What to know about GlucaGen (glucagon)

GlucaGen (glucagon) is an injectable prescription medicine used to treat very low blood sugar or hypoglycemia in people with diabetes when there are no other options. It works by triggering the liver to release stored sugar, raising blood sugar levels.

Unlike sugar (glucose or dextrose), GlucaGen can be injected directly into the muscle, making it easy to use in an emergency. It may be provided by a trained home caregiver, emergency responder, or health care provider.

Glucagon is also used in certain diagnostic imaging and off-label treatment of overdose of two classes of cardiac drugs.

use

Glucagon is part of a class of drugs called hormonal agents, which are natural or synthetic forms of hormones.

The U.S. Food and Drug Administration (FDA) has approved glucagon for two uses:

  • Emergency management of severe hypoglycemia in adults and children with diabetes
  • As a diagnostic aid in imaging studies, especially computed tomography (CT) scans and magnetic resonance imaging (MRI) of the gastrointestinal (GI) tract

severe hypoglycemia

Hypoglycemia is a potentially life-threatening medical emergency, most commonly in people with insulin-dependent diabetes. Patients with this condition manage their blood sugar through a combination of insulin injections and diet. It’s easy to accidentally push your blood sugar too low, leading to emergency hypoglycemia.

In general, severe hypoglycemia is defined as a blood glucose measurement of 70 milligrams per deciliter (mg/dL) or 3.9 millimoles per liter (mmol/L) or less. This is associated with confusion or coma.

The preferred treatment for hypoglycemia is to increase the patient’s blood sugar by consuming carbohydrates. In other words, eat sugar.

Because low blood sugar can cause confusion and, in some severe cases, loss of consciousness, they may not be able to eat anything. In this case, only injectable glucagon or glucagon nasal spray can help.

Emergency healthcare providers (paramedics, emergency nurses, and emergency physicians) may administer intravenous glucose as a rescue medication for patients with hypoglycemia. But without medical training, patients or family members cannot use glucose.

Previously, only orally ingested glucose was available to patients and lay rescuers without the help of a healthcare provider. Oral glucose is just one carbohydrate, and almost any carbohydrate will do. Patients usually respond well to frozen fruit juice concentrates or other simple sugars as emergency treatment for mild hypoglycemia.

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GlucaGen enables health professionals and others to treat severe cases of hypoglycemia without active patient involvement.

The American Diabetes Association (ADA) says that all individuals at increased risk for grade 2 or 3 hypoglycemia should be prescribed glucagon for use when needed. Grade 2 hypoglycemia was defined as blood glucose <54 mg/dL (3.0 mmol/L); grade 3 hypoglycemia was defined as a serious event requiring assistance with altered mental and/or physical functioning.

diagnostic imaging

Glucagon is used in some imaging procedures along with MRI or CT scans to see stomach function.

Glucagon relaxes the smooth muscle of the gastrointestinal tract and temporarily stops bowel movements so that clear images can be taken.

Off-label use

High doses of glucagon are often used to treat an overdose of beta-blockers and calcium channel blockers — both of which are heart medications. The role of glucagon in this, if not fully understood, is well documented.

Glucagon improves heart rate and blood pressure in patients taking too many beta-blockers or calcium channel blockers.

In these cases, glucagon is short-acting and may need to be administered as an infusion (intravenous infusion) to maintain any substantial change in cardiac output.

Before taking

Glucagon is primarily used as an emergency medication used during severe hypoglycemia episodes. Glucagon emergency kits and training in use can be provided to caregivers of patients at risk for severe hypoglycemia.

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Precautions and contraindications

Some patients should not receive GlucaGen due to medical history. However, severe hypoglycemia is a serious condition that requires prompt treatment.

If the patient cannot communicate with rescue personnel and their medical history is unknown, glucagon can be given as part of the usual treatment regimen.

If known, the following will prevent patients from getting GlucaGen:

  • Adrenal tumors: Patients with a history of pheochromocytoma may have a severe hypertensive (hypertension) reaction to glucagon administration.
  • Pancreatic tumors: Patients with a history of insulinoma or glucagonoma may develop secondary hypoglycemia from glucagon use.
  • Known Allergy: The patient may be allergic to glucagon and have an allergic reaction to the drug.
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Glucagon is only effective in patients with glycogen stores in the liver and muscle. If the patient’s glycogen stores are depleted, glucagon is ineffective.

If hypoglycemia is caused by alcohol, glucagon may not be useful because alcohol impairs the glycogen stores that glucagon needs to work.

Glucagon may cause a temporary increase in heart rate and blood pressure. It is because of this side effect that glucagon is used in cases of beta-blocker or calcium channel blocker overdose.

Other hormone preparations

Insulin is the most commonly used hormonal agent and a hormone naturally secreted by the pancreas to control blood sugar. Normally, insulin works in the opposite way to glucagon and lowers blood sugar. Glucagon increases it.

Epinephrine, norepinephrine, and dopamine are other examples of hormonal drugs. All of these are used in emergency situations to treat various metabolic and cardiac diseases.

dose

The initial dose for emergency hypoglycemia in adults is 1 milligram (mg) administered intravenously (IV), intramuscularly (IM) or subcutaneously (SQ). There is also a new intranasal formulation, Baqsimi (glucagon), ready-to-use.

If no improvement is seen within 15 minutes, the initial dose may be repeated once. Further repeated administration of hypoglycemia in adults may not be effective and other emergency treatment should be tried, usually intravenous dextrose.

Children weighing less than 25 kilograms (kg) (about 55 pounds) may receive 0.5 mg IV, IM, or SQ for severe hypoglycemia. This dose can be repeated once.

How to take and store

Glucagon is supplied in powder form in 1 mg vials and must be reconstituted with Sterile Water for Injection. In emergency kit form, glucagon is provided with a second vial filled with sterile water.

Sterile water is introduced into the vial containing the glucagon powder and the mixture is stirred (gently shaken) to produce an injectable solution. The solution is then drawn into a syringe for injection.

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Any reconstituted glucagon must be administered immediately or discarded.

Once glucagon is given and the patient’s level of consciousness increases, the patient should consume some form of complex carbohydrate to maintain blood sugar levels. Without food, the effect of glucagon is temporary, and the patient is likely to quickly return to a hypoglycemic state.

Glucagon should be stored at room temperature and out of direct sunlight.

side effect

Glucagon causes intestinal motility to slow down, which simply means it slows or stops the churning that occurs in the esophagus, stomach, and intestines. That’s why glucagon is used for GI imaging, but it can cause GI discomfort.

Common

Common side effects of glucagon include:

  • nausea
  • Vomit
  • headache
  • irritation or pain at the injection site
  • energy shortage
  • pale complexion
  • diarrhea
  • drowsiness

Nausea is the most common side effect of glucagon, sometimes causing vomiting.

For patients receiving glucagon on imaging tests, when the effects of glucagon wear off, hypoglycemia may result an hour or two after administration. People usually give juice or cookies after the test to prevent this from happening.

serious

Rare side effects of glucagon include:

  • Necrotizing erythema migratory (NME): This rash may be caused by prolonged continuous infusion of glucagon. Although usually associated with the pancreatic cancer glucagonoma described above, in this case the rash was not associated with the cancer.
  • allergic reaction
  • anxiety
  • stomach ache
  • Changes in heart rate or blood pressure, especially that cause the heart rate to increase

Warning and Interaction

The most clinically significant interaction between glucagon and another drug is with Indocin (indomethacin), which is used to treat certain headache disorders.

Indomethacin blocks the effect of glucagon on blood sugar, which would affect its usefulness in emergency situations. Although rare and less well known, glucagon may also increase bleeding in patients on blood thinners, especially coumarin (warfarin).

Consult your healthcare provider if you are taking these medicines.