Glucagon

INTRODUCTION

Indications

Acute management of severe hypoglycemia when administration of glucose is not feasible. Facilitation of radiographic examination of the GI tract. Unlabeled Use: Antidote to Beta blockers, Calcium channel blockers.

Action

Stimulates hepatic production of glucose from glycogen stores (glycogenolysis). Relaxes the musculature of the GI tract (stomach, duodenum, small bowel, and colon), temporarily inhibiting movement. Has positive inotropic and chronotropic effects. Therapeutic Effects: Increase in blood glucose. Relaxation of GI musculature, facilitating radiographic examination.

Adverse Reactions/Side Effects

CV: hypotension. GI: nausea, vomiting. Misc: HYPERSENSITIVITY REACTIONS, INCLUDING ANAPHYLAXIS.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of hypersensitivity reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

• Assess blood pressure periodically and compare to normal values (See Appendix F). Report low blood pressure (hypotension), especially if patient experiences dizziness, fatigue, or syncope.

Interventions

• Because of the risk of recurrent hypoglycemia, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (blood pressure, heart rate, fatigue levels, dizziness), and terminate exercise immediately if any untoward responses occur (See Appendix L).

• Provide a source of oral glucose (fruit juice, glucose gels/tablets, etc.) to treat mild hypoglycemia. Call for emergency assistance if symptoms persist or in cases of severe hypoglycemia. Emergency treatment typically consists of IV glucose, glucagon, or epinephrine.

Patient/Client-Related Instruction

• Educate patient and family/caregivers about the signs of hypoglycemia (see above in Evaluation and Examination). Emphasize that early recognition and administration of glucose may prevent acute reactions and need for subsequent glucagon administration.

• Instruct patient to report severe or prolonged GI reactions such as nausea and vomiting.

Pharmacokinetics

Absorption: Well absorbed following IM and SC administration.

Distribution: Unknown.

Metabolism and Excretion: Extensively metabolized by the liver, plasma, and kidneys.

Half-life: 8–18 min.

Contraindications/Precautions