Ask Joslin: Glucagon

What is glucagon and do I need to take it?

We tend to think of diabetes as a disease related to insulin and it is. However, keeping your blood glucose in the target range is a function of two hormones: insulin and glucagon. Insulin helps to lower blood glucose by moving glucose into the muscle and fat cells when glucose is high, such as after a meal. Glucagon which is secreted by the alpha cells in the pancreas has the opposite role. Its job is to raise the level of glucose in the blood when it is too low.

During the night or anytime when blood glucose drops too low, glucagon is secreted by the alpha cells in the pancreas. Glucagon functions to stimulate the liver to secret glucose. It does this by promoting the breakdown of glycogen, a storage form of glucose, into glucose.

It also causes the liver to start rebuilding glycogen from available amino acids. The amino acids that make up protein molecules are composed of carbohydrate backbones that can be used to make glucose. This process is called gluconeogenesis.

Diabetes affects the systems of both insulin and glucagon. Normally glucagon is only called on when glucose levels are depressed. But in people with diabetes, sometimes the internal thermostat that regulates glucagon release is impaired and glucagon is secreted even when glucose levels are elevated. This often happens overnight. You may have heard of something called the Dawn Effect. This occurs when blood glucose levels rises precipitously in the early morning hours without the addition of carbohydrate.

This same hormone comes in an injectable form to be used in cases of emergency, such as if you become unconscious during an episode of hypoglycemia or are unable to swallow. If you are able to take oral treatment (even with help) it is best to administer it.

Glucagon injections are usually used by people with type 1 diabetes. That is because people with type 2 don’t often experience the severe low blood glucose levels that cause unconsciousness. Since it is likely that you will be unconscious when glucagon is used; someone else will give you the injection. That is why you need to teach whoever you select as your partner in this endeavor.

Your partner will need to know how to assemble the glucagon kit and then feel confident enough to give you an injection. It is a good idea to practice every so often so if the occasion arises, the procedure is second nature.

Glucagon comes in a kit containing a vial with powder and a syringe filled with liquid. In order to use the glucagon effectively, all of the effluent must be mixed with the powder. Once this happens the mixed solution is drawn into the syringe. Glucagon can cause nausea and vomiting; it is important you are turned on your side while administering glucagon to avoid aspiration. It can be injected into any fatty tissue: a good place is the buttocks. It usually starts working in about 10 to 15 minutes.

Even though your partner has injected glucagon it is still important to call an ambulance to have it at the ready in case it is needed.

As soon as you are alert enough to swallow, have your partner give you 15 to 30 grams of carbohydrate, such as four to eight ounces of juice or regular soda, or four to eight glucose tablets. Once any nausea has resolved, have a 15 to 30 gram carbohydrate snack.

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