of traditional glucagon preparations is precisely why newer formulations (intranasal glucagon, dasiglucagon, ready-to-inject preparations) have been developed and are now strongly preferred for emergency hypoglycemia treatment 2, 5.