II. Physiology

  1. Endogenous polypeptide Hormone
  2. Secreted by pancreatic alpha cells
  3. Opposite effect of Insulin
    1. While Insulin lowers Serum Glucose (glycogen storage, Glycolysis), Glucagon increases Serum Glucose
    2. However, both Insulin and Glucagon increase Amino Acid uptake from the liver
  4. Hypoglycemia effect (primary)
    1. Hypoglycemia Increases pancreatic secretion of Glucagon
    2. Glucagon stimulates Glucose release from glycogen (glycogenolysis)
    3. Glucagon also stimulates Glucose synthesis (Gluconeogenesis)
  5. Inhibitors of Glucagon release
    1. Hyperglycemia
      1. Inhibits pancreatic secretion of Glucagon
    2. GLP1 (Incretin)
      1. Secreted by Small Bowel
      2. Stimulates pancreatic beta cells and inhibits Glucagon
      3. See Incretin Mimetics (used in Type 2 Diabetes Mellitus)
  6. Amino Acid Excess Effect
    1. Increases pancreatic secretion of Glucagon
    2. Glucagon stimulates liver uptake of Amino Acids
      1. Both Insulin and Glucagon increase liver uptake of Amino Acids
  7. Acts at Catecholamine-independent receptors on cardiac cells
    1. Increases intracellular Calcium in cardiac cells
    2. Increases myocardial contractions

III. Pathophysiology

  1. Glucagonomas
    1. Glucagon Secreting tumor resulting in Diabetes Mellitus, as well as dermatitis (necrolytic migratory erythema)

IV. Indications: Glucagon Administration

V. Pharmacokinetics

  1. Onset of action: 5 to 20 minutes

VI. Preparations

  1. Background
    1. Cost approximately $280 for each agent (in 2019)
    2. Shelf-life: 2 years
  2. GlucaGen Hypokit (IM)
    1. Standard IM Injection
  3. Gvoke (SC)
    1. Subcutaneous Injection using a prefilled syringer (autoinjector release pending in 2020)
  4. Bagsimi (Intranasal)
    1. Powder sprayed into a single nostril

VII. Dosing: Hypoglycemia

  1. Adult: 1 mg IV, IM or SC
  2. Pediatric
    1. Standard dose: 30 ug/kg IM
    2. Newborn of diabetic mother: 300 ug/kg IM
    3. Maximum dose: 1 mg

VIII. References

  1. Goldberg (2014) Clinical Physiology, Medmasters, Miami, 140-1
  2. (2019) Presc Lett 26(11): 62-3

Images: Related links to external sites (from Bing)

Related Studies

Cost: Medications

glucagon (on 5/2/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
GLUCAGON 1 MG EMERGENCY KIT $269.59 each
glucagen (on 2/23/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
GLUCAGEN 1 MG HYPOKIT $250.50 each

Ontology: Glucagon (C0017687)

Definition (NCI_NCI-GLOSS) A hormone produced by the pancreas that increases the level of glucose (sugar) in the blood.
Definition (NCI) A pancreatic hormone consisting of 29 amino acids that causes increases in blood sugar levels by stimulating hepatic glycogenolysis and gluconeogenesis.
Definition (CSP) pancreatic hormone secreted by the alpha cells of the pancreatic islets; a 29-amino acid straight chain polypeptide that plays an important role in regulation of blood glucose concentration, ketone metabolism, and several other biochemical and physiological processes.
Definition (MSH) A 29-amino acid pancreatic peptide derived from proglucagon which is also the precursor of intestinal GLUCAGON-LIKE PEPTIDES. Glucagon is secreted by PANCREATIC ALPHA CELLS and plays an important role in regulation of BLOOD GLUCOSE concentration, ketone metabolism, and several other biochemical and physiological processes. (From Gilman et al., Goodman and Gilman's The Pharmacological Basis of Therapeutics, 9th ed, p1511)
Concepts Pharmacologic Substance (T121) , Neuroreactive Substance or Biogenic Amine (T124) , Hormone (T125) , Amino Acid, Peptide, or Protein (T116)
MSH D005934
SnomedCT 10712001, 66603002
LNC LP32562-8, LP14667-7, MTHU005175
English Glucagon, Glucagon (1-29), Proglucagon (33-61), glucagon, Glucagon preparation, Hyperglycemic-Glycogenolytic Factor, HG Factor, HG-Factor, Glukagon, glucagon (medication), GLUCAGON, Glucagon [Chemical/Ingredient], glucagons, antidiabetic hormone, Glucagon product, Glucagon (substance), Glucagon product (product), Hyperglycaemic-glycogenolytic factor product, Hyperglycemic-glycogenolytic factor product, Glucagon, NOS, Hyperglycemic-glycogenolytic factor preparation, Hyperglycaemic-glycogenolytic factor preparation, Glucagon preparation (substance), Hyperglycemic Glycogenolytic Factor, GCG, Antidiabetic Hormone
German Glucagon, Glukagon (1-29), Glukagon, Glucagon (1-29), Hyperglykämisch-glykogenolytischer Faktor, HG-Faktor
Swedish Glukagon
Czech glukagon
Finnish Glukagoni
Italian Fattore glicogenolitico iperglicemico, Pro-glucagone, Fattore HG, Glucagone
Russian GLIUKAGON, ГЛЮКАГОН
Spanish preparado con glucagón (producto), preparado con glucagón, preparado con factor hiperglucemiante-glucogenolítico, producto con glucagón (producto), glucagón (producto), producto con factor hiperglucemiante-glucogenolítico, producto con glucagón, glucagón (sustancia), glucagón, preparado de factor hiperglucemiante-glucogenolítico, preparado de glucagón (producto), preparado de glucagón (sustancia), preparado de glucagón, Glucagón
Japanese グルカゴン
Croatian GLUKAGON
Polish Glukagon
Norwegian Hyperglykemisk-glykogenolytisk faktor, Proglukagon (33-61), Glukagon, HG-faktor, Glukagon (1-29)
French Glucagon, Facteur glycogénolytique hyperglycémique, Glucagon (1-29)
Portuguese Glucagon

Ontology: GlucaGen (C0591569)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
English GlucaGen kit, glucagen, GlucaGen