From the FDA Drug Label
• If there has been no response after 15 minutes, an additional dose of Glucagon for Injection may be administered while waiting for emergency assistance. • If there has been no response after 15 minutes, an additional 1 mg dose (1 mL) of Glucagon for Injection may be administered while waiting for emergency assistance. • If there has been no response after 15 minutes, an additional 0.5 mg dose (0.5 mL) of Glucagon for Injection may be administered while waiting for emergency assistance. The patient can be administered one additional dose of glucagon if there is no response after 15 minutes, making it a total of two doses 1.
From the Research
Glucagon can typically be administered once for hypoglycemia emergencies, with a second dose possible if the patient doesn't respond within 15 minutes, as supported by the most recent study 2. The standard dose for adults and children weighing 25kg or more is 1mg, while children under 25kg should receive 0.5mg. Some key points to consider when administering glucagon include:
- Repeated glucagon administration may become less effective because glucagon works by stimulating the liver to release stored glucose; with multiple doses, hepatic glycogen stores can become depleted, rendering subsequent doses ineffective 3.
- Additionally, repeated administration can cause side effects including nausea, vomiting, and in rare cases, severe allergic reactions.
- After glucagon administration and once the patient is conscious, oral carbohydrates should be provided to restore blood glucose levels and replenish glycogen stores. It's also important to note that alternative interventions such as intravenous dextrose should be considered if the patient remains unresponsive after two doses of glucagon, as seen in a study comparing intravenous glucagon and dextrose in the treatment of severe hypoglycemia 3. A more recent study on intranasal versus injectable glucagon for hypoglycemia in type 1 diabetes found that both forms of glucagon are equally effective in resolving hypoglycemia 4. However, the most recent study on prehospital intranasal glucagon for hypoglycemia found that intranasal administration of recombinant glucagon resulted in a clinically significant improvement in mental status and a corresponding increase in blood glucose levels in select cases in the prehospital setting 2. Some other points to consider are:
- The use of intravenous glucagon as an adjunct to infusion of dextrose in the management of insulin overdose in youth with type 1 diabetes mellitus, as seen in a case study 5.
- The evolving role of glucagon in the management of hypoglycemia, including the development of new formulations such as nasal powder glucagon and liquid-stable glucagon 6.