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Glucagon

Classification

Pancreatic hormone and insulin antagonist

Indications

FR: Confirmed hypoglycemia where patient mentation is unable to safely support administration of oral glucose

⚠️ EMR: requires completion of scope expansion education. Confirmed hypoglycemia where patient mentation is unable to safely support administration of oral glucose

PCP: confirmed hypoglycemia where IV access is unavailable and patient mentation unable to safely support administration of oral glucose

Contraindications

Intranasal glucagon is contraindicated in patients under 4 years of age
Hypersensitivity
Pheochromocytoma
Insulinoma

Adult dosages

⚠️ EMR: Requires completion of scope expansion education.

Suspected or confirmed hypoglycemia where patient mentation is insufficient to safely support administration of oral glucose
- 3 mg IN or 1 mg IM (choice will depend upon availability of product pending changeover)
- If no clinical response within 15 minutes is seen following the first dose, consider administration of second 3 mg intranasal dose. ☎️ CliniCall consultation is required prior to administration of second dose.

Pediatric Considerations And Dosing

⚠️ EMR: Requires completion of scope expansion education.

Suspected or confirmed hypoglycemia where patient mentation is insufficient to safely support administration of oral glucose
- 3 mg IN or 1 mg IM (choice will depend upon availability of product pending changeover)
- If no clinical response within 15 minutes is seen following the first dose, consider administration of second 3 mg intranasal dose. ☎️ CliniCall consultation is required prior to administration of second dose.

Mechanism Of Action

Glucagon accelerates the conversion of glycogen to glucose in the liver, elevating blood glucose levels. It is only effective in treating hypoglycemia if liver glycogen is available.

Pharmacokinetics

Onset: 15 minutes
Peak: 15 minutes
Duration: 90 minutes

Adverse Effects

Nausea and vomiting can be common
Possible transient increase in blood pressure and heart rate

Overdose

Excessive parenteral administration of glucagon can cause nausea, vomiting, and diarrhea. Ingestion of glucagon is unlikely to result in symptoms as it is rapidly broken down in the gastrointestinal tract.

Warning And Precautions

Glucagon must be reconstituted with the supplied diluent. Do not attempt to reconstitute or administer with normal saline.
In patients with pheochromocytoma, glucagon can cause a release of catecholamines that leads to significant hypertension and tachycardia and may provoke an intracerebral hemorrhage.

Drug Interactions

Hypoglycemia produced by excessive alcohol consumption is unlikely to be reversible with glucagon.