II. Physiology
- Endogenous polypeptide Hormone
- Secreted by pancreatic alpha cells
- Opposite effect of Insulin
- While Insulin lowers Serum Glucose (glycogen storage, Glycolysis), Glucagon increases Serum Glucose
- However, both Insulin and Glucagon increase Amino Acid uptake from the liver
-
Hypoglycemia effect (primary)
- Hypoglycemia Increases pancreatic secretion of Glucagon
- Glucagon stimulates Glucose release from glycogen (glycogenolysis)
- Glucagon also stimulates Glucose synthesis (Gluconeogenesis)
- Inhibitors of Glucagon release
- Hyperglycemia
- Inhibits pancreatic secretion of Glucagon
- GLP1 (Incretin)
- Secreted by Small Bowel
- Stimulates pancreatic beta cells and inhibits Glucagon
- See Incretin Mimetics (used in Type 2 Diabetes Mellitus)
- Hyperglycemia
-
Amino Acid Excess Effect
- Increases pancreatic secretion of Glucagon
- Glucagon stimulates liver uptake of Amino Acids
- Both Insulin and Glucagon increase liver uptake of Amino Acids
- Acts at Catecholamine-independent receptors on cardiac cells
- Increases intracellular Calcium in cardiac cells
- Increases myocardial contractions
III. Pathophysiology
- Glucagonomas
- Glucagon Secreting tumor resulting in Diabetes Mellitus, as well as dermatitis (necrolytic migratory erythema)
IV. Indications: Glucagon Administration
-
Hypoglycemia
- Hypoglycemia with difficult Intravenous Access
- Neonatal Hypoglycemia
-
Esophageal Foreign Body
- Relaxes Lower esophageal tone
- Calcium Channel Blocker Overdose and Beta Blocker Overdose
V. Pharmacokinetics
- Onset of action: 5 to 20 minutes
VI. Preparations
- Background
- Cost approximately $280 for each agent (in 2019)
- Shelf-life: 2 years
- GlucaGen Hypokit (IM)
- Standard IM Injection
- Gvoke (SC)
- Subcutaneous Injection using a prefilled syringer (autoinjector release pending in 2020)
- Bagsimi (Intranasal)
- Powder sprayed into a single nostril
VII. Dosing: Hypoglycemia
- Adult: 1 mg IV, IM or SC
- Pediatric
- Standard dose: 30 ug/kg IM
- Newborn of diabetic mother: 300 ug/kg IM
- Maximum dose: 1 mg
VIII. References
- Goldberg (2014) Clinical Physiology, Medmasters, Miami, 140-1
- (2019) Presc Lett 26(11): 62-3
Images: Related links to external sites (from Bing)
Related Studies
| glucagon (on 6/22/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| GLUCAGON 1 MG EMERGENCY KIT | Generic | $224.95 each |
| glucagen (on 6/22/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| GLUCAGEN 1 MG HYPOKIT | $272.94 each | |
| gvoke (on 2/1/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| GVOKE HYPOPEN 1-PK 1 MG/0.2 ML | $1,427.39 per ml | |
| GVOKE HYPOPEN 2PK 0.5 MG/0.1 ML | $2,853.59 per ml | |
| GVOKE HYPOPEN 2-PK 1 MG/0.2 ML | $1,423.08 per ml | |
| GVOKE PFS 1-PK 1 MG/0.2 ML SYR | $1,426.19 per ml | |
| GVOKE PFS 2-PK 1 MG/0.2 ML SYR | $1,424.86 per ml | |