What is the difference between glucagon and glycogen. How do these substances affect blood glucose levels. What role do glucagon and glycogen play in diabetes management. What are the new developments in glucagon therapy for hypoglycemia.

The Fundamental Differences Between Glucagon and Glycogen

Glucagon and glycogen are two distinct substances that play crucial roles in regulating blood glucose levels, but they serve very different functions in the body. Understanding these differences is essential for effective diabetes management.

What is Glycogen?

Glycogen is a complex carbohydrate that serves as the primary storage form of glucose in the body. When blood glucose levels are high, such as after a meal, excess glucose is converted into glycogen and stored primarily in the liver and muscles. This process helps maintain stable blood sugar levels by preventing excessive spikes in glucose concentration.

What is Glucagon?

Glucagon, on the other hand, is a hormone produced by the pancreas. Its primary function is to raise blood glucose levels when they become too low. Glucagon signals the liver to break down stored glycogen into glucose, which is then released into the bloodstream. This mechanism helps prevent dangerous hypoglycemic episodes, especially in individuals with diabetes.

The Role of Glucagon and Glycogen in Blood Sugar Regulation

The interplay between glucagon and glycogen is a critical aspect of the body’s glucose homeostasis mechanism. This delicate balance is particularly important for individuals with diabetes, who may have impaired natural regulatory processes.

How does glycogen affect blood sugar levels?

Glycogen acts as a glucose reservoir, helping to stabilize blood sugar levels. When blood glucose drops, glycogen is broken down into glucose through a process called glycogenolysis. This glucose is then released into the bloodstream, raising blood sugar levels and providing energy to cells.

What triggers glucagon release?

Glucagon release is primarily triggered by low blood glucose levels. When blood sugar drops below normal levels, alpha cells in the pancreas secrete glucagon. This hormone then stimulates the liver to convert stored glycogen back into glucose, effectively raising blood sugar levels.

Glucagon in Diabetes Management: Current and Emerging Therapies

For individuals with diabetes, especially those prone to severe hypoglycemia, glucagon can be a life-saving treatment. Traditional glucagon kits have been available for years, but they have some limitations. Recent advancements have led to the development of new, more user-friendly glucagon formulations.

What are the limitations of traditional glucagon kits?

Traditional glucagon kits require a complex, multi-step preparation process that can be challenging to administer, especially in emergency situations. The glucagon powder must be reconstituted with a diluent before injection, which can be time-consuming and prone to errors. Additionally, the need for injection can be intimidating for some caregivers.

What new glucagon formulations are available?

Two notable new glucagon formulations have recently been introduced to the market:

• Nasal glucagon (Baqsimi): This is a dry nasal powder that can be administered without injection or reconstitution.
• Ready-to-use glucagon autoinjector (Gvoke): This is a pre-mixed, liquid glucagon that can be administered via a simple autoinjector device.

These new formulations aim to simplify the administration process, potentially improving the accessibility and utilization of glucagon in emergency situations.

The Impact of Glucagon on Glycogen Stores

Understanding the relationship between glucagon and glycogen is crucial for comprehending the body’s glucose regulation mechanisms. Glucagon’s primary action is to stimulate the breakdown of glycogen stores, particularly in the liver.

How does glucagon affect glycogen metabolism?

When glucagon binds to receptors on liver cells, it triggers a cascade of events that lead to the activation of enzymes responsible for glycogen breakdown. This process, known as glycogenolysis, results in the release of glucose into the bloodstream. Simultaneously, glucagon inhibits glycogen synthesis, ensuring that available glucose is not immediately re-stored as glycogen.

What happens to glycogen stores during prolonged fasting or exercise?

During extended periods of fasting or intense physical activity, glycogen stores can become depleted. In these situations, glucagon continues to play a crucial role by promoting gluconeogenesis – the production of new glucose molecules from non-carbohydrate sources such as amino acids and lipids. This process helps maintain blood glucose levels even when glycogen stores are low.

Glucagon vs. Insulin: The Hormonal Balance in Glucose Regulation

The interplay between glucagon and insulin is a crucial aspect of glucose homeostasis. These two hormones work in opposition to maintain blood sugar levels within a healthy range.

How do glucagon and insulin work together?

While glucagon raises blood glucose levels, insulin lowers them. After a meal, when blood glucose rises, the pancreas secretes insulin, which promotes glucose uptake by cells and the conversion of excess glucose to glycogen. Conversely, when blood glucose drops, glucagon is released to raise blood sugar levels. This balanced hormonal system helps maintain stable blood glucose levels throughout the day.

What happens in diabetes?

In diabetes, this delicate balance is disrupted. In type 1 diabetes, the body doesn’t produce insulin, while in type 2 diabetes, cells become resistant to insulin’s effects. This can lead to chronically elevated blood glucose levels. Additionally, in some cases, the glucagon response to hypoglycemia may be impaired, increasing the risk of severe low blood sugar episodes.

Glucagon Therapy: Beyond Emergency Hypoglycemia Treatment

While glucagon is primarily known for its role in treating severe hypoglycemia, research is ongoing into its potential applications in other areas of diabetes management and beyond.

Can glucagon be used for mild hypoglycemia?

Traditionally, glucagon has been reserved for severe hypoglycemia where the individual is unable to consume oral glucose. However, with the development of new, easy-to-use formulations, there is growing interest in using small doses of glucagon for the treatment of mild to moderate hypoglycemia. This approach could potentially reduce the reliance on high-calorie sugar sources for treating less severe low blood sugar episodes.

What are some potential future applications of glucagon therapy?

Researchers are exploring several novel uses for glucagon:

• Bi-hormonal artificial pancreas systems: These systems use both insulin and glucagon to more closely mimic natural glucose regulation.
• Treatment of congenital hyperinsulinism: Chronic glucagon infusion has shown promise in managing this rare genetic disorder.
• Management of hypoglycemia associated with gastric bypass surgery: Glucagon may help counteract post-surgical hypoglycemia in some patients.

These potential applications highlight the ongoing importance of glucagon in medical research and treatment development.

Educating Patients and Caregivers: The Key to Effective Glucagon Use

Despite its potential life-saving benefits, glucagon remains underutilized in diabetes management. Proper education of both patients and their caregivers is crucial to ensure that glucagon is available and used effectively when needed.

What should patients and caregivers know about glucagon?

Key points for education include:

1. Recognition of severe hypoglycemia symptoms
2. Proper storage and handling of glucagon preparations
3. Step-by-step instructions for administering glucagon
4. The importance of seeking medical attention after using glucagon
5. Regular checks of glucagon expiration dates and replacement as needed

How can healthcare providers improve glucagon education?

Healthcare providers can enhance glucagon education by:

• Incorporating glucagon training into routine diabetes education sessions
• Providing hands-on practice with demonstration devices
• Discussing glucagon at every diabetes-related appointment
• Offering refresher courses and updates on new glucagon formulations
• Addressing any fears or concerns patients and caregivers may have about using glucagon

By prioritizing glucagon education, healthcare providers can help ensure that this vital treatment is available and properly used when needed, potentially saving lives and reducing the complications of severe hypoglycemia.

The Future of Glucose Regulation: Integrating Glucagon and Glycogen Research

As our understanding of glucose metabolism continues to evolve, researchers are exploring new ways to leverage the roles of glucagon and glycogen in diabetes management and beyond. These advancements could lead to more effective treatments and improved quality of life for individuals with diabetes.

What are some promising areas of research?

Several exciting avenues of research are currently being pursued:

• Glucagon receptor antagonists: These drugs could potentially help manage hyperglycemia in type 2 diabetes by blocking glucagon’s glucose-raising effects.
• Glycogen phosphorylase inhibitors: These compounds could modulate glycogen breakdown, offering a new approach to controlling blood glucose levels.
• Dual-hormone delivery systems: Advanced insulin pumps that deliver both insulin and glucagon are being developed to more closely mimic natural pancreatic function.
• Glucagon analogs: Modified forms of glucagon with improved stability or tailored effects are being investigated for various therapeutic applications.

How might these advancements change diabetes management?

These research directions could lead to several potential improvements in diabetes care:

1. More precise blood glucose control with reduced risk of hypoglycemia
2. Simplified treatment regimens that better account for the body’s natural glucose regulation mechanisms
3. Improved management of both hypo- and hyperglycemia
4. Reduced long-term complications of diabetes through better overall glucose control
5. Personalized treatment approaches based on individual glycogen metabolism and glucagon responsiveness

As research progresses, the intricate relationship between glucagon and glycogen continues to reveal new possibilities for enhancing diabetes management and improving patient outcomes. The future of glucose regulation therapy looks promising, with potential benefits extending beyond diabetes to other metabolic disorders.

Are glucagon and glycogen the same thing?

Medically reviewed by Melisa Puckey, BPharm. Last updated on June 6, 2023.

Are glucagon and glycogen the same thing?

No, glucagon and glycogen are NOT the same thing.

Glycogen is the stored form of energy that our body uses, and
glucagon is what induces the body to convert glycogen back into glucose to be used for energy.

What is the difference between glucose, glycogen, glucagon and GlucoGen?

There is often confusion between glucagon, glycogen and GlucaGen, and how they relate to glucose levels in the body.

Glucose is the sugar in our bloodstream that our body uses for energy.

Glycogen is a stored form of energy. After eating, when there is too much glucose to be used, the extra glucose is converted to glycogen to be stored. When blood glucose levels drop the glycogen gets converted back to glucose and is released into the bloodstream to be used.

Glucagon signals the body to convert the stored glycogen back into glucose. Glucagon is naturally produced in the body when blood sugars become low but is also manufactured as a medicine to treat very low blood sugar levels in diabetes.

GlucaGen is a brand name of the medicine glucagon injection, which is used to treat severe hypoglycemia (very low blood sugar) in diabetics, as it increases blood glucose levels.

So the difference between glycogen and glucagon is that

• glycogen is the stored form of energy that our body uses, and
• glucagon is what induces the body to convert glycogen back into glucose to be used for energy.

Summary:

Glucagon (produced naturally in the body or given as injection or nasal powder eg GlucoGen, Gvoke, Baqsimi) signals the body to convert the stored energy glycogen into glucose, which is released into the bloodstream.

References

• GlucaGen Medication Information: https://www. drugs.com/mtm/glucagen-injection.html
• Baqsimi Medication Information: https://www.drugs.com/baqsimi.html
• Gvoke Medication Information: https://www.drugs.com/gvoke.html

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Medical Disclaimer

Glucagon Therapy: A Comparison of Current and Novel Treatments

Diabetes Spectr. 2020 Nov; 33(4): 347–351.

doi: 10.2337/ds19-0076

Author information Copyright and License information Disclaimer

Hypoglycemia has been a barrier to A1C attainment in people with diabetes (1). It is well known that a glucocentric approach with intensive control reduces microvascular complications, but at what cost? Worse clinical outcomes, increased risk of severe hypoglycemia, and heavier treatment burden can result from aggressive efforts to lower A1C (2). People with diabetes also tend to experience more stress as a result of fear of hypoglycemia, higher costs of care, and increased prevalence of polypharmacy—especially for those with type 2 diabetes of longer duration. New medication classes (e.g., sodium–glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists) are providing impetus for replacing the glucocentric treatment paradigm with an individualized multifactorial approach (2).

Traditional glucagon kits have long been available for the ambulatory treatment of patients with hypoglycemia. However, these kits have disadvantages. Their complicated multistep injection procedure can be difficult to perform. Additionally, the use of glucagon must be taught to the family members, friends, or caregivers because it is administered by someone else when a person with diabetes is unconscious or otherwise incapacitated by severe hypoglycemia (3). For these reasons, glucagon is undertaught and underutilized (3).

Two new glucagon formulations offer potentially easier delivery. The purpose of this article is to review all available glucagon formulations, discussing the associated literature and possible new directions for the treatment of hypoglycemia.

The American Diabetes Association has adopted a three-level classification of hypoglycemia. Level 1 is a glucose concentration <70 and ≥54 mg/dL; level 2 is glucose <54 mg/dL; and level 3 is defined as a severe event characterized by altered mental and/or physical status requiring assistance (1). Symptoms include dizziness, shakiness, sweating, intense hunger or thirst, irritability, and anxiety.

Although many patients experience symptoms, possible impaired counterregulatory responses necessitate adherence to glucose concentrations as clinical indicators. Patients may adopt behaviors to avoid hypoglycemia in the short term; however, frequent hypoglycemia over the long term can have significant consequences (1). Young children with type 1 diabetes and elderly people with diabetes may have reduced recognizable symptoms and are particularly vulnerable (4,5). A history of level 3 hypoglycemia in older adults with type 2 diabetes may be correlated with increased dementia risk (4). Thus, fear of hypoglycemia can be a significant barrier to the attainment of glycemic targets.

Hypoglycemia treatment involves the ingestion of fast-acting carbohydrates when blood glucose is ≤70 mg/dL (1). Although pure glucose is the preferred treatment, any carbohydrate form containing glucose will suffice. For unconscious patients and those unable to ingest oral glucose, glucagon in the ambulatory setting or intravenous (IV) glucose or dextrose in the hospital setting is indicated.

The two traditional glucagon kits available in the United States are the Glucagon Emergency Kit (Eli Lilly) and the GlucaGen HypoKit (Novo Nordisk). Both were approved by the U.S. Food and Drug Administration (FDA) in 1998 for severe hypoglycemia, with no age limitations (6,7). They are structurally identical to the 29–amino acid human glucagon, with no clinically significant difference in terms of pharmacology, efficacy, or safety (8).

Whether given intramuscularly or subcutaneously, plasma glucose concentrations should increase within ∼10 minutes. The dose for adults and children weighing >55 lb (>6 years of age if weight is unknown) is 1 mg, reconstituted with the 1 mL diluent included in the kit. The dose is 0.5 mg for children <55 lb or <6 years of age. Glucagon should be administered immediately after reconstitution, and oral carbohydrate should be given after the patient regains consciousness and is able to swallow. Medical help should be sought if the patient does not respond to glucagon, with IV glucose or dextrose administered as soon as possible (8).

Both kits have instructions on the case. A brightly colored case contains a vial of glucagon powder and a prefilled syringe to provide a 1-mg/1-mL injection. Each kit includes specific directions (9). The user breaks off the plastic cap from the vial, and the diluent is injected into the vial. The contents are shaken until the reconstituted solution is clear and void of particulate matter. The solution is then drawn into the syringe and immediately injected into the unconscious patient’s thigh or abdomen. The patient is rolled over onto his or her side during recovery in case of vomiting.

Glucagon is contraindicated for people with a known hypersensitivity or pheochromocytoma, which could cause secondary hypoglycemia from catecholamine release after glucagon administration (6,7). The adverse reactions most often reported with glucagon have been nausea and vomiting. Glucagon given extraneously can interact with β-blockers (leading to increased pulse and blood pressure), indomethacin (possibly rendering the glucagon unable to raise blood glucose levels), anticholinergics (causing increased gastrointestinal side effects), and warfarin (possibly increasing its anticoagulant effect) (6,7).

Nasal Glucagon

Baqsimi Nasal Powder (Eli Lilly) is a nasal glucagon formulation that was approved by the FDA on 25 July 2019. It is a fixed dosage of 3 mg for the treatment of severe hypoglycemia in individuals who are ≥4 years of age (10). The portable, dry nasal spray needs no reconstitution or priming. This product can be stored at temperatures up to 86°F.

Longer-molecule hormones such as glucagon need a promoter (e.g., β-cyclodextrin plus dodecylphosphocholine) for intranasal administration (11). The bioavailability of intranasal glucagon generally is less than that of the traditional formulations, resulting in lower peak plasma concentrations. However, the clinical efficacy of intranasal glucagon is comparable to that of injectable formulations.

The nasal powder is dispensed ready to use in a single-dose dispenser (12). Instructions are printed on the shrink-wrapped tube label. The tip is inserted into one nostril and the plunger is pressed all the way until the green line is no longer showing. Inhalation is not required. A response should occur within 15 minutes. If no response occurs, an additional 3-mg dose from another dispenser may be administered. Regardless of response, emergency medical services should be called immediately after dose administration. Oral carbohydrates should be given when the patient responds.

Contraindications, warnings, precautions, and drug interactions are the same as with the traditionally available kits. The most common adverse reactions include nausea, vomiting, headache, upper respiratory tract irritation, watery eyes, redness of eyes, and itchy nose, throat, and eyes (12). Of note, one study compared the efficacy of the nasal powder in patients with nasal congestion and after recovery from cold symptoms and found no difference in blood glucagon or glucose concentrations, even before and after giving a nasal decongestant (13).

Two noninferiority clinical studies were conducted in adult patients, both as randomized, multicenter, open-label, crossover trials comparing a 3-mg dose of the nasal formulation with a 1-mg dose of glucagon for injection (14,15). The first study included 70 adults with type 1 diabetes, and the second included 83 adults with either type 1 or type 2 diabetes. Both groups achieved 100% treatment success in the first study, and, in the second study, success levels were 98.8 and 100% for intranasal administration and injection, respectively. Treatment success was defined as an increase in plasma glucose levels to ≥70 mg/dL or an increase of ≥20 mg/dL in plasma glucose from the nadir within 30 minutes of glucagon administration.

A total of 48 children and adolescents with type 1 diabetes ranging in age from 4 to 17 years were evaluated in one multicenter trial (16). After hypoglycemia was induced, children aged 4–8 years and those aged 8–12 years were randomized to receive either 2 or 3 mg at the first visit and the alternative dose at the second visit. Weight-based injectable glucagon was used as the comparator. For participants who were 12–17 years of age, 1 mg intramuscular glucagon and 3 mg intranasal glucagon were given in alternate visits. The primary outcome, an increase in glucose levels of ≥25 mg/dL from nadir, was achieved in all groups within 30 minutes of dosing, with no statistically significant differences among groups.

Liquid-Stable Glucagon

The Gvoke HypoPen (Xeris Pharmaceuticals) is a liquid-stable formulation (delivered via autoinjector) that was approved on 10 September 2019 for the treatment of severe hypoglycemia (17). Gvoke PFS, a prefilled syringe containing the same liquid glucagon formulation, was approved simultaneously. Both are approved for pediatric and adult patients with diabetes who are ≥2 years of age.

The main problem in the past with developing a stable liquid formulation that does not have to be mixed before administration was that amyloid-like fibrils form in aqueous solution (18). Both Gvoke formulations use a native human glucagon protein dissolved in an aprotic polar solvent, dimethyl sulfoxide (DMSO). Other FDA-approved injectable medications have used DMSO to promote stable liquid formulations (19).

Dose administration is weight dependent for pediatric patients aged 2 to <12 years (17). For those <45 kg, the recommended dose is 0.5 mg/0.1 mL. For those whose weight is ≥45 kg, the recommended dose is 1 mg/0.2 mL.

These products come packaged in a foil pouch with instructions. Before administration, the autoinjector or prefilled syringe should be inspected to ensure that the solution is clear and colorless and free of particulate matter. Injection with the autoinjector is intended to be similar to using an EpiPen, which injects when pressed against the body (17). Both products require subcutaneous injection in the lower abdomen, outer thigh, or upper arm. Emergency services should be contacted immediately after administration, and oral carbohydrates should be given when the patient is responsive. If response does not occur within 15 minutes, an additional dose from a new dispenser may be delivered.

Contraindications, warnings, precautions, and drug interactions are the same as with traditional kits, with one exception. The package inserts note that a skin rash, known as necrolytic migratory erythema, has been reported but is resolved with glucagon discontinuation (20). The most common adverse reactions for adults include nausea, vomiting, and injection site edema; hypoglycemia, headache, abdominal pain, hyperglycemia, injection site reactions, and urticaria additionally have been reported for pediatric patients. Drug interactions are similar to those of other glucagon products.

Clinical studies leading to FDA approval included two multicenter crossover trials with adults and one with pediatric participants, all with type 1 diabetes (20–22). The two studies in adults involved a total of 161 patients aged 18–74 years with two clinic visits 7 to 28 days apart. Random assignment of either the autoinjector or a traditional glucagon kit was administered on alternate clinic visits for patients with a mean plasma glucose manipulated to <45.2 mg/dL. Treatment success, as the primary end point, was defined as mean plasma glucose increased to >70 mg/dL or a relative increase of ≥20 mg/dL 30 minutes after glucagon administration. Treatment success rates were 98.7 and 100%, respectively, in the autoinjector and traditional glucagon kit groups and demonstrated noninferiority for the auto-injector. The median times to blood glucose elevation for treatment success were 13.8 and 10 minutes, respectively. In the study that included 31 pediatric patients, those who were 2–12 years of age were given a 0.5-mg dose, and those who were >12 years of age received 1 mg (or 0.5 mg, depending on weight). All pediatric patients were given the autoinjector and achieved a plasma glucose increase of ≥25 mg/dL.

As previously mentioned, fear of hypoglycemia is a significant barrier to achieving therapeutic A1C targets (23). Hypoglycemia symptoms can be uncomfortable and can lead to death in worse-case scenarios. Patients often adopt behaviors to avoid hypoglycemia. In older adults, especially those with frequent hypoglycemia, it can lead to substantial complications (24). Lowered adaptive physiologic responses to hypoglycemia can be accompanied by cognitive and functional loss over time. Thus, the availability of more ways to use glucagon as a counteractive measure to hypoglycemia may be of benefit for people with diabetes (10,17).

Simulation studies have compared the ease of use and patient and caregiver perceptions of traditional glucagon kits versus nasal and autoinjector formulations. One study comparing the nasal formulation to a traditional glucagon kit found that 90 and 13% of caregivers delivered full doses with the nasal and traditional formulations, respectively (25). A usability study with adult caregivers and first responders experienced with glucagon administration was also completed. Whereas 88% administered the autoinjector glucagon successfully, only 31% were successful with a traditional glucagon kit (26). Another study used telephone interviews to qualitatively compare nasal- versus autoinjector-delivered (27). Patients, caregivers, and acquaintances commented favorably regarding nasal glucagon, noting that that it appeared easy to carry and use, lacked a needle, and did not require removal of clothing and that others would most likely feel comfortable using it. Overall, the new glucagon formulations appear acceptable by patients and may offer improved ease of use compared with traditional injections.

Two mechanisms for developing stable, aqueous glucagon formulations are being studied: 1) using amino acid substitution in comparison with native glucagon and 2) using biochaperones (polymers, oligomers, and organic compounds) that form a complex with glucagon (18). Both methods protect against degradation and fibril formation. Dasiglucagon is an analog with seven substituted amino acids. The autoinjector and prefilled syringe for this investigatory agent currently uses a DMSO solvent for stabilization, as previously described, and other biochaperones are being studied (8).

Tight glycemic control reduces the risk of long-term microvascular complications of diabetes. However, attaining such control carries an increased risk of levels 1–3 hypoglycemic episodes. Even with levels 1 and 2, oral carbohydrate intake can be prohibitive when a patient is unwilling to ingest carbohydrates or unable to do so because of vomiting or nausea. Mini-dose glucagon, which involves giving a small dose of glucagon to raise blood glucose, has been used as an approach for such cases. The amount of glucagon used in this strategy is 1 unit per year of patient age. Blood glucose should be checked every 15 minutes, and the mini-dose should be repeated if blood glucose has not started to rise after 15 minutes or has not risen to >80 mg/dL within 30 minutes. Mini-dose glucagon has been studied for hypoglycemia in children and adults with type 1 diabetes and to prevent exercise-related hypoglycemia (28–30). The advantages of using mini-dose glucagon are that patients and caregivers are already familiar with syringes and that this approach could reduce patients’ fear of hypoglycemia. However, the price of glucagon dosing may be a disadvantage that could necessitate a novel formulation for widespread use of mini-dosing in the future (18).

New nasal and liquid-stable glucagon formulations offer the potential to optimize treatment during hypoglycemia episodes when patients are unresponsive or cannot ingest oral carbohydrates.

Duality of Interest

No potential conflicts of interest relevant to this article were reported.

Author Contributions

Both authors researched the data and wrote the manuscript. J.J.S. is the guarantor of this work and, as such, takes responsibility for the integrity of the data reported and the accuracy of the analysis.

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How to use the glucagon injection kit in an emergency

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Approximately 3 min.

This information will help you know what the glucagon emergency kit is and how to use it. It also provides instructions for carers of patients who may need emergency glucagon treatment.

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What is an emergency glucagon injection kit?

Glucagon Emergency Injection Kit is an intramuscular preparation. An intramuscular injection (shot) is an injection that is given directly into a muscle. The glucagon emergency injection kit does not come ready-to-use like some other drugs. You will need to prepare it just before use.

An emergency injection of glucagon will quickly raise your blood glucose (sugar) levels. This will ensure your safety in case of hypoglycemia (low blood sugar). It is important to begin treatment of hypoglycemia immediately. For more information, read the resource Understanding Hypoglycemia (Low Blood Sugar).

Glucagon Emergency Kit (see Figure 1) includes:

• a vial of glucagon in the form of a dry powder;
• syringe with sterile water.

Figure 1 Glucagon Emergency Kit

How to use the glucagon injection kit in an emergency

To give the injection, you will need a glucagon injection kit and an alcohol swab.

Do the following:

1. Open the glucagon injection kit. On the inside of the plastic container or on the paper insert, a graphic description in the form of drawings may be presented. Read and follow the instructions that come with the kit.
2. Remove the cap from the vial of glucagon powder (see Figure 2).

   Figure 2. Removing the plastic cover

3. Take the pre-filled syringe and remove the needle cap.

4. Insert the needle into the center of the rubber stopper. Slowly press down on the plunger of the syringe to inject all of the liquid into the glass vial (see Figure 3). Do not remove the needle from the vial.

   Figure 3. Injection of dilution liquid into glucagon vial

5. Gently shake or roll the vial between your palms to mix the contents. Hold the vial and syringe in one hand with the vial on top and the syringe on the bottom (see Figure 4). Mix until the powder is completely dissolved.

   The solution should be clear and colorless. Mixing may cause air bubbles to form. This is fine. Do not use the medicine if it is cloudy or shows solid particles that do not dissolve after mixing. Call 9 immediately11.

   Figure 4. Mixing glucagon powder with liquid

6. Hold the vial and syringe with the vial on top and the syringe on the bottom. Bring the tip of the needle to the bottom of the vial near the rubber stopper (see Figure 5).

   Gently pull the plunger of the syringe to draw the medicine from the vial into the syringe. If air is trapped in the top of the syringe, gently press the plunger to remove it.

   Figure 5 Filling the syringe with glucagon mixture

7. Choose an injection site. Glucagon can be injected into the upper thigh (upper leg), outer gluteal region, or upper outer arm. Clean the area with an alcohol swab if you have one.
8. Inject glucagon into the muscle. In one quick motion, insert the needle into the skin at a 90-degree angle (moving straight up and down). Press the plunger with your thumb and lower it all the way until you have injected all the medicine (see Figure 6).

   Inject glucagon through the person’s clothing only if you cannot quickly remove it from the injection site.

   Figure 6. Injection of glucagon into a muscle during an emergency

9. When the syringe is empty, withdraw the needle from the skin by moving vertically upwards.

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What to do after emergency glucagon treatment

‌After the injection, turn the person on their side. Sometimes glucagon causes vomiting, so turning on your side will help you avoid choking. Then call 911 and call an ambulance.

Check the person’s blood sugar level 15 minutes after administration. Usually a person regains consciousness after 15 minutes.

If the person regained consciousness after 15 minutes:

• If his blood sugar is still below 70 mg/dl, follow the 15/15 rule.
• If your blood sugar is 70 mg/dL or more, your next meal or small snack should be within 1 hour. Eating will prevent a second drop in blood sugar levels. A small snack may include one of the following foods:
  • Peanut butter or cheese with 4-5 crackers.
  • Half sandwich and 4 oz (120 ml) milk.
  • One serving of Greek yogurt.

If the person has not regained consciousness after 15 minutes:

• Give the second dose of the drug, if he has it.
• Wait for the ambulance to arrive.

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How to safely dispose of the glucagon injection kit in an emergency

Each emergency glucagon treatment device should only be used once. Throw it away after use. If the person needs repeat treatment, use a new device.

Do not throw needles and syringes directly into the trash or flush them down the toilet. Place them in a sharps container or a hard plastic container with a screw top, such as a detergent bottle. Label the container “ Household Medical Sharps – Not for Recycling “. For more information, read the resource How to Store and Dispose of Your Household Medical Needles.

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Date last updated

Friday, July 14, 2023

Glucagen 1 mg Hypokit: instructions, price, alternatives | lyophilisate for solution for injection Novo Nordisk

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• Pharmacological properties
• Indications Glucagen 1 mg Hypokit
• Application Glucagen 1 mg Hypokit
• Contraindications
• Side effects
• Special instructions
• Interactions
• Overdose
• Storage conditions
• Diagnosis
• Recommended alternatives
• Trade names

GlucaGen 1 mg HypoKit is a drug that contains biosynthetic glucagon, identical in structure to human glucagon.

Pharmacodynamics. Glucagon is a hyperglycemic agent that mobilizes liver glycogen, which is released into the blood as glucose. Glucagon will not be effective if there is a lack of glycogen in the liver. Therefore, the effect of glucagon is negligible or absent in patients who have not eaten for a long time, in patients with adrenal insufficiency, with chronic hypoglycemia or hypoglycemia caused by excessive alcohol consumption. Glucagon stimulates the release of catecholamines. In the presence of a pheochromocytoma, glucagon can cause the tumor to release significant amounts of catecholamines, leading to acute hypertensive reactions. Glucagon inhibits the tone and peristalsis of the smooth muscles of the gastrointestinal tract.

Pharmacokinetics. The metabolic clearance of glucagon in humans is 10 ml/kg/min. It is broken down by enzymes in the blood plasma and the organs into which it enters. The liver and kidneys are the main organs that determine the clearance of glucagon.

T _½ blood glucagon is 3-6 min. The onset of action was noted 1 min after the intravenous injection. The duration of action varies from 5 to 20 minutes, depending on the dose and organ. After an IM injection, the action begins after 5-15 minutes and lasts 10-40 minutes, depending on the dose and organ.

In the treatment of severe hypoglycemic reactions, effects on blood glucose levels are usually expected within 10 minutes.

severe hypoglycemic reactions that may occur in patients with insulin-dependent diabetes mellitus.

GlucaGen 1 mg HypoKit is supplied as a sterile lyophilized powder of glucagon (GlucaGen) in a 2 ml vial complete with diluent (sterile water for injection) in a 1.5 ml disposable syringe. The bottle has a protective plastic cap that must be removed to dissolve the powder. If the cap is loose on the vial or missing, the drug should not be used.

After dilution of glucagon powder with sterile water for injection, a solution is formed with a concentration of 1 mg (1 IU) per 1 ml.

Dissolve freeze-dried powder in the supplied solvent as indicated below. The solution of the drug GlukaGen 1 mg HypoKit is intended for s / c, / m or / in injections.

Dosage for adults. Inject the entire contents of the 1 ml vial.

Pediatric dosing. Use in children depends on the age and/or body weight of the child.

Children weighing >25 kg or aged 6–8 years, inject the entire contents of the 1 ml vial. For children weighing <25 kg or under the age of 6-8 years, the contents of ½ vial - 0.5 ml are administered.

Administer subcutaneously or intramuscularly. Usually the clinical effect of the drug administration occurs within 10 minutes. When the patient is able to swallow, he should eat a meal rich in carbohydrates to restore glycogen stores in the liver and prevent relapse. If the patient does not respond to the administration of the drug within 10 minutes, intravenous glucose should be administered.

Preparation of injection solution

1. Remove the orange cap from the vial. Insert the needle through the rubber stopper into the vial containing GlucaGen and inject the liquid from the syringe into the vial.

2. Without removing the needle from the vial, gently shake the vial until GlucaGen is completely dissolved and a clear solution is formed.

3. Make sure the piston is fully pushed forward. Collect the entire solution in a syringe. Care must be taken not to pull the plunger out of the syringe.

4. Bleed out the syringe and inject.

Administered by relatives, friends, and co-workers

In the case of severe hypoglycaemia, when the patient is in a state in which he cannot ingest carbohydrates, relatives or friends should inject glucagon sc or IM into the upper outer part of the muscles thighs (at the doses indicated above).

After the patient regains consciousness, he should be given food that contains carbohydrates to prevent recurrent hypoglycemia and consult a doctor.

hypersensitivity to glucagon or any component of the formulation; pheochromocytoma.

The most common side effects after administration of GlucaGen 1 mg HypoKit are nausea and vomiting, especially when administered in doses greater than 1 mg or when the drug is administered rapidly (less than 1 minute). Occasionally, nausea and vomiting may occur 2 to 3 hours after injection. In rare cases, secondary hypoglycemia may occur (see SPECIAL INSTRUCTIONS).

The frequency of side effects that occurred during clinical trials and / or in post-marketing observations associated with the use of the drug is indicated below. The frequency of adverse events that were not noted during clinical trials, but which were reported spontaneously, is designated as “very rare”.

The frequency of adverse reactions according to the data collected during the marketing research was listed as “very rare” (<1/10,000).

Estimated number of treatment episodes was 46,900,000 over a 16-year period.

The frequency of adverse reactions was assessed according to the following criteria: often (≥1/100 to <1/10), infrequently (≥1/1000 to <1/100), very rarely (≤1/10,000).

From the immune system: very rarely – hypersensitivity reactions, including anaphylactic reactions.

From the gastrointestinal tract: often – nausea; infrequently – vomiting; very rarely – pain in the abdominal cavity.

it must be remembered that glucagon is an insulin antagonist. Precautions should be observed when using GlucaGen 1 mg HypoKit in patients with insulinoma or glucagonoma.

Do not use solution if it has the consistency of a gel or powder GlucaGen has not completely dissolved.

Use in pregnancy and breastfeeding . GlucaGen 1 mg HypoKit does not cross the human placental barrier and can be used to treat severe hypoglycemia during pregnancy. Breast-feeding after the use of the drug in severe hypoglycemic reactions does not pose any risk to the child.

Children. Use in children depends on the age and/or body weight of the child.

Dosing is carried out according to the following scheme:

children weighing >25 kg or aged 6-8 years, enter the entire contents of the vial – 1 ml;

children weighing <25 kg or under the age of 6–8 years are administered the contents of ½ bottle - 0.5 ml.

The ability to influence the reaction rate when driving vehicles or working with other mechanisms. Studies of the effect of GlucaGen 1 mg HypoKit on the ability to drive vehicles or operate other mechanisms have not been conducted.

The following types of interactions may be noted when using the drug GlucaGen 1 mg HypoKit.

Insulin acts as an antagonist to the drug. In the presence of indomethacin GlucaGen 1 mg HypoKit may lose the ability to raise blood glucose levels or may act paradoxically and even cause hypoglycemia. GlucaGen 1 mg HypoKit may enhance the anticoagulant effect of warfarin .

Incompatible. Do not mix in the same syringe or vial with other medicines. It should be administered in the original syringe included in the package.

administration of GlucaGen 1 mg HypoKit in excessive dose may cause nausea and vomiting. Specific treatment in such cases, as a rule, is not required. A decrease in the concentration of potassium in the blood plasma can be noted, which requires monitoring and dose adjustment if necessary.