GLUCAGON

GLUCAGON
(gloo'ka-gon)
GlucaGen
Classifications: hormone; antihypoglycemic agent;
Therapeutic:antihypoglycemic
; diagnostic test aid
Pregnancy Category: B

Availability

1 mg powder for injection

Action

Recombinant glucagon identical to glucagon produced by alpha cells of islets of Langerhans. Stimulates uptake of amino acids and their conversion to glucose precursors. Promotes lipolysis in liver and adipose tissue with release of free fatty acid and glycerol, which further stimulates ketogenesis and hepatic gluconeogenesis. Action in hypoglycemia relies on presence of adequate liver glycogen stores.

Therapeutic Effect

Increases blood glucose secondary to gluconeogenesis, the breakdown of glycogen to glucose in the liver.

Uses

Emergency treatment of severe hypoglycemic reactions in diabetic patients who are unconscious or unable to swallow food or liquids and in psychiatric patients receiving insulin shock therapy. Also radiologic studies of GI tract to relax smooth muscle and thereby allow finer detail of mucosa; to diagnose insulinoma.

Unlabeled Uses

GI disturbances associated with spasm, cardiovascular emergencies, and to overcome cardiotoxic effects of beta blockers, quinidine, tricyclic antidepressants; as an aid in abdominal imaging.

Contraindications

Hypersensitivity to glucagon or protein compounds; depleted glycogen stores in liver; insulinemia; pheochromocytoma.

Cautious Use

Cardiac disease, CAD; pregnancy (category B), lactation.

Route & Dosage

Hypoglycemia
Adult: IM/IV/SC 1 mg, may repeat q5–20min if no response for 1–2 more doses
Child: IM/IV/SC >20 kg, 1 mg; <20 kg, 20–30 mcg/kg (max: 1 mg/dose), may repeat q5–20min if no response for 1–2 more doses

Insulin Shock Therapy
Adult: IM/IV/SC 1 mg usually 1 h after coma develops, may repeat in 25 min if no response

Diagnostic Aid to Relax Stomach or Upper GI Tract
Adult: IM/IV 0.25–2 mg 10 min before procedure

Diagnostic Aid for Colon Exam
Adult: IM/IV 2 mg 10 min before procedure

Administration

Note: 1 mg = 1 unit

Subcutaneous/Intramuscular
  • Dilute 1 unit (1 mg) of glucagon with 1 mL of diluent supplied by manufacturer.
  • Use immediately after reconstitution of dry powder. Discard any unused portion.
  • Note: Glucagon is incompatible in syringe with any other drug.
Intravenous

PREPARE: Direct: Prepare as noted above. Do not use a concentration >1 unit/mL.  

ADMINISTER: Direct: Give 1 unit or fraction thereof over 1 min. May be given through a Y-site D5W (not NS) infusing.  

INCOMPATIBILITIES Solution/additive: Sodium chloride.

  • Store unreconstituted vials and diluent at 20°–25° C (68°–77° F).

Adverse Effects (≥1%)

GI: Nausea and vomiting. Body as a Whole: Hypersensitivity reactions. Skin: Stevens-Johnson syndrome (erythema multiforme). Metabolic: Hyperglycemia, hypokalemia.

Interactions

Drug: May enhance effect of oral anticoagulants.

Pharmacokinetics

Onset: 5–20 min. Peak: 30 min. Duration: 1–1.5 h. Metabolism: In liver, plasma, and kidneys. Half-Life: 3–10 min.

Nursing Implications

Assessment & Drug Effects

  • Be prepared to give IV glucose if patient fails to respond to glucagon. Notify physician immediately.
  • Note: Patient usually awakens from (diabetic) hypoglycemic coma 5–20 min after glucagon injection. Give PO carbohydrate as soon as possible after patient regains consciousness.
  • Note: After recovery from hypoglycemic reaction, symptoms such as headache, nausea, and weakness may persist.

Patient & Family Education

  • Note: Physician may request that a responsible family member be taught how to administer glucagon SC or IM for patients with frequent or severe hypoglycemic reactions. Notify physician promptly whenever a hypoglycemic reaction occurs so the reason for the reaction can be determined.
  • Review package insert and directions (see ADMINISTRATION).

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

(2356)
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