Glucose-raising hormone · hypoglycemia
Made by the pancreas, glucagon is a single chain of 29 amino acids1 and the main hormone that counterbalances insulin, pushing blood sugar back up by drawing on the liver's glucose stores2. As a medicine it is used to rescue people with diabetes from severe low blood sugar and, in radiology, to briefly quiet the gut during imaging.
By activating glucagon receptors in the liver, glucagon stimulates the breakdown of stored glycogen and the release of glucose into the blood1,2. Because it depends on those stores, it may not work in people whose liver glycogen is depleted, such as during starvation, adrenal insufficiency or long-lasting low blood sugar; they need glucose instead1. Glucagon also relaxes the smooth muscle of the stomach and intestines, briefly slowing their movement, which is why some forms are approved as a diagnostic aid for radiologic exams of the gut1,5. Newer products change the delivery rather than the molecule: Baqsimi is a dry powder sprayed into the nose2, and Gvoke is a liquid solution that skips the mixing step older emergency kits required4,5.
Glucagon's role in severe hypoglycemia is long established, so recent human trials focus on easier delivery. In a randomized crossover trial in 75 adults with type 1 diabetes, nasal glucagon met its success criteria at all but one visit (98.7%) versus 100% for an injected kit, with mean recovery times of 16 versus 13 minutes; head and facial discomfort was more common with the nasal form3. Two phase 3 crossover trials in 161 adults with type 1 diabetes found a ready-to-use autoinjector non-inferior to the traditional kit; glucose recovered a few minutes more slowly, but preparing and giving it took about 27 seconds instead of 974. These trials induced low blood sugar with insulin under supervision, so real emergencies may differ. The nasal form is now approved for children from age one2.
FDA-approved in several forms, including generic glucagon for injection, Gvoke and the nasal powder Baqsimi, for severe hypoglycemia in people with diabetes; some forms are also approved as a diagnostic aid in radiology1,2,5. The first glucagon product was approved in 1960.
Labels list nausea, vomiting, headache, dizziness and injection-site reactions, and for the nasal form, irritation of the nose, eyes and throat1,2. Glucagon is contraindicated in pheochromocytoma, where it can sharply raise blood pressure, and in insulinoma, where it can provoke rebound low blood sugar. Serious allergic reactions, including anaphylaxis, have been reported. Continuous infusions have been linked to a rash called necrolytic migratory erythema1.
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