Glucagon

Pronunciation

Pronunciation: GLUE-kuh-gahn
Class: Glucose elevating agent

Trade Names

GlucaGen
- Powder for Injection 1 mg (1 unit)

Glucagon Emergency Kit
- Powder for Injection 1 mg (1 unit)

Glucagon Diagnostic Kit
- Powder for Injection 1 mg (1 unit)

Pharmacology

Elevates blood glucose concentrations (by stimulating production from liver glycogen stores), relaxes smooth muscle of GI tract, decreases gastric and pancreatic secretions in GI tract, and increases myocardial contractility.

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Pharmacokinetics

Absorption

Mean C max is 1,686 pg/mL (IM). Median T max is 12.5 min (IM).

Metabolism

Degraded in liver, kidney, and plasma.

Elimination

Mean apparent t 1/ 2 45 min (IM).

Onset

10 min.

Peak

30 min.

Indications and Usage

Treatment of severe hypoglycemic reactions in diabetic patients when glucose administration is not possible or during insulin shock therapy in psychiatric patients; diagnostic aid in radiologic examination of stomach, duodenum, small bowel, and colon when diminished intestinal motility would be advantageous.

GlucaGen

Treatment of severe hypoglycemic reactions that may occur in patients with diabetes treated with insulin; as a diagnostic aid during radiologic examinations to temporarily inhibit movement of the GI tract.

Unlabeled Uses

Treatment of propranolol overdose, CV emergencies, and GI disturbances associated with spasms.

Contraindications

Patients with pheochromocytoma or insulinoma; hypersensitivity to any component of the product.

Dosage and Administration

Diagnostic Aid
Adults and children

IM/IV 0.25 to 2 mg, depending on procedure and desired length of smooth muscle relaxation.

Hypoglycemia
Adults and children more than 20 kg

Subcutaneous/IM/IV 1 mg (1 unit). Do not use glucagon at concentrations above 1 mg/mL (1 unit/mL).

Children less than 20 kg

Subcutaneous/IM/IV 0.5 mg (0.5 unit) or a dose equivalent to 20 to 30 mcg/kg.

GlucaGen Adults and children weighing 25 kg or more

Subcutaneous/IM/IV 1 mg.

Children weighing less than 25 kg or younger than 8 yr of age

Subcutaneous/IM/IV 0.5 mg. Emergency assistance should be sought if patient fails to respond within 15 min after subcutaneous or IM injection of glucagon. The glucagon injection may be repeated while waiting for emergency assistance. IV glucose must be administered if patient fails to respond to glucagon. When the patient has responded, give oral carbohydrate to restore liver glycogen and prevent recurrence of hypoglycemia.

Insulin Shock Therapy
Adults

Subcutaneous/IM/IV 0.5 to 1 mg after 1 h of coma (larger doses have been used to reverse coma). Patient will usually awaken in 10 to 25 min. If no response, may repeat dose.

General Advice

  • For subcutaneous, IM, or IV administration only. Not for intradermal or intra-arterial administration.
  • Reconstitute powder for injection using only supplied diluent ( GlucaGen ); may be reconstituted with supplied diluent or with 1 mL sterile water for injection. Roll vial gently until powder is completely dissolved and is free of particles.
  • Administer solution immediately after reconstitution. Discard any unused solution. Do not save solution for future use.
  • Do not administer glucagon if particulate matter, cloudiness, or discoloration is noted or if solution shows any signs of gel formation.

Storage/Stability

Store unopened vials at controlled room temperature (68° to 77°F). Avoid freezing; protect from light.

Drug Interactions

Anticoagulants, oral

May increase hypoprothrombinemic effects, possibly with bleeding.

Laboratory Test Interactions

None well documented

Adverse Reactions

Cardiovascular

Transient increase in BP and pulse rate; positive inotropic and chronotropic effects (tachycardia).

GI

Nausea; vomiting.

Miscellaneous

Generalized allergic reactions, including urticaria, respiratory distress, and hypotension.

Precautions

Monitor

Blood sugar

Monitor fingerstick blood sugars frequently in hypoglycemic patient until the patient is asymptomatic. Notify health care provider immediately if patient has not responded within 15 min of subcutaneous or IM dose of glucagon. Be prepared to administer IV glucose.

BP and pulse

Monitor BP and pulse after administering glucagon. Transient increases are not uncommon. Notify health care provider immediately if increase in BP is dramatic or patient experiences symptoms. Be prepared to administer phentolamine to reduce BP in patient with pheochromocytoma or with coronary artery disease.


Pregnancy

Category B .

Lactation

Undetermined.

Children

Treatment of hypoglycemia

Glucagon has been shown to be safe and effective.

As diagnostic aid

Safety and efficacy not established.

Insulinoma/Pheochromocytoma

Administer cautiously to patient with history of insulinoma or pheochromocytoma.

Hypoglycemia

Glucagon is effective in treating hypoglycemia only if sufficient liver glycogen is present. Because glucagon is of little or no help in states of starvation, adrenal function impairment, or chronic hypoglycemia, treat hypoglycemia in these conditions with glucose. When using glucagon for radiologic examinations, ensure that patient is given oral carbohydrates as soon as the procedure has been completed.

Overdosage

Symptoms

Nausea, vomiting, gastric hypotonicity, diarrhea without consequential toxicity, increased BP and pulse rate.

Patient Information

  • Advise patient and family members to read the patient information leaflet before using the first time and with each refill.
  • Ensure that patient and family members understand how to store, prepare, and administer the dose of glucagon, and dispose of used equipment and supplies.
  • Ensure that patient and family members can recognize symptoms of mild hypoglycemia and know how to treat it appropriately to prevent severe hypoglycemia from developing.
  • Educate patient and family members regarding the risks of prolonged hypoglycemia and the need to arouse the hypoglycemic patient as rapidly as possible.
  • Instruct patient or family members to monitor fingerstick blood sugars frequently when treating hypoglycemia until the patient is asymptomatic. Advise family members to call 911 if patient has not responded within 15 min of injection and to administer second dose of glucagon while awaiting emergency assistance.
  • Instruct patient and family members that supplemental carbohydrates must be given as soon as the patient awakens and is able to swallow.
  • Advise patient to inform health care provider when hypoglycemic reactions occur so that the treatment regimen may be adjusted if necessary.
  • Instruct patient and family members regarding the following measures that may prevent or be used to rapidly treat hypoglycemic reactions caused by insulin: reasonable uniformity from day to day with regard to diet, insulin dose, and exercise; careful adjustment of insulin program; frequent monitoring of fingerstick blood sugars so that a change in insulin requirements can be foreseen; carrying sugar, candy, or other readily absorbable carbohydrate at all times so that it may be taken at the first warning of an oncoming hypoglycemic reaction.

Copyright © 2009 Wolters Kluwer Health.

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