All About Glucagon
Editor’s Note: This content has been verified by Marina Basina, MD, a Clinical Associate Professor at Stanford University. She’s a clinical endocrinologist and researcher with a focus on diabetes management and diabetes technology. Dr. Basina is an active member of multiple medical advisory boards and community diabetes organizations, and she is on the Beyond Type 1 Science Advisory Council.
What is glucagon?
Besides being a hormone that occurs naturally in the body, glucagon is also an emergency medicine used when a person with diabetes is experiencing severe hypoglycemia (low blood sugar) and cannot take sugar orally or in non-emergency situations with mini-dosing to prevent “glycemic overshoot.”
Once injected, it raises the blood sugar by sending a signal to the muscles and liver (where glucose is stored in your body). The effect of glucagon is opposite of the effect of insulin, raising blood sugar instead of lowering it. It comes in several forms including a nasal spray, auto-injectors, prefilled syringes, or a powder that must be mixed with a liquid before injecting.
Types of Emergency Glucagon
While there was only one option for decades—and it was complicated to use—there are more recent and improved emergency glucagon treatment products available in Canada today, including:
- Nasal glucagon – Baqsimi®: This is an emergency glucagon that’s administered through your nose.
- GlucaGen® / GlucaGen® HypoKit: This glucagon comes in the form of a powder that you mix with a liquid and inject into your muscle.
Read all about glucagon, including a step-by-step treatment to administer.
How do I administer these medications?
Baqsimi® (see Patient Medication Information section of product monograph for administration instructions):
Preparing the dose:
- Remove the shrink wrap by pulling on red stripe.
- Open the lid and remove the device from the tube. Do not test before use.
- Hold the device between fingers and thumb. Caution: do not press the plunger until ready to give the dose.
Giving the dose:
- Insert the tip gently in one of the nostrils until finger(s) touch the outside of the nose.
- Push the plunger all the way in.
- The dose is complete when the green line is no longer showing.
After giving the dose:
- Remove the tip from nose. Throw away the used device and tube.
- Call for medical help right away.
- If the person is unconscious, turn them on their side.
- Patients usually respond to Baqsimi® within 15 minutes. Encourage the person to eat as soon as they can safely swallow.
GlucaGen® and GlucaGen® HypoKit (see Patient Medication Information section of product monograph for administration instructions):
1. Remove the plastic cap from the vial. Pull the needle cover off the syringe. Do not remove the plastic back-stop from the syringe. Insert the needle through the rubber stopper (within the marked circle) of the vial containing GlucaGen® and inject all the liquid from the syringe into the vial.
2. Without taking the needle out of the vial, gently shake the vial until GlucaGen® has completely dissolved, and the solution is clear.
3. Make sure the plunger is completely down. While keeping the needle in the liquid, slowly withdraw all the solution back into the syringe. Do not pull the plunger out of the syringe.
It is important to remove any air bubbles from the syringe as follows:
- With the needle pointing upwards, tap the syringe with your finger
- Push the plunger slightly to release any air that has collected at the top of the syringe.
Continue to push the plunger until you have the correct dose for injection. A small amount of liquid will be pushed out when you do this.
4. Inject the dose into a muscle.
Do not attempt to put the cap back on the needle of the used syringe. Place the used syringe in the orange box and dispose the used needle in a sharps container at the next available opportunity.
What is the difference between glucagon and insulin?
In people with a fully functional pancreas, insulin and glucagon work in tandem to keep blood sugars stable. Insulin lowers blood sugar, while its partner, glucagon, releases the body’s glucose reserves from the liver to raise blood sugars.
When do you use glucagon?
If you are conscious but cannot consume sugar orally, you can self-administer glucagon. If you are unconscious, someone else will need to inject the glucagon into muscle or administer nasal glucagon to the nostril. If hospitalized, an injection may be given intravenously. Always contact emergency services if glucagon is administered in an emergency situation.
In cases of hypoglycemia (low blood sugar), glucagon allows the body to release sugar into the blood stream, so blood glucose levels can elevate to a safer range. Consult a physician to see if it would be helpful to use glucagon in glycemic overshoot prevention. It is important to note that glucagon may not work effectively if a person has been consuming alcohol.
How to store glucagon?
When not in use glucagon should be stored at room temperature. Do not freeze or refrigerate and keep away from direct sunlight. If using for mini-dosing, opened glucagon can be stored in the refrigerator for 24 hours. Consult the Patient Medication Information section of the GlucaGen®/GlucaGen® HypoKit product monograph and Baqsimi® product monograph for respective storage instructions.
What can cause hypoglycemia?
- Too much insulin causing an “insulin reaction”
- Not eating when scheduled to eat
- Being sick (excessive vomiting or diarrhea)
- Excessive exercise
What are symptoms of hypoglycemia?
- anxious feeling
- behavior change similar to being drunk
- blurred vision
- cold sweats
- cool pale skin
- difficulty in concentrating
- excessive hunger
- fast heartbeat
- restless sleep
- slurred speech
- unusual tiredness or weakness
Untreated hypoglycemia will cause convulsions (seizures), unconsciousness and possibly death.
Possible side-effects of glucagon:
- itchy skin
If the following occur, call your physician immediately:
- difficulty breathing