Glucagon Use for Severe and Moderate Hypoglycemia

Indications for Glucagon Administration

Glucagon should be prescribed and kept readily available for anyone at risk of Level 2 hypoglycemia (blood glucose < 54 mg/dL or < 3.0 mmol/L) or Level 3 (severe) hypoglycemia, and administered when the patient cannot or will not take oral carbohydrates. 1, 2
For Level 3 hypoglycemia, glucagon is the primary treatment when the patient has altered mental or physical status that requires assistance, regardless of the exact glucose value. 1, 2, 3
Glucagon is indicated for Level 3 hypoglycemia when the patient is unconscious. 4
Glucagon is indicated for Level 3 hypoglycemia when the patient is experiencing seizures or convulsions. 5
Glucagon is indicated for Level 3 hypoglycemia when the patient cannot swallow safely or cannot take oral glucose. 4
In Level 2 hypoglycemia (glucose < 54 mg/dL), oral glucose (15–20 g) remains the preferred first‑line therapy if the patient is conscious and able to swallow; glucagon is reserved for situations where oral treatment is not feasible. 1, 6

Adults and children weighing ≥ 20 kg (≈ 44 lb): 1 mg administered subcutaneously, intramuscularly, or intravenously. 4
Children weighing < 20 kg: 0.5 mg (or 20–30 µg/kg) administered subcutaneously, intramuscularly, or intravenously. 5, 4

After a correct dose of glucagon, the patient should regain consciousness within approximately 15 minutes. 4

All individuals using insulin, sulfonylureas, or meglitinides who have an increased risk of Level 2 or Level 3 hypoglycemia. 1, 3, 7
Patients with a history of hypoglycemia unawareness. 1, 2
Patients who have previously experienced Level 3 (severe) hypoglycemic events. 1, 2
Patients with recurrent Level 2 hypoglycemia. 2, 3

Caregivers, family members, school personnel, and any other support persons must be educated about the location of glucagon and how to administer it; glucagon administration is not limited to healthcare professionals. 1, 2, 6, 3