Glucagen


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Related to Glucagen: glucagon, Glucogen

glucagon

GlucaGen

Pharmacologic class: Antihypoglycemic

Therapeutic class: Insulin antagonist

Pregnancy risk category B

Action

Increases blood glucose concentration by converting glycogen in liver to glucose. Also relaxes GI smooth muscle.

Availability

Powder for injection: 1-mg vials

Indications and dosages

Severe hypoglycemia

Adults and children weighing more than 20 kg (44 lb): 1 mg subcutaneously, I.M., or I.V.

Children weighing 20 kg (44 lb) or less: 20 to 30 mcg/kg or 0.5-mg dose subcutaneously, I.M., or I.V.

Diagnostic aid for radiologic examination

Adults: 0.25 to 2 mg I.V. or 1 to 2 mg I.M. before radiologic procedure

Contraindications

• Hypersensitivity to drug
• Pheochromocytoma

Precautions

Use cautiously in:
• cardiac disease, adrenal insufficiency, chronic hypoglycemia
• history suggesting insulinoma or pheochromocytoma
• elderly patients
• pregnant or breastfeeding patients.

Administration

Use only in hypoglycemic emergencies for patients with diabetes mellitus.
• Mix drug in 1-mg vial with 1 ml of diluent supplied by manufacturer.
• For I.V. injection, give 1 mg over 1 minute.
• Use drug immediately after preparing; discard unused portion.

Patient should respond within 15 minutes. Because of potential serious adverse reactions linked to prolonged cerebral hypoglycemia, give I.V. glucose if patient fails to respond to glucagon.
• Give patient carbohydrate-rich foods as soon as he's alert.
• Dilute diagnostic aid doses above 2 mg with sterile water for injection.

Adverse reactions

CV: hypotension

GI: nausea, vomiting

Metabolic: hypokalemia (with overdose)

Respiratory: bronchospasm, respiratory distress

Skin: urticaria, rash

Interactions

Drug-drug.Anticoagulants: enhanced anticoagulant effect

Drug-diagnostic tests.Potassium: decreased level

Patient monitoring

• Monitor blood glucose level.
• Monitor patient for aspiration.
• Assess blood pressure, electrolyte levels, and respiratory status.

Patient teaching

• Teach patient and family members the proper technique and timing for using this emergency drug.

Emphasize importance of contacting prescriber right away if hypoglycemic emergency occurs.

Tell caregiver or family member to arouse patient immediately and give additional carbohydrate by mouth as soon as patient can tolerate it.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.

glucagon

(gloo-ka-gon) ,

GlucaGen

(trade name)

Classification

Therapeutic: hormones
Pharmacologic: pancreatics
Pregnancy Category: B

Indications

Acute management of severe hypoglycemia when administration of glucose is not feasible.Facilitation of radiographic examination of the GI tract.Antidote to:
  • Beta blockers,
  • Calcium channel blockers.

Action

Stimulates hepatic production of glucose from glycogen stores (glycogenolysis).
Relaxes the musculature of the GI tract (stomach, duodenum, small bowel, and colon), temporarily inhibiting movement.
Has positive inotropic and chronotropic effects.

Therapeutic effects

Increase in blood glucose.
Relaxation of GI musculature, facilitating radiographic examination.

Pharmacokinetics

Absorption: Well absorbed following IM and subcut administration.
Distribution: Unknown.
Metabolism and Excretion: Extensively metabolized by the liver, plasma, and kidneys.
Half-life: 8–18 min.

Time/action profile

ROUTEONSETPEAKDURATION
IM (hyperglycemic action)within 10 min 30 min12–27 min
IV (hyperglycemic action)1 min5 min9–17min
Subcut (hyperglycemic action)within 10 min 30–45 min60–90 min
IV (effect on GI musculature)45 sec (for 0.25–2-mg dose)unknown9–17 min (0.25–0.5-mg dose); 22–25 min (2-mg dose)
IM (effect on GI musculature)8–10 min (1-mg dose); 4–7 min (2-mg dose) unknown9–27 min (1-mg dose); 21–32 min (2-mg dose)

Contraindications/Precautions

Contraindicated in: Hypersensitivity;Pheochromocytoma;Some products contain glycerin and phenol—avoid use in patients with hypersensitivities to these ingredients.
Use Cautiously in: History suggestive of insulinoma or pheochromocytoma;Prolonged fasting, starvation, adrenal insufficiency or chronic hypoglycemia (low levels of releasable glucose);When used to inhibit GI motility, use cautiously in geriatric patient with cardiac disease or diabetics; Obstetric: Should be used during pregnancy only if clearly needed; Lactation: Safety not established.

Adverse Reactions/Side Effects

Cardiovascular

  • hypotension

Gastrointestinal

  • nausea (most frequent)
  • vomiting (most frequent)

Miscellaneous

  • hypersensitivity reactions including anaphylaxis (life-threatening)

Interactions

Drug-Drug interaction

Large doses may enhance the effect of warfarin.Negates the response to insulin or oral hypoglycemic agents.Phenytoin inhibits the stimulant effect of glucagon on insulin release.Hyperglycemic effect is intensified and prolonged by epinephrine.Patients on concurrent beta blocker therapy may have a greater increase in heart rate and BP.

Route/Dosage

Hypoglycemia
Intravenous Intramuscular Subcutaneous (Adults and Children ≥20 kg) 1 mg; may be repeated in 15 min if necessary.
Intravenous Intramuscular Subcutaneous (Children <20 kg ) 0.5 mg or 0.02–0.03 mg/kg; may be repeated in 15 min if necessary.
Radiographic Examination of the GI Tract
Intramuscular Intravenous (Adults) 0.25–2 mg; depending on location and duration of examination (0.5 mg IV or 2 mg IM for relaxation of stomach; for examination of the colon 2 mg IM 10 min before procedure).
Antidote (unlabeled)
Intravenous (Adults) To beta blockers—50–150 mcg (0.05–0.15 mg)/kg, followed by 1–5 mg/hr infusion. To calcium channel blockers—2 mg; additional doses determined by response.

Availability

Powder for injection: 1-mg (equivalent to 1 unit) vials as an emergency kit for low blood glucose and a diagnostic kit

Nursing implications

Nursing assessment

  • Assess for signs of hypoglycemia (sweating, hunger, weakness, headache, dizziness, tremor, irritability, tachycardia, anxiety) prior to and periodically during therapy.
  • Assess neurologic status throughout therapy. Institute safety precautions to protect patient from injury caused by seizures, falling, or aspiration. For insulin shock therapy, 0.5–1 mg is administered after 1 hr of coma; patient usually awakens in 10–25 min. If no response occurs, repeat the dose. Feed patient supplemental carbohydrates orally to replenish liver glycogen and prevent secondary hypoglycemia as soon as possible after awakening, especially pediatric patients.
  • Assess nutritional status. Patients who lack liver glycogen stores (starvation, chronic hypoglycemia, adrenal insufficiency) will require glucose instead of glucagon.
  • Assess for nausea and vomiting after administration of dose. Protect patients with depressed level of consciousness from aspiration by positioning on side; ensure that a suction unit is available. Notify health care professional if vomiting occurs; patient will require parenteral glucose to prevent recurrent hypoglycemia.
  • Lab Test Considerations: Monitor serum glucose levels throughout episode, during treatment, and for 3–4 hr after patient regains consciousness. Use of bedside fingerstick blood glucose determination methods is recommended for rapid results. Follow-up lab results may be ordered to validate fingerstick values, but do not delay treatment while awaiting lab results, as this could result in neurologic injury or death.
    • Large doses of glucagon may cause a ↓ in serum potassium concentrations.

Potential Nursing Diagnoses

Risk for injury (Indications)
Noncompliance (Patient/Family Teaching)

Implementation

  • May be given subcut, IM, or IV. Reconstitute with diluent supplied in kit by manufacturer. Inspect solution prior to use; use only clear, water-like solution. Solution is stable for 48 hr if refrigerated, 24 hr at room temperature. Unmixed medication should be stored at room temperature.
    • Administer supplemental carbohydrates IV or orally to facilitate increase of serum glucose levels.
  • Intravenous Administration
  • pH: 2.5–3.5.
  • Diluent: Reconstitute each vial with 1 mL of an appropriate diluent. For doses ≤2 mg, use diluent provided by manufacturer. For doses >2 mg, use sterile water for injection instead of diluent supplied by manufacturer to minimize risk of thrombophlebitis, CNS toxicity, and myocardial depression from phenol preservative in diluent supplied by manufacturer. Reconstituted vials should be used immediately.Concentration: Not exceed 1 mg/mL.
  • Rate: Administer at a rate not exceeding 1 mg/min. May be administered through IV line containing D5W.
  • Continuous Infusion: Diluent: Reconstitute vials as per directions above (use sterile water for injection). Further dilute 10 mg of glucagon in 100 mL of D5W.Concentration: 0.1 mg/mL.
  • Rate: See Route/Dosage section.
  • Y-Site Compatibility: No information available.

Patient/Family Teaching

  • Teach patient and family signs and symptoms of hypoglycemia. Instruct patient to take oral glucose as soon as symptoms of hypoglycemia occur—glucagon is reserved for episodes when patient is unable to swallow because of decreased level of consciousness.
  • Home Care Issues: Instruct family on correct technique to prepare, draw up, and administer injection. Health care professional must be contacted immediately after each dose for orders regarding further therapy or adjustment of insulin dose or diet.
  • Advise family that patient should receive oral glucose when alertness returns.
  • Instruct family to position patient on side until fully alert. Explain that glucagon may cause nausea and vomiting. Aspiration may occur if patient vomits while lying on back.
  • Instruct patient to check expiration date monthly and to replace outdated medication immediately.
  • Review hypoglycemic medication regimen, diet, and exercise programs.
  • Patients with diabetes mellitus should carry a source of sugar (such as a packet of sugar or candy) and identification describing disease process and treatment regimen at all times.

Evaluation/Desired Outcomes

  • Increase of serum glucose to normal levels with improved level of consciousness.
  • Smooth muscle relaxation of the stomach, duodenum, and small and large intestine in patients undergoing radiologic examination of the GI tract.

Glucagen

A brand name for GLUCAGON.
Mentioned in ?
References in periodicals archive ?
GlucaGen is used to treat severe hypoglycemic (low blood sugar) reactions which may occur in patients with diabetes treated with insulin.
GlucaGen is the Novo Nordisk brand name for recombinant biosynthetic glucagon.
In the treatment of severe hypoglycemia in people living with insulin- dependent diabetes, GlucaGen raises blood glucose by promoting the release of glucose from glycogen stores in the liver.
said "We believe the agreement we have reached with Ben Venue reflects our best opportunity to achieve the full marketing potential of GlucaGen in the US.
The recombinant form of GlucaGen is chemically identical to human glucagon.