Brand Name
GlucaGen, Glucagon Diagnostic Kit, Glucagon Emergency Kit
Class and Category
Chemical class: Synthetic hormone
Therapeutic class: Antihypoglycemic, diagnostic aid
adjunct
Pregnancy category: B
Indications and Dosages
To provide emergency treatment of severe hypoglycemia
I.V., I.M., OR SUBCUTANEOUS INJECTION
Adults and children weighing more than 20 kg (44 lb) or, with
GlucaGen, more than 25 kg (55 lb). 1 mg, repeated in 15 min if needed.
Children weighing 20 kg or less or, with GlucaGen, 25 kg or less. 0.5 mg, or
0.02 to 0.03 mg/kg, repeated in 15 min, if needed.
To provide diagnostic assistance by inhibiting bowel
peristalsis in radiologic examination of GI tract
I.V. INJECTION
Adults. 0.25 to 2 mg before procedure. Dose, route, and timing vary with
segment of GI tract examined and length of procedure.
Route Onset
Peak Duration
I.V. 5–20
Unknown 90 min
I.M. 15–26
Unknown 90 min
SubQ 30–45
Unknown 90 min
Mechanism of Action
Increases production of adenylate cyclase, which catalyzes
conversion of adenosine triphosphate to cAMP, a process that in turn activates
phosphorylase. Phosphorylase promotes breakdown of glycogen to glucose
(glycogenolysis) in the liver. As a result, blood glucose level increases and
GI smooth muscles relax.
Incompatibilities
Don’t mix glucagon with sodium chloride or solutions that have a
pH of 3.0 to 9.5; use with dextrose solutions instead.
Contraindications
Hypersensitivity to glucagon or its components, pheochromocytoma
Interactions
DRUGS
oral anticoagulants: Possibly increased anticoagulant effects
Adverse Reactions
CV: Hypertension, hypotension (with hypersensitivity reaction),
tachycardia
GI: Nausea, vomiting
RESP: Bronchospasm, respiratory distress
SKIN: Urticaria
Nursing Considerations
• Rouse patient as quickly as possible because prolonged
hypoglycemia can cause cerebral damage.
• For I.V. use, reconstitute 1-mg vial of glucagon with 1 ml of
diluent or 10-mg vial with 10 ml of diluent. Don’t give more than 1 mg/ml. For
large doses, dilute with sterile water for injection.
• Before injecting glucagon, place unconscious patient on his side
to prevent aspiration of vomitus when he regains consciousness.
• Administer by slow I.V. injection to decrease risk of adverse
reactions, such as tachycardia and vomiting.
• If patient doesn’t respond to glucagon, expect to give I.V.
dextrose.
•When patient is conscious or diagnostic procedure is completed,
give oral carbohydrates to restore hepatic glycogen stores and prevent
secondary hypoglycemia.
• Keep in mind that glucagon isn’t effective in patients with
depleted hepatic glycogen stores caused by such conditions as adrenal insufficiency,
chronic hypoglycemia, and starvation.
PATIENT TEACHING
• Instruct patient to monitor blood glucose level, especially with
signs of hypoglycemia.
•
Teach patient and family members how to recognize signs of hypoglycemia and
when to notify prescriber.
•
Advise patient to carry candy or other simple sugars to treat early
hypoglycemia.
•
Emphasize importance of a consistent diet, regular exercise, and proper use of insulin
or oral antidiabetic drug.
•Make
sure unstable diabetic patients and family members know how to give glucagon
subcutaneously in case of hypoglycemia. Instruct family members to keep patient
on his side and give him a carbohydrate when he awakens. Advise against giving
fluids by mouth until patient is fully conscious.
•
Instruct patient and family members to call for emergency medical assistance
after glucagon treatment, especially if patient can’t ingest oral glucose or if
he’s taking the sulfonylurea chlorpropamide, in case secondary hypoglycemia
occurs.
