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Glucagon for Injection (rDNA origin) is a polypeptide hormone identical to human glucagon that increases blood glucose and relaxes smooth muscle of the gastrointestinal tract.
Glucagon is a single-chain polypeptide that contains 29 amino acid residues and has a molecular weight of 3483.
Glucagon is available for use intravenously, intramuscularly, or subcutaneously in a kit that contains a vial of sterile glucagon and a syringe of sterile diluent.
Glucagon increases blood glucose concentration and is used in the treatment of hypoglycemia. Glucagon administered through a parenteral route relaxes smooth muscle of the stomach, duodenum, small bowel, and colon. Glucagon has been studied following intramuscular, subcutaneous, and intravenous administration in adult volunteers. Because patients with type 1 diabetes may have less of an increase in blood glucose levels compared with a stable type 2 patient, supplementary carbohydrate should be given as soon as possible, especially to a pediatric patient. Glucagon is indicated as a diagnostic aid in the radiologic examination of the stomach, duodenum, small bowel, and colon when diminished intestinal motility would be advantageous. Glucagon is contraindicated in patients with known hypersensitivity to it or in patients with known pheochromocytoma.
Glucagon should be administered cautiously to patients with a history suggestive of insulinoma, pheochromocytoma, or both.
Generalized allergic reactions, including urticaria, respiratory distress, and hypotension, have been reported in patients who received glucagon by injection.
Glucagon is effective in treating hypoglycemia only if sufficient liver glycogen is present. Refer patients and family members to the attached Information for the User for instructions describing the method of preparing and injecting glucagon.
Careful adjustment of the insulin program so that the type (or types) of insulin, dose, and time (or times) of administration are suited to the individual patient. Frequent testing of the blood or urine for glucose so that a change in insulin requirements can be foreseen. Routine carrying of sugar, candy, or other readily absorbable carbohydrate by the patient so that it may be taken at the first warning of an oncoming reaction. To prevent severe hypoglycemia, patients and family members should be informed of the symptoms of mild hypoglycemia and how to treat it appropriately.
Family members should be informed to arouse the patient as quickly as possible because prolonged hypoglycemia may result in damage to the central nervous system. Patients should be advised to inform their physician when hypoglycemic reactions occur so that the treatment regimen may be adjusted if necessary.
Blood glucose determinations should be obtained to follow the patient with hypoglycemia until patient is asymptomatic. Because glucagon is usually given in a single dose and has a very short half-life, no studies have been done regarding carcinogenesis. For the treatment of hypoglycemia: The use of glucagon in pediatric patients has been reported to be safe and effective. Clinical studies of glucagon did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Severe adverse reactions are very rare, although nausea and vomiting may occur occasionally.
If overdosage occurs, nausea, vomiting, gastric hypotonicity, and diarrhea would be expected without causing consequential toxicity.
Intravenous administration of glucagon has been shown to have positive inotropic and chronotropic effects. When glucagon was given in large doses to patients with cardiac disease, investigators reported a positive inotropic effect. Because glucagon is a polypeptide, it would be rapidly destroyed in the gastrointestinal tract if it were to be accidentally ingested. To obtain up-to-date information about the treatment of overdose, a good resource is your certified Regional Poison Control Center. In view of the extremely short half-life of glucagon and its prompt destruction and excretion, the treatment of overdosage is symptomatic, primarily for nausea, vomiting, and possible hypokalemia. If the patient develops a dramatic increase in blood pressure, 5 to 10 mg of phentolamine mesylate has been shown to be effective in lowering blood pressure for the short time that control would be needed. Forced diuresis, peritoneal dialysis, hemodialysis, or charcoal hemoperfusion have not been established as beneficial for an overdose of glucagon; it is extremely unlikely that one of these procedures would ever be indicated. The diluent is provided for use only in the preparation of glucagon for parenteral injection and for no other use. Reconstituted glucagon solutions should be used only if they are clear and of a water-like consistency. Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration.
If parenteral glucose can not be used, dissolve the lyophilized glucagon using the accompanying diluting solution and use immediately. For adults and for pediatric patients weighing more than 44 lb (20 kg), give 1 mg (1 unit) by subcutaneous, intramuscular, or intravenous injection. An unconscious patient will usually awaken within 15 minutes following the glucagon injection. After the patient responds, supplemental carbohydrate should be given to restore liver glycogen and to prevent secondary hypoglycemia. Dissolve the lyophilized glucagon using the accompanying diluting solution and use immediately.

The doses in the following table may be administered for relaxation of the stomach, duodenum, and small bowel, depending on the onset and duration of effect required for the examination. For examination of the colon, it is recommended that a 2 mg (2 units) dose be administered intramuscularly approximately 10 minutes prior to the procedure. Make sure that your relatives or close friends know that if you become unconscious, medical assistance must always be sought. THE PATIENT MAY BE IN A COMA FROM SEVERE HYPERGLYCEMIA (HIGH BLOOD GLUCOSE) RATHER THAN HYPOGLYCEMIA. Use glucagon to treat insulin coma or insulin reaction resulting from severe hypoglycemia (low blood sugar). INFORMATION ON HYPOGLYCEMIA below for more information on the symptoms of hypoglycemia.) Glucagon is not active when taken orally. Remove the needle protector from the syringe, and inject the entire contents of the syringe into the bottle of glucagon.
Using the same syringe, hold bottle upside down and, making sure the needle tip remains in solution, gently withdraw all of the solution (1 mg mark on syringe) from bottle. The occurrence of early symptoms calls for prompt and, if necessary, repeated administration of some form of carbohydrate. A few people may be allergic to glucagon or to one of the inactive ingredients in glucagon, or may experience rapid heart beat for a short while. If you experience any other reactions which are likely to have been caused by glucagon, please contact your doctor.
Hypoglycemia is a medical emergency that may result in seizures and permanent brain damage (1-5).
Untreated, severe, prolonged hypoglycemia can lead to stupor, coma, and even death in some animals. If the animal responds to intravenous or oral glucose administration, it then should be fed a small, high-protein meal and kept as quiet as possible.
All patients with serious neurologic signs referable to hypoglycemia should be treated immediately by intravenous administration of a 50% dextrose solution (1-5 ml is given slowly over 10 minutes). Regardless of the glucose concentration chosen to be administered in an emergency, it is important to keep in mind that it is not necessary to completely normalize the serum glucose concentration, but rather, to eliminate the clinical signs related to hypoglycemia. When glucose is administered intravenously to a patient with insulinoma, the tumor may be stimulated to release massive amounts of insulin, leading to severe hypoglycemia.
In dogs with insulinoma, intravenous glucagon should be considered if hypoglycemia and associated clinical signs cannot be not stabilized with infusions of dextrose alone. One milligram of lyophilized glucagon USP should be reconstituted according to package directions and mixed with 1 liter of 0.9% saline solution.
Prolonged hypoglycemia can cause focal laminar and pseudolaminar necrosis of the cerebral cortex, which can result in an acquired seizure disorder (2-6). If seizures persist despite the correction of hypoglycemia, cerebral hypoxia and edema may be responsible. Case Scenario 1 Student is escorted to your office stating they “don’t feel good.” Symptoms of shaking and sweating noted. Case Scenario 2 ? Student is in PE and starts complaining of “feeling low.” The coach calls the nurse, stating the student appears confused and lethargic.
Case Scenario 2 (cont.) ? Give student a snack containing 15 grams of complex carbohydrates and protein ? Send student back to normal activity and recheck prior to lunch. Case Scenario 3 ? You are called to the classroom to find a student with diabetes having a seizure. Diabetes Update for School Nurses Arkansas Children’s Hospital Jennifer Sellers, RN,CDE Lisa Still, RN,CDE July 2007. Glucagon Emergency Administration Training Tool A Resource for School Nurses and School Personnel. Diabetes Info Fast and Furious Facts … 23 million have diabetes in the US 5-10%Type 1 1 in every 400 kids have Type I diabetes Type II diabetes is significantly.
Helping Belton ISD Students Stay Safe & Healthy What Every BISD Staff Needs to Know About: Helping Belton ISD Students Stay Safe & Healthy What Every BISD. Diabetes at School March 2009 Training For School Personnel Insulin, Blood Checking and Glucagon. DATA Program Diabetes Awareness, Training, and Action Training Curriculum North Carolina Public School System NC Session Law 2002-103, Senate Bill 911. Diabetes Awareness, Training, and Action Program Developed by: Wake Forest Baptist Hospital Diabetes Care Center & American Diabetes Association & Nursing. ACUTE POISONING Major C J Porter RAMC Army Medical Directorate Emergency Medicine Registrar Bristol Royal Infirmary. It is relatively insoluble in water but is soluble at a pH of less than 3 or more than 9.5. In patients with insulinoma, intravenous administration of glucagon may produce an initial increase in blood glucose; however, because of glucagon's hyperglycemic effect the insulinoma may release insulin and cause subsequent hypoglycemia. In the presence of pheochromocytoma, glucagon can cause the tumor to release catecholamines, which may result in a sudden and marked increase in blood pressure. Because glucagon is of little or no help in states of starvation, adrenal insufficiency, or chronic hypoglycemia, hypoglycemia in these conditions should be treated with glucose.
Advise the patient and family members to become familiar with the technique of preparing glucagon before an emergency arises. Glucagon or intravenous glucose should awaken the patient sufficiently so that oral carbohydrates may be taken. Because many drugs are excreted in human milk, caution should be exercised when glucagon is administered to a nursing woman.

Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In a three month controlled study of 75 volunteers comparing animal-sourced glucagon with glucagon manufactured through rDNA technology, no glucagon-specific antibodies were detected in either treatment group. A transient increase in both blood pressure and pulse rate may occur following the administration of glucagon. In managing overdosage, consider the possibility of multiple drug overdoses, interaction among drugs, and unusual drug kinetics in your patient. If the response is delayed, there is no contraindication to the administration of an additional dose of glucagon; however, in view of the deleterious effects of cerebral hypoglycemia emergency aid should be sought so that parenteral glucose can be given. Colon relaxation and reduction of patient discomfort may allow the radiologist to perform a more satisfactory examination.
Glucagon may have been prescribed so that members of your household can give the injection if you become hypoglycemic and are unable to take sugar by mouth. You must mix the contents of the syringe with the glucagon in the accompanying bottle before giving injection.
Symptoms of severe hypoglycemia include disorientation, unconsciousness, and seizures or convulsions. The plastic clip on the syringe will prevent the rubber stopper from being pulled out of the syringe; however, if the plastic plunger rod separates from the rubber stopper, simply reinsert the rod by turning it clockwise. Give the patient a fast-acting source of sugar (such as a regular soft drink or fruit juice) and a long-acting source of sugar (such as crackers and cheese or a meat sandwich). Patients should always carry a quick source of sugar, such as candy mints or glucose tablets.
Mild cases of hypoglycemia can quickly become serious and life threatening if the low blood glucose concentration continues to fall. This may result in a viscous cycle of the patient receiving larger volumes and more frequent dosing of intravenous dextrose even as clinical signs become more severe (2,3,6,7).
Glucagon stimulates hepatic gluconeogensis and glycogenolysis, thereby raising the circulating glucose concentrations.
Anticonvulsants may be required long-term for some animals recovering from hypoglycemic seizures. Glucagon constant-rate infusion: a novel strategy for the management of hyperinsulinemic-hypoglycemic crisis in the dog. I've divided the posts into 3 types: (1) my insights into specific endocrine issues, (2) Q & A posts that deal with questions I've gotten from veterinarians, and (3) reviews of current endocrine publications (with my comments and "insights").
Presented by District Nurses Cheryl Closser, RN, MSN, PHN Beth Munns, RN, BA, BSN Emily Henke, RN, BSN, PHN. No difference in maximum blood glucose concentration between animal-sourced and rDNA glucagon was observed after subcutaneous and intramuscular injection.
A patient developing symptoms of hypoglycemia after a dose of glucagon should be given glucose orally, intravenously, or by gavage, whichever is most appropriate. If a patient develops a sudden increase in blood pressure, 5 to 10 mg of phentolamine mesylate may be administered intravenously in an attempt to control the blood pressure.
Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed. If the drug is excreted in human milk during its short half-life, it will be hydrolyzed and absorbed like any other polypeptide. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy. Patients taking (beta)-blockers might be expected to have a greater increase in both pulse and blood pressure, an increase of which will be transient because of glucagon's short half-life. Total doses ranged from 25 to 996 mg, and a 21-month-old infant received approximately 8.25 mg in 165 hours.
IF YOU HAVE QUESTIONS CONCERNING THE USE OF THIS PRODUCT, CONSULT A DOCTOR, NURSE OR PHARMACIST. Give glucagon if (1) the patient is unconscious (2) the patient is unable to eat sugar or a sugar-sweetened product (3) the patient is having a seizure, or (4) repeated administration of sugar or a sugar-sweetened product such as a regular soft drink or fruit juice does not improve the patient's condition.
If the patient does not awaken within 15 minutes, give another dose of glucagon and INFORM A DOCTOR OR EMERGENCY SERVICES IMMEDIATELY. The prompt treatment of mild hypoglycemic symptoms can prevent severe hypoglycemic reactions. However, owners should be warned not to place their hands directly into the mouth of an animal that is having a seizure and not to pour a sugar solution into the mouth of an unconscious pet (2,3,6). Glucagon is not active when taken orally because it is destroyed in the gastrointestinal tract before it can be absorbed.
The increase in blood pressure and pulse rate may require therapy in patients with pheochromocytoma or coronary artery disease. Milder cases of hypoglycemia should be treated promptly by eating sugar or a sugar-sweetened product.
If the patient does not improve or if administration of carbohydrate is impossible, glucagon should be given or the patient should be treated with intravenous glucose at a medical facility. However, we should also consider the possibility that a condition other than hypoglycemia may be the cause of the seizures. Serum potassium concentration could be maintained within normal limits with supplemental potassium.

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