Intramuscular Glucagon for Hypoglycemia Treatment
Indications for Glucagon Use
- The American Diabetes Association recommends glucagon for treatment of hypoglycemia in people unable to consume carbohydrates orally, particularly those with altered states of consciousness, coma, seizures, or disorientation 2, 1
- All individuals treated with insulin or who are at high risk of hypoglycemia should be prescribed glucagon, as appropriate glucagon prescribing is currently very low in clinical practice 1, 3
- Severe hypoglycemia requires treatment with glucagon or intravenous glucose, especially when the patient cannot take glucose orally 2, 4
Administration Guidelines
- A glucagon dose of 30 mcg/kg subcutaneously to a maximum dose of 1 mg will increase blood glucose levels within 5–15 minutes 2, 4
Efficacy and Response
- Intramuscular glucagon typically increases blood glucose levels within 5-15 minutes after administration 4, 5
- Blood glucose should be monitored after glucagon administration to ensure adequate response 5
Formulations and Practical Considerations
- Newer formulations include intranasal and ready-to-inject glucagon preparations, which are now preferred due to their ease of administration resulting in more rapid correction of hypoglycemia 1, 3
- Care should be taken to replace glucagon products when they reach their expiration date and to store according to specific product instructions 1, 3, 5
Education and Training
- Those in close contact with patients at risk (family members, roommates, school personnel, childcare professionals, correctional institution staff) should be instructed on glucagon use 1, 6, 3
- It is essential that caregivers be explicitly educated to never administer insulin to individuals experiencing hypoglycemia 1, 3
Special Settings
- In correctional institutions, staff should have glucagon for intramuscular injection available to treat severe hypoglycemia without requiring transport of the hypoglycemic patient to an outside facility 6, 7, 8
Important Clinical Considerations
- Lower doses of glucagon (10 mcg/kg) result in a smaller glycemic response but are associated with less nausea than higher doses 4
- Patients with impaired awareness of hypoglycemia are at higher risk for severe episodes and may particularly benefit from glucagon availability 1, 3, 9