GlucaGen: 7 things you should know
Medically reviewed by Carmen Fookes, BPharm. Last updated on Dec 14, 2020.
1. How it works
- GlucaGen is a brand (trade) name for glucagon, which is a hormone that helps to control blood sugar levels.
- Glucagon is produced naturally in our bodies by alpha cells, found in the islet cells of the pancreas, but is also manufactured as a medicine to treat very low blood sugar levels in diabetes. Glucagon helps stimulate the conversion of stored glycogen in the liver into glucose. This is then released into the bloodstream. It also stimulates the liver to produce more glucose from amino acid molecules and reduces how much glucose the liver needs to function so that as much glucose as possible can be released into the bloodstream. Glucagon also slows down digestion and acts on adipose (fat) tissue to increase the breakdown of fat stores into the bloodstream. Glucagon is naturally produced in the body when blood sugars become low but is also manufactured as a medicine to treat very low blood sugar levels in diabetes.
- GlucaGen helps to increase blood sugar (glucose) levels in those with severe low blood sugar levels (also called a hypoglycemic emergency) by releasing stored glucose from the liver.
- GlucaGen belongs to the class of medicines called glucose elevating agents.
- May be used to treat severe hypoglycemia (extremely low blood sugar levels) in adults and children.
- GlucaGen is used to treat severe hypoglycemic (low blood sugar) reactions which may occur in patients with diabetes mellitus treated with insulin.
- GlucaGen may be used as a diagnostic aid during radiologic examinations to temporarily inhibit movement of the gastrointestinal tract. Do not use in combination with anticholinergic agents due to the possibility of increased side effects. After the end of the diagnostic procedure, give oral carbohydrates to patients who have been fasting if not contraindicated by the diagnostic procedure.
- GlucaGen can be administered to people with suspected severe hypoglycemia who are unconscious or having a seizure.
- There does not appear to be a risk associated with using GlucaGen during pregnancy; however, studies have indicated that there is a lack of transfer of pancreatic glucagon across the placenta during early gestation. In breastfeeding infants, GlucaGen is likely to be broken down in an infant's digestive tract and is unlikely to cause harm.
- Reported to be safe and effective in children.
- The dose of GlucaGen is 1mL (1mg) for everyone over 55 pounds [25kg] or 0.5mL (0.5mg) for everyone who weighs less than 55 pounds [25kg].
- GlucaGen is available as a generic under the name glucagon.
If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:
- Nausea, vomiting, and transient tachycardia (fast heartbeat), and high blood pressure are the most common side effects reported with GlucaGen. Vomiting was the most common side effect reported in children, followed by a headache. Allergic reactions have also been reported with glucagon preparations, including anaphylactic shock and a generalized rash.
- A GlucaGen vial contains a dry powder that must be mixed with sterile water (supplied) before being administered as an injection. Ensure patients and their caregivers know how to prepare and administer GlucoGen.
- Because GlucaGen depletes glycogen stores, the patient should be given supplemental carbohydrates as soon as he/she awakens and can swallow, especially children or adolescents. Medical evaluation is recommended for all patients who experience severe hypoglycemia.
- If there is no response to GlucaGen within 15 minutes, administer a second dose of GlucaGen. After GlucaGen has been administered, call for emergency help right away. Turn the person on their side and put them in the recovery position if they are unconscious.
- GlucaGen is only effective in treating hypoglycemia if sufficient liver glycogen is present. GlucaGen may not be effective in people who are malnourished, with adrenal insufficiency, or with longstanding hypoglycemia.
- GlucaGen should not be given to people with pheochromocytoma because glucagon may stimulate the release of catecholamines (hormones such as dopamine; norepinephrine and epinephrine) from the tumor. If a person has a sudden increase in blood pressure after GlucaGen administration, consider the possibility of previously undiagnosed pheochromocytoma and administer 5 to 10 mg of phentolamine mesylate.
- Do not use in patients with insulinoma. In people with insulinoma, although GlucaGen may produce an initial increase in blood glucose, it may then directly or indirectly (through an initial rise in blood glucose) stimulate exaggerated insulin release from an insulinoma and cause hypoglycemia. If a person develops symptoms of hypoglycemia after a dose of GlucaGen, give oral or intravenous glucose.
- Has been associated with necrolytic migratory erythema (NME), a skin rash characterized by scaly, pruritic erythematous plaques, bullae, and erosions, has been reported following continuous glucagon infusion. NME resolved with discontinuation of glucagon, and treatment with corticosteroids was ineffective.
- In people with cardiac disease, be careful using GlucaGen in endoscopic or radiographic procedures to inhibit gastrointestinal motility.
Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. View complete list of side effects
- The GlucaGen kit contains a vial with dry powder that must be mixed with sterile water before being administered as an injection. Follow the instructions below on how to prepare and administer GlucoGen.
- Severe low blood sugar levels are an emergency and if you are caring for somebody with suspected hypoglycemia (low blood sugar levels) you should not leave them alone. If untreated, very low blood sugar levels can cause seizures, coma, or death.
- Symptoms of very low blood sugar include confusion, coordination difficulties, difficulty eating or drinking due to the person being confused or uncooperative, unconsciousness, or seizures.
- To administer a GlucaGen injection, first, open the GlucaGen HypoKit and take out the GlucaGen powder vial and the prefilled syringe containing sterile water. The GlucaGen powder must be mixed with the syringe of sterile water just before administration. Remove the orange plastic cap of the GlucaGen vial. Pick up the prefilled sterile water syringe in one hand and with the other hand remove the needle cover, being careful not to remove the plastic backstop from the syringe. Insert the needle into the rubber stopper of the GlucaGen vial and slowly push the plunger of the syringe down until the syringe is empty. Do NOT remove the syringe from the vial. Hold the vial and syringe together and gently shake to dissolve the powder. The powder should dissolve to form a clear liquid. Do NOT use if you can see particles in the solution or if a gel has formed. With the needle still inserted into the vial carefully turn the vial and syringe upside down, then gently pull down the plunger of the syringe to draw up all of the liquid into the syringe. With the needle still inside the vial check for any air bubbles within the syringe. If there are any air bubbles in the syringe gently tap the syringe until the bubbles rise to the top and then gently push the plunger to move the air bubbles out of the syringe and back into the vial. Draw up the correct dose of GlucaGen (1mL for everyone over 55 pounds [25kg] or 0.5mL for everyone who weighs less than 55 pounds [25kg]; see below).
- The GlucaGen dose for adults and children who weigh over 55 pounds (25kg) is 1mg (1ml). This is all of the contents of one syringe. The GlucaGen dose for a person who weighs less than 55 pounds (25kg) is 0.5mg (0.5ml). This means you need to measure out the correct dose by gently pushing the plunger down until it is on the 0.5ml mark on the syringe.
- Once you have drawn up the correct dose, remove the syringe from the vial. Choose the site where you will be giving the injection and roll away clothing to expose skin. The injection site can be the upper outer arm, thigh, or buttocks. Gently pinch the skin to form a bump, then insert the needle into the person’s skin and push the plunger down until the syringe is empty. Once the syringe is empty pull the needle out of the skin.
- After a GlucaGen injection, put the person in the recovery position (roll them onto their side) if they are unconscious to prevent choking, as they may vomit. Call for emergency help. After having an episode of very low blood sugar levels it is important that the patient has medical attention afterward, even if the patient seems well. Once the patient has woken up and can swallow, the patient should eat something that is a fast-acting source of sugar and a long-acting source of sugar.
- Each GlucaGen vial contains 1mg glucagon for injection as a powder that must be mixed with the sterile water for injection provided in the kit.
- GlucaGen should be administered as soon as severe hypoglycemia (low blood sugar levels) are recognized. After you have administered a dose of GlucaGen you should call for emergency help right away. Turn the person on their side and put them in the recovery position if they are unconscious.
- If the person does not respond within 15 minutes give them another dose of GlucaGen if available.
- Encourage the person to eat as soon as they can and can swallow safely. Initially give them a fast-acting source of sugar, such as juice, then a snack such as cheese and crackers or peanut butter.
- Throw away the used GlucaGen syringe. Arrange for a replacement GlucaGen kit as soon as possible.
- Signs and symptoms of hypoglycemia come on quickly and may include shaking, dizziness, anxiety or nervousness, confusion, irritability or impatience, sweating, chills and clamminess, fast heartbeat, hunger, headache, seizures, or unconsciousness.
- Tell your family, friends, and work colleagues that you have diabetes and explain what they should do if you develop severe hypoglycemia. Show them where you keep your GlucaGen kit and how to use it. Explain to them that hypoglycemia needs to be treated as quickly as possible because having low blood sugar levels for too long can cause seizures, coma, or death.
- Keep your GlucaGen Hypokit package for up to 24 months at controlled room temperature 20C to 25C (68F to 77F) before reconstitution. Do not freeze. Keep in the original package to protect from light. GlucaGen should not be used after the expiry date on the vials. Administer reconstituted GlucaGen immediately unless the solution shows gel or particle formation. Discard any unused portion.
- Tell your doctor about any medications you take and if you have any medical conditions such as kidney problems, pancreas problems, glucagonomas (insulin-producing tumors), have not had food or water for a long time (prolonged fasting or starvation), have low blood sugar that does not go away (chronic hypoglycemia), have heart problems, or are planning to have a family in the future.
6. Response and Effectiveness
- One injection of GlucaGen given either IM or IV lasts 60 to 90 minutes.
- GlucaGen starts working within 10 minutes of injection, with peak levels being reached 30 minutes after administration after IM or IV administration. Maximal concentrations are reached 30 to 45 minutes after SC injection.
- In clinical trials, 100% of people with severe hypoglycemia (low blood sugar levels) treated with glucagon responded within 30 minutes.
- A dose of GlucaGen should always be followed up with a fast-acting source of sugar (eg fruit juice, glucose gel) and a snack or small meal such as crackers with cheese or peanut butter because the effects of GlucaGen will start to wear off after at least 90 minutes. Seek emergency assistance immediately after subcutaneous or intramuscular injection of glucagon.
Medicines that interact with GlucaGen may either decrease its effect, affect how long it works for, increase side effects, or have less of an effect when taken with GlucaGen. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.
Common medications that may interact with GlucaGen include:
- anticholinergics, such as benztropine (increased gastrointestinal side effects)
- beta-blockers, such as atenolol, propranolol, sotalol, or timolol (may cause a short-term increase in blood pressure and pulse)
- indomethacin (may interfere with GlucaGen's ability to raise blood sugar levels and may cause hypoglycemia)
- insulin Has the opposite effect to GlucaGen)
- warfarin (may increase the anticoagulant effect).
Note that this list is not all-inclusive and includes only common medications that may interact with GlucaGen. You should refer to the prescribing information for GlucaGen for a complete list of interactions.
- GlucaGen (glucagon) Updated 11/2020. Novo Nordisk https://www.drugs.com/mtm/glucagen-injection.html
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use GlucaGen only for the indication prescribed.
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