Neonatal Drug Therapy Manual

Glucagon

Disclaimer: Official controlled document is the CHEO and Ottawa Hospital online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Updated March 18, 2025 - 4:12pm

Classification: 
Antihypoglycemic Agent (hormone)
Original Date: 
April 1998
Revised Date: 
March 2024
Indications: 
  • Hypoglycemia
Administration: 
  • IV direct: over 1 - 5 minutes undiluted
  • IV continuous infusion
  • SC
  • IM

 

  • Although GlucaGen (Novo Nordisk) is not approved by Health Canada for IV or SC administration, there is strong documentation in the literature supporting its efficacy and safety by these routes.
Dosage: 
  • IV direct, SC, IM:  
    • 0.03 mg/kg/dose (Maximum: 0.5 mg/dose)
    • May repeat prn
    • rise in glucose may last about 2 hours, typically between 30 minutes to 2 hours
  • IV continuous infusion:
    • Initial dose: 1 - 1.5 mg/day
    • Maintenance dose: 0.1 - 1.5 mg/day
Side Effects: 
  • CVS: hypotension
  • Endocrine and metabolic: hypocalcemia, hypokalemia, rebound hypoglycemia
  • GI: nausea and vomiting
  • Miscellaneous: hypersensitivity reactions
Parameters to Monitor: 
  • BP
  • Blood glucose
  • Serum electrolytes
Reconstitution and Stability: 
  • IV direct, SC, IM:
    • Glucagon 1 mg vial
      • Reconstitute content of vial with 1 mL of the diluent provided 
      • Final concentration: 1 mg/mL
  • IV continuous infusion:
    • Glucagon 1 mg vial
      • Reconstitute content of vial with 1 mL of the diluent provided
      • Take 1 mL (1 mg) and add to 23 mL of D10W
      • Final concentration: 0.04 mg/mL
Compatibility: 

- Solutions Compatible: D5W, D10W

 

- Incompatible: 0.9% NaCl (including flushes)

Notes: 
  • 1 mg  =  1 unit
  • Catheter occlusions can occur due to glucagon instability and precipitation in prepared solutions.  The use of additional clear fluids (not NaCL) down the same line can help to reduce precipitation and improve delivery of the active drug. It's also ideal to avoid running glucagon with  high concentration of dextrose (>15%) to avoid this issue. 
References: 

- Thornton S, Stanley C, De Leon D, Harris D, Haymond M, Hussain K, et al. Recommendations from the Pediatric Endocrine Society for Evaluation and Management of Persistent Hypoglycemia in Neonates, Infants, and Children. The Journal of Pediatrics. 2015, Vol 167, No 2, 238-244

-Mohnike K, Blankenstein O, Pfuetzner A, Pötzsch S, Schober E, Steiner S, Hardy OT, Grimberg A, van Waarde WM. Long-term non-surgical therapy of severe persistent congenital hyperinsulinism with glucagon. Horm Res. 2008;70(1):59-64. 

 

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