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Pharmacologic class: Antihypoglycemic
Therapeutic class: Insulin antagonist
Pregnancy risk category B
Increases blood glucose concentration by converting glycogen in liver to glucose. Also relaxes GI smooth muscle.
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
• Hypersensitivity to drug
Use cautiously in:
• cardiac disease, adrenal insufficiency, chronic hypoglycemia
• history suggesting insulinoma or pheochromocytoma
• elderly patients
• pregnant or breastfeeding patients.
☞ 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.
GI: nausea, vomiting
Metabolic: hypokalemia (with overdose)
Respiratory: bronchospasm, respiratory distress
Skin: urticaria, rash
Drug-drug.Anticoagulants: enhanced anticoagulant effect
Drug-diagnostic tests.Potassium: decreased level
• Monitor blood glucose level.
• Monitor patient for aspiration.
• Assess blood pressure, electrolyte levels, and respiratory status.
• 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.
- Beta blockers,
- Calcium channel blockers.
|IM (hyperglycemic action)||within 10 min||30 min||12–27 min|
|IV (hyperglycemic action)||1 min||5 min||9–17min|
|Subcut (hyperglycemic action)||within 10 min||30–45 min||60–90 min|
|IV (effect on GI musculature)||45 sec (for 0.25–2-mg dose)||unknown||9–17 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)||unknown||9–27 min (1-mg dose); 21–32 min (2-mg dose)|
Adverse Reactions/Side Effects
- nausea (most frequent)
- vomiting (most frequent)
- hypersensitivity reactions including anaphylaxis (life-threatening)
Drug-Drug interactionLarge 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.
- 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 DiagnosesRisk for injury (Indications)
Noncompliance (Patient/Family Teaching)
- 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.
- 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.
- 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.
- 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.