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Monitoring

What is Glucagon?

Glucagon is a hormone made in the pancreas that does the opposite of insulin-it raises blood glucose by stimulating your liver to release glucose.

It is available by prescription as an emergency kit and is given by injection with the same technique you use to inject insulin.

How does Glucagon work?

Glucagon is a counter-regulatory hormone that helps your body regulate blood glucose levels. In people without diabetes, whenever the blood glucose level drops, the beta cells of the pancreas secrete less insulin, while the alpha cells of the pancreas secrete more glucagon. Glucagon stimulates the liver to release its stored glucose (glucose is stored in the liver in a form called glycogen) into the bloodstream to help raise the blood glucose levels.

As you know, people with type 1 diabetes do not produce insulin. In addition, after several years of having type 1 diabetes, many people lose their ability to secrete glucagon in response to low blood glucose, which can make them especially prone to severe hypoglycemia.

When is Glucagon used?

Someone would administer glucagon by injection to you if you were unable to take food/fluids by yourself. Glucagon should be injected if:

• You are unconscious, or
• You are unable to eat sugar or a sugar-sweetened product, or
• You are having a seizure, or
• Repeated administration of sugar or a sugar-sweetened product such as a regular soft drink or fruit juice did not improve your condition.

Who should have a Glucagon Emergency Kit?

• Talk to your healthcare team to see if you should keep glucagon on hand. You need to tell people around you (such as family members and co-workers) how and when to inject glucagon should you ever need it.

Important things to know

• Show your family members and others where you keep the glucagon kit and how to use it BEFORE you need it! They can practice injections by giving you your normal insulin injection. It is important that they practice, because a person who has never given a shot probably would not be able to do it in an emergency.
• Glucagon is for emergencies and should be used only under the direction of your healthcare provider.
• Exceptions: There are some exceptions where glucagon might not be effective. Since glucagon works by telling the liver to release its storage of glycogen, then the effectiveness of glucagon depends on how much glucose is stored in the liver. For example:
  • 2nd dose in a day: Glucagon might not be as effective if this were the second time it were given in one day, because the body would not have had time to replenish its storage of glycogen in the liver.
  • Exercise: The same applies for the period after prolonged exercise (such as a long strenuous hike, or a marathon), as you may have depleted your glycogen stores.
  • Alcohol intake: As you can read in the related question at right about the effects of alcohol, alcohol inhibits the liver from making glucose (because the liver is "busy" metabolizing the alcohol), so if you haven't eaten, you run the risk of hypoglycemia. In addition, if you had alcohol in your system and had such a severe low glucose that caused you to go unconscious, then glucagon may not work. This is because normally glucagon tells your liver to release more glucose into your bloodstream, but alcohol blocks that process. So in this situation, you might require glucose-not glucagon-injected by a healthcare professional, directly into your bloodstream.

Details about the emergency kit

• You need a prescription to buy the kit. Ask your doctor for a prescription, and then be sure to tell your friends and relatives where you have stored the kit.
• Glucagon is available in a package with the supplies that are needed to take it. The emergency kit contains a bottle of glucagon (dry powder) and a syringe filled with a diluting liquid. This is called either a Lilly Glucagon Emergency Kit (by Eli Lilly and Co.) or a GlucGen® Hypokit® (by Novo Nordisk).
• The contents of the syringe must be mixed with the glucagon in the accompanying bottle just before giving the injection.
• There are important details you should read, which are all available on the product web sites in the links listed below.
• If you have questions concerning the use of this product, consult your healthcare provider or pharmacist.
• You should always report any severe unexplained low blood glucose to your healthcare provider so both of you can analyze why it occurred and determine how to prevent this from happening again.

Sources: Product insert from the Lilly Glucagon Emergency Kit, the NovoNordisk GlucaGen® Hypokit®, and Diabetes Self-Management.