LIVES Level 4 Glucagon PMA

Question 1

Glucagon

Inclusion Criteria

Answer 1

Diabetic patients presenting w/ signs and symptoms of hypoglycaemia, in whom oral glucose is contraindicated.

CBG < 4.0 mMol/L
Reduced conscious level - unresponsive to voice or pain
(AVPU = P or U)

Question 2

Glucagon

Exclusion Criteria

Answer 2

Patient can tolerate oral glucose
Alcohol or starvation induced hypoglycaemia (as glycogen stores are likely to be low)
Other cause of low glycogen (i.e. recent Glucagon Rx)
Known phaeochromocytoma
Known glucagon allergy
Hypoglycaemic seizures (IV glucose is preferable)

Question 3

Glucagon

Cautions - Medical

Answer 3

Insulinoma or glucagonoma

Avoid IM administration of any drug if Pt is likely to require thrombolysis (i.e. for MI or CVA)

Question 4

Glucagon

Cautions - Medications

Answer 4

Indomethacin
- glucagon may lose hyperglycaemic effect, may even produce hypoglycaemia

Warfarin [BNF - Severe Interaction]
- increased anticoagulant effect (raised INR)

Question 5

Glucagon

Name, Form, Strength

Answer 5

Glucagon Hydrochloride Injection

1 mg of powder in vial for reconstitution with water for injections

Question 6

Glucagon
Dose:
Adults & Children over 20 kg (8 yrs and above)

Answer 6

1 milligrams IM

Recheck CBG after 5-10 mins, should improve to > 5 mMol/L
If Pt has responded, administer Oral Glucose (AVPU = A or V) to prevent relapse
If no response, Pt requires IV glucose (carried by paramedics)

DO NOT GIVE IV

Question 7

Glucagon
Dose:
Children below 20 kg (usually below 8 yrs)

Answer 7

500 micrograms IM

Recheck CBG after 5-10 mins, should improve to > 5 mMol/L
If Pt has responded, administer Oral Glucose (AVPU = A or V) to prevent relapse
If no response, Pt requires IV glucose (carried by paramedics)

DO NOT GIVE IV

Question 8

Glucagon
Dose:
Children (Age < 1 month)

Answer 8

NOT SUITABLE FOR ADMINISTRATION IN CHILDREN YOUNGER THAN 1 MONTH

Question 9

Glucagon

Legal Status

Answer 9

Prescription Only Medicine

Included in Schedule 19 of the Human Medicines Regulations 2012 as a drug that can be administered for the purpose of saving a life in an emergency

Question 10

Glucagon

Route of Administration

Answer 10

Intramuscular Injection

• anterolateral thigh (preferable)
• deltoid

Question 11

Glucagon

Maximum Number of Doses

Answer 11

Single dose for acute administration only

- time well documented

Question 12

Glucagon

Adverse Effects

Answer 12

Occasional:
Nausea
Vomiting
Diarrhoea
Hypotension
Hypokalaemia

Rare:
Tachycardia
Hypersensitivity Reactions