GLUCAGON

GlucaGen HypoKit

Reviewed by Clinical Practice Committee
February 2018
Administration Newborn Drug Protocol Index Newborn Services Home Page

Dose and Administration

  1. 200 microgram/kg/dose by slow IV injection over 1 minute: or IM or SC. Maximum dose 1mg; or or IM or SC. Maximum stat dose 1mg (1000 microgram).
  2. Continuous infusion 20 microgram/kg/hour. Consider starting dose of 20 microgram/kg/hour and decrease carefully, monitoring blood glucose, until the minimum effective dose is reached.

Indications

To treat hypoglycaemia

  1. When dextrose infusion is unavailable.
  2. Refractory hypoglycaemia with high dextrose requirements and/or fluid restriction.
  3. In documented cases of glucagon deficiency.

Contraindications and Precautions

  1. Hypersensitivity to glucagon or any excipients.
  2. Phaeochromocytom
  3. Use with caution in infants with hypertension
     

Clinical Pharmacology

Glucagon stimulates synthesis of cyclic AMP, especially in liver and adipose tissue. Stimulates gluconeogenesis. In high doses, glucagon has a positive cardiac inotropic effect. Inhibits small-bowel motility and gastric acid secretion.

Glucagon is secreted by the alpha-cells of the pancreas and transported via the portal circulation to the liver where the major portion is bound. From the liver it is excreted into the bile. A lesser portion is distributed to other organs, particularly the kidneys which have a high binding capacity for it. It is degraded enzymatically in blood plasma and in the organs to which it is distributed. Metabolised primarily in the liver.

Increased blood glucose levels occur within 5-30 minutes after injection and fall to normal or hypoglycaemia levels within 1-2 hours. Half-life reported in adults is 8-18 minutes.

Evidence

The data for the use of glucagon to treat neonatal hypoglycaemia are mostly from case series and reports.1, 2, 3 Glucose production in response to a glucagon 100 microgram/kg bolus was comparable in preterm, appropriately grown for age and small for gestational age infants.4

Possible Adverse Effects

Generally well tolerated. May cause transient increase in blood pressure and pulse

  1. Gastrointestinal disturbances (nausea and vomiting) and possible ileus
  2. Tachycardia.
  3. Rebound hypoglycaemia (result of insulin release and rebound effect).
  4. Hypersensitivity reactions and Anaphylaxis (rare -reported in adults).
  5. Hypertension and hypotension (rare).
  6. Hyponatraemia (variable reports)

Special Considerations

  1. Supplemental carbohydrates should be ongoing, parenteral or PO.
  2. Follow blood glucoses closely.
  3. May be of less benefit if liver glycogen stores are low or insulin secretion is excessive e.g. SGA babies or insulinoma.

References 

1 Carter PE, Lloyd DJ, Duffty P. Glucagon for hypoglycaemia in infants small for gestational age. Arch Dis Child. 1988;63:1264-6.
2 Charsha DS, McKinley PS, Whitfield JM. Glucagon infusion for treatment of hypoglycaemia: efficacy and safety in sick, preterm infants. Pediatrics. 2003;111:220-1.
3 Miralles RE, Lodha A, Perlman M, Moore AM. Experience with intravenous glucagon infusions as a treatment for resistant neonatal hypoglycaemia. Arch Pediatr Adolesc Med. 2002;156:999-1004.
4 Van Kempen AA, Ackermans MT, Endert E, Kok JH and Sauerwein HP. Glucose production in response to glucagon is comparable in preterm AGA and SGA infants. Clin Nutr. 2005;24:727-36.
5 Neonatal Medicines Formulary Consensus Group. Version 1, 18/05/2017