What is Glucagon

and How
Does it Work?

Glucagon is used to raise blood sugar levels in patients with glucagon secretion deficiency. It is also an important hormone used as an antiperistaltic agent in imaging tests, like CT scans that require the digestive muscles to relax.

Other effects of glucagon include the following;

This article will cover what is glucagon and how it works. We’ll also include its side effects, precautions, functions, and forms.
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What is Glucagon?

Glucagon is a hormone that’s produced in the pancreas. It works in body organs, like the liver, to raise blood sugar levels by releasing glucose into the bloodstream. Some of the conditions that may lead to glucose being released by the liver include;

Low blood sugar levels in people with diabetes lead to a condition called hypoglycemia that can be fatal if left untreated. Therefore, hypoglycemic patients have to use synthetic glucagon to treat hypoglycemia.

Synthetic glucagon belongs to a class of drugs called anti-hypoglycemic medications. This medication is only available as a prescription drug.

How Does Glucagon Work?

Glucagon and insulin work to counterbalance each other. They both affect blood glucose levels. Glucagon is produced when there are low blood sugar levels in the body. This hormone works by raising blood sugar levels to avoid hypoglycemia.

On the other hand, insulin is released in response to high sugar levels. When sugar levels spike too high, insulin can help to lower blood sugar to normal levels.

Once glucagon is released, it raises glucose levels by influencing the liver through the following processes;

The effectiveness of glucagon can be felt within 15 minutes. However, this efficacy may be limited in people with high alcohol consumption and those suffering from any kind of liver illness due to depleted glycogen levels.

How is Glucagon Regulated?

Glucagon is regulated either through increased secretion or glucagon inhibition. Consuming carbohydrate-rich meals, increased insulin secretion, and a rise in glucose levels result in
glucagon inhibition. This makes glucagon levels in your blood to fall.

On the contrary, eating meals rich in amino acids, and parasympathetic and sympathetic nerve stimulations leads to glucagon secretion, increasing the levels of glucagon in your body.

Insulin secretion regulates glucagon levels when blood glucose levels get too high. An acceptable blood sugar range can fall between 50 to 100 pg/ml.

However, cases of excess glucagon levels can be experienced due to a pancreas condition called
glucagonoma. Glucagonoma can lead to cases of weight loss, diabetes mellitus, skin rash, and venous thrombosis.

On the other hand, glucagon secretion deficiency cases can be controlled by administering glucagon medication. Such deficiencies are common among diabetic patients taking insulin shots, leading to low glucose levels and sometimes, unconscious patients.

Unconscious patients who’ve fully recovered due to glucagon use should eat carbohydrate-rich meals immediately.

What are the Functions of Glucagon?

Glucagon plays several functions, they include the following;

  • In diabetic patients, glucagon is used to raise blood sugar levels and avoid hypoglycemia. Symptoms of hypoglycemia include hunger, dizziness, sweating, shaking, irritability, confusion, anxiety, and a fast
    heartbeat.
  • Glucagon is used in the imaging procedures of MRI and CT scans, whereby it slows down gut
    movement and relaxes the muscles of your intestines and stomach. This facilitates clear imaging
    and proper diagnosing of patients.
  • Glucagon is crucial in the fight or flight response to stress. In this case, glucagon is used to increase glucose levels in your bloodstream, which is necessary for the prolonged functioning of your body. 
  • Glucagon receptors in the brain have been linked to appetite suppression in humans. Similar to the effects of GLP-1 medications such as Wegovy and Saxenda
  • In the adipocyte, glucagon is responsible for releasing free fatty acids and glycerol into the
    bloodstream, which the liver uses for gluconeogenesis.
  • Glucagon acts as a vasodilator in the heart causing low blood pressure.
  • In the kidney, glucagon increases glomerular filtration and electrolyte secretion due to its diuretic effects.

Forms of Glucagon

Glucagon may come in either of the following forms;

Nasal Powder
This is where powdered glucagon is sprayed into your nose using a device that resembles a typical nasal spray. The powder then gets absorbed into the bloodstream. Nasal glucagon is perhaps the safest, fastest and straightforward way of administering glucagon, especially for unconscious people.

Pre-Mixed, Shelf-Stable Pen
For this method, glucagon is administered similarly to other pens prefilled with medication such as type 2 injectable medicines. The glucagon solution should be clear, colorless, and particle-free. The pre-mixed solution is given to people with severe hypoglycemia by simply removing the cap and injecting it into the person.

Here are the general steps you should follow when administering mixed glucagon;

  • After removing the needle cover from the syringe and seal from the vial of powder, insert the needle into the vial and empty the saline into the powder.
  • Dissolve the powder into the liquid by gently rolling the vial, till it’s clear. Fill the solution into the syringe by drawing it back to the syringe
  • Inject the solution into the arm muscle or outer mid-thigh of the person suffering from severe hypoglycemia
  • Place the person on their side to prevent them from chocking due to vomiting

The unconscious person with low blood sugar should take around 15 minutes to awaken. If not, give them another shot of glucagon after 15 minutes and contact an emergency medical team for immediate treatment. As soon as the person awakens and can swallow, give them a fast-acting sugar source like a soft drink and then a long-acting one like cheese or crackers.

You can follow the manufacturer’s instructions on how to use glucagon. Alternatively, talk to your medical team to guide you on how to use the different forms of glucagon. Remember to always stick to your glucagon prescription refills to avoid lacking medication.

Glucagon Dosage

Glucagon dosages vary from patient to patient depending on their medical problem, the duration of the medication, the time between different doses, and your daily number of dosages. As such, you should stick to your doctor’s dosage instructions or the directions of use on your glucagon medication.

Below is an average dosage of glucagon for an emergency treatment of low blood sugar;

As a Powder for Solution

  • Administer 1 ml under the skin for adults and children older than 6 years. They should weigh above 25
    kilograms. You can repeat the dosage while waiting for emergency care.
  • Administer 0.5 ml under the skin for children younger than 6 years and who weigh less than 25 kilograms.

As an Auto-Injector or Pre-Filled Pen

  • Administer 1 mg or 0.2 ml under the skin for adults and children above the age of 12 years. If there’s no re sponse after 15 minutes, repeat the dosage and wait for emergency care.
  • Administer 1 mg or 0.2 ml under the skin for children between 2 to 11 years and weighing more than 45 kg. Repeat the dosage after 15 minutes, if there’s no response and wait for emergency care.
  • Administer 0.5 mg or 0.1 ml under the skin for children ages 2 to 11 and weighing less than 45 kg.
    If there’s no response after 15 minutes, repeat the dosage and wait for emergency care.
  • Administer glucagon to children less than 2 years as directed by your doctor.

How to Check Glucagon Levels

Glucagon blood tests check the amount of glucagon in your blood. The test is conducted by a health care professional, who’ll draw a blood sample from your body for analysis. You may be instructed to fast for some duration before the test.

Your doctor may perform a blood glucagon test if you show symptoms of the following;

  • Liver cirrhosis
  • Diabetes
  • Glucagonoma syndrome
  • Growth hormone deficiency in kids
  • Hypoglycemia
  • Pancreatitis
  • Multiple endocrine neoplasia type 1

Abnormal glucagon levels may indicate that you’re suffering from one of the above-mentioned conditions, but be sure to consult your doctor for an appropriate diagnosis.

Precautions for Using Glucagon

Before you use glucagon, let your doctor know about all your medical conditions. They’ll then let you
know of the potential risks involved in taking glucagon and assist you in deciding how to use it and
whether you should avoid it.

Some conditions that can affect or be affected by how glucagon works include:

Liver Cirrhosis
The scar tissues that replace healthy liver tissues due to liver cirrhosis may affect glucagon’s ability to release stored glucose, in the form of glycogen, which is stored in the liver. Other liver-related diseases may also have the same effect on glucagon’s functionality.

Pregnant or Breastfeeding Mothers
You should discuss with your doctor how glucagon usage may affect you if you’re pregnant or breastfeeding.

Pancreatitis (Inflammation of the Pancreas)
Due to pancreatitis, your pancreatic cells may be damaged causing glucagon secretion deficiency.

Multiple Endocrine Neoplasia
This rare genetic condition is characterized by tumors in your endocrine system glands, including the pancreas. As such, the ability of the pancreas to produce a sufficient amount of glucagon will be affected.

Glucagonoma
Glucagonoma is a rare pancreatic condition that causes tumors to develop in the pancreas resulting in high glucagon levels. Its symptoms include a swollen tongue, anemia, stomatitis, and weight loss.

Pancreatectomy Side Effect
Pancreatectomy is a surgical procedure that involves removing part of or the entire pancreas due to pancreas failure. As a result, you may end up losing cells associated with insulin and glucagon secretion, which affects the ability of your body to use glucagon.

What are the Side Effects of Glucagon Medication

Common glucagon side effects include the following;

  • Nausea
  • Vomiting
  • Headache
  • Dizziness
  • Anaphylactic reactions, especially on the injection site include a rash.
  • Hypotension

Less common side effects of glucagon include the following;

  • Sleepiness
  • Body weakness
  • Diarrhea
  • Rebound hypoglycemia in the setting of insulinoma

Your body may tolerate the side effects of glucagon as you continue with the medication.

Glucagon Storage
and Disposal

You can store glucagon in its package for 24 months at room temperature. It should be stored away from light, moisture, and heat, and don’t refrigerate or freeze glucagon medication. Always remember to store your glucagon package tightly locked and out of sight and reach of children.

Expired glucagon or unused medication should be discarded through a medicine-take program. Talk to your pharmacist or local garbage collector on how to access an existing medicine-take program.

When to Seek Help

You should seek immediate help in case of a glucagon overdose. You can contact the poison control helpline at 1-800-222-1222 or go to their website for online
information that’ll help. Also, call for emergency help services at 911 for patients who’ve collapsed, have breathing difficulties, have a seizure, or can’t be awakened.

Conclusion

Glucagon is a crucial body hormone. People with a glucagon secretion deficiency have to use synthetic glucagon or risk suffering from severe hypoglycemia. It’s crucial that you know how to administer the different forms of glucagon and stick to your glucagon dosage as prescribed by your doctor. Also, notify your doctor of your medical history to avoid adverse side effects, like severe hypoglycemia. Always remember to properly store your glucagon medication and seek for help in case of an overdose.

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