Glucagon

Emergency Treatment for Low Blood Sugar

Glucagon is primarily used to treat severe hypoglycemia (very low blood sugar) in people with diabetes who use insulin. It is intended for emergency situations where the person cannot safely consume sugar by mouth. This may occur if the person:

• Is unconscious or unresponsive.
• Is having a seizure.
• Is too confused or disoriented to swallow food or drink safely.

In these emergencies, glucagon works by prompting the liver to release stored glucose into the bloodstream to quickly raise blood sugar levels.

Diagnostic Use

Healthcare providers also use glucagon during certain radiologic (X-ray) or imaging examinations of the gastrointestinal tract, including the stomach, small intestine, and colon. During these procedures, the medication is used to:

• Temporarily slow or stop the natural muscle contractions and movement of the digestive system.
• Provide a clearer, more stable view of the organs for the medical professional performing the exam.

Raising Blood Sugar

Glucagon is a hormone naturally produced by the pancreas. Its primary function is to prevent blood sugar levels from dropping too low. When blood sugar levels fall significantly, glucagon works by:

• Stimulating the liver to convert stored energy, known as glycogen, back into glucose.
• Releasing that glucose into the bloodstream to provide immediate energy.

This process helps restore blood sugar to a safe level during a severe hypoglycemic event, particularly when a person is unconscious or unable to swallow food or drinks containing sugar.

Digestive System Effects

Glucagon also acts on the muscles of the digestive system. It can temporarily slow down or stop the movement of the stomach and intestines. Because of this effect, healthcare providers may use it during certain medical imaging tests to get a clearer view of the digestive tract.

Common Side Effects

The most frequent side effects of glucagon include nausea and vomiting. Other common side effects may vary depending on whether the medication is injected or administered as a nasal powder.

Injection side effects:

• Headache
• Redness, swelling, or itching at the injection site

Nasal powder side effects:

• Runny or stuffy nose
• Watery, itchy, or red eyes
• Itchy nose or throat
• Cough
• Headache

Serious Side Effects

Serious side effects are rare but require immediate medical attention. Seek emergency help if you experience symptoms of a severe allergic reaction, such as:

• Rash or hives
• Swelling of the face, lips, tongue, or throat
• Difficulty breathing or swallowing

Other serious side effects can include a very fast or irregular heartbeat and temporary but significant changes in blood pressure. If the person treated with glucagon does not wake up or is unable to swallow after the dose, they must receive professional medical assistance immediately.

Contraindications

Glucagon is contraindicated in individuals with certain medical conditions, including:

• Pheochromocytoma: Glucagon may stimulate the release of catecholamines from the tumor, which can cause a sudden and dangerous increase in blood pressure.
• Insulinoma: In people with an insulin-secreting tumor, glucagon can stimulate an exaggerated insulin response, leading to severe hypoglycemia (low blood sugar).
• Glucagonoma: Similar to insulinoma, glucagon may trigger a secondary drop in blood sugar in those with this type of tumor.
• Hypersensitivity: Individuals with a known history of severe allergic reactions to glucagon or any of its ingredients should avoid use.

Hypersensitivity and Allergic Reactions

Serious allergic reactions, including anaphylaxis, generalized rash, and respiratory distress, have been reported with the use of glucagon. Emergency medical help is necessary if these symptoms occur.

Factors Affecting Effectiveness

Glucagon is only effective if there are sufficient glycogen stores in the liver. It may not work effectively in individuals who are in a state of starvation, have adrenal insufficiency, or have chronic hypoglycemia. Additionally, glucagon may be less effective if the person has consumed a significant amount of alcohol, as alcohol inhibits the liver's ability to release glucose.

Necrolytic Migratory Erythema (NME)

NME, a skin condition characterized by migrating red, blistering rashes, has been reported in cases of continuous glucagon infusion. The condition typically resolves after the infusion is stopped.

Cardiovascular Effects

Glucagon may cause a temporary increase in heart rate and blood pressure. Caution is advised for individuals with underlying cardiovascular conditions, such as heart disease, where these changes could be problematic.

Pregnancy

Glucagon is a hormone that occurs naturally in the body. Current medical evidence suggests that glucagon does not cross the placenta and is unlikely to harm a developing fetus. In emergency situations involving severe low blood sugar (hypoglycemia), the benefits of using glucagon typically outweigh the potential risks, as untreated hypoglycemia can be dangerous for both the pregnant person and the baby.

Breastfeeding

It is not known for certain whether glucagon passes into human breast milk. However, because glucagon is a protein, it is expected to be broken down in the infant's digestive tract if it were ingested through breast milk. There are no known reports of harm to nursing infants when the parent uses glucagon for emergency treatment.

Consulting Your Healthcare Provider

If you are pregnant, planning to become pregnant, or breastfeeding, you should discuss the use of glucagon with your doctor. They can provide guidance on managing severe hypoglycemia and help you ensure that an appropriate emergency plan is in place.

Injectable Forms

Glucagon injections are provided in several different delivery systems designed for rapid use during a severe low blood sugar event:

• Emergency Kits: These kits typically contain a vial of sterile powder and a syringe pre-filled with a liquid diluent. The liquid must be manually mixed into the powder vial before the dose is drawn back into the syringe for injection.
• Pre-filled Syringes: This form contains a stable liquid version of the medication that is ready for immediate injection without the need for mixing.
• Auto-injectors: These are single-use devices that contain a pre-mixed dose. They are designed to be pressed against the skin, usually on the thigh, to automatically deliver the medication.

Nasal Form

Glucagon is also available as a nasal powder. This needle-free option is provided in a portable, single-use device. The medication is delivered by inserting the tip of the device into a nostril and pressing a plunger. The powder is absorbed through the lining of the nose and does not require the person to inhale or sniff for it to be effective.

FDA Approval and Indications

Glucagon is FDA-approved for the emergency treatment of severe hypoglycemia (very low blood sugar) in pediatric and adult patients with diabetes. It is intended for use when the patient is unconscious or unable to consume oral carbohydrates. Additionally, the FDA has approved glucagon as a diagnostic aid during radiologic examinations of the gastrointestinal tract, where it is used to temporarily decrease the movement of the stomach and intestines to improve image quality.

Approved Formulations

The FDA has approved several delivery methods for glucagon to facilitate rapid administration during emergencies. These include:

• Emergency kits containing a vial of powder and a pre-filled syringe of sterile water for reconstitution.
• Pre-mixed, ready-to-use autoinjectors and pre-filled syringes.
• A dry nasal powder formulation for needle-free administration.

Regulatory Status

Glucagon is available by prescription only. The FDA regulates the manufacturing, labeling, and marketing of all glucagon products. Regulatory actions, such as warning letters, may be issued to manufacturers if they fail to comply with current good manufacturing practices or if marketing materials do not meet federal requirements. There are currently no Boxed Warnings or Risk Evaluation and Mitigation Strategies (REMS) associated with glucagon.

Emergency Treatment for Severe Hypoglycemia

Glucagon is used to treat severe low blood sugar (hypoglycemia) in people with diabetes. It is specifically intended for emergency situations where the person is unable to consume sugar by mouth because they are unconscious, having a seizure, or are too confused to swallow safely.

The medication works by signaling the liver to release stored glucose into the bloodstream. This action helps raise blood sugar levels quickly to restore consciousness and safety.

When to Administer Glucagon

Caregivers or family members should be trained to recognize the signs of severe hypoglycemia and know how to use glucagon. It should be administered if the person:

• Is unconscious or unresponsive.
• Is having a seizure.
• Is unable to swallow food or drink.
• Is severely disoriented or unable to follow simple instructions.

Because severe low blood sugar is a medical emergency, it is essential to call for emergency medical assistance immediately after administering the dose. Once the person is awake and able to swallow, they should be given a fast-acting source of sugar, such as fruit juice or glucose tablets, followed by a snack containing protein and complex carbohydrates to maintain stable blood sugar levels.