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Glucagon
Aka: Glucagon, GlucaGen, Bagsimi, Gvoke
- See Also
- Hypoglycemia
- Calcium Channel Blocker Overdose
- Esophageal Foreign Body
- 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)
- 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
- Pathophysiology
- Glucagonomas
- Glucagon Secreting tumor resulting in Diabetes Mellitus, as well as dermatitis (necrolytic migratory erythema)
- 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
- Pharmacokinetics
- Onset of action: 5 to 20 minutes
- 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
- 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
- References
- Goldberg (2014) Clinical Physiology, Medmasters, Miami, 140-1
- (2019) Presc Lett 26(11): 62-3