Glucagon Injection

Glucagon injection is approved for two main categories of use across the supported products.

• Severe hypoglycemia (very low blood sugar): Glucagon injection is used to treat life-threatening low blood sugar in people with diabetes mellitus, including both adults and children aged 2 and older. People with type 1 diabetes may see a smaller rise in blood sugar and need carbohydrates as soon as they are able to eat.
• Diagnostic aid during imaging: Gvoke VialDx, given intravenously by a healthcare provider, is used in adults during radiologic (X-ray or fluoroscopy) exams of the stomach, duodenum, small bowel, and colon to temporarily slow gut movement and improve image quality.

Glucagon is a natural hormone that tells the liver to break down its stored sugar reserves (glycogen) and release glucose into the blood, raising blood sugar levels. It works by activating specific receptors on liver cells. This is why it is effective in a low blood sugar emergency. Glucagon also relaxes the smooth muscle of the gastrointestinal tract — the stomach, small intestine, and colon — which is the property that makes it useful for slowing gut movement during imaging procedures.

One important limitation: glucagon can only raise blood sugar if the liver has enough stored glycogen. If glycogen stores are depleted — from prolonged fasting, starvation, adrenal insufficiency, or chronic low blood sugar — glucagon may not work.

For treating severe hypoglycemia, glucagon is injected under the skin (subcutaneously) in the lower abdomen, outer thigh, or outer upper arm as quickly as possible. Each device or vial contains a single dose — it cannot be reused. After giving the injection, call emergency services right away. If there is no response after 15 minutes, a second dose from a new device may be given while waiting for help. Once the person responds, give them oral carbohydrates promptly.

• For patients 12 years and older, a single standard dose is used; for children aged 2 to under 12 years, the dose depends on body weight — follow the prescriber's and product's instructions exactly.
• Gvoke VialDx for diagnostic use is given intravenously by a healthcare provider in a clinical setting only — it is not for home use.

The most commonly reported side effects differ slightly between the subcutaneous (under the skin) and intravenous uses:

Serious reactions — including severe allergic reactions (anaphylaxis with breathing difficulty and very low blood pressure) — have been reported. Seek emergency care immediately if these occur.

• Pheochromocytoma (adrenal tumor): Glucagon is contraindicated. It can cause the tumor to release stress hormones, leading to a sudden and severe spike in blood pressure.
• Insulinoma (insulin-producing tumor): Glucagon is contraindicated. It can trigger a dangerous rebound drop in blood sugar by stimulating excess insulin release.
• Glucagonoma (glucagon-producing tumor): Gvoke VialDx used as a diagnostic aid is contraindicated in these patients due to risk of secondary hypoglycemia.
• Serious allergic reactions: Anaphylaxis — including trouble breathing and a dangerous drop in blood pressure — has been reported. Stop use and get emergency care immediately if this happens.
• May not work if liver glycogen is depleted: People who are starving, have adrenal insufficiency, or have chronic hypoglycemia may not respond to subcutaneous glucagon. Emergency glucose (given through a vein) may be needed.
• Heart disease and Gvoke VialDx: Intravenous glucagon can increase heart rate, blood pressure, and the heart's oxygen demand. Cardiac monitoring is recommended when using Gvoke VialDx in patients with heart disease.
• Diabetes and Gvoke VialDx: This product can raise blood sugar in patients with diabetes when used for diagnostic imaging — monitor blood glucose closely.

Glucagon can interact with several medications in clinically meaningful ways:

• Beta-blockers (e.g., metoprolol, atenolol): may amplify a temporary rise in heart rate and blood pressure after glucagon — may need treatment in patients with coronary artery disease.
• Indomethacin (an NSAID pain reliever): can blunt glucagon's ability to raise blood sugar or even trigger hypoglycemia — monitor blood glucose carefully.
• Warfarin (blood thinner): glucagon can enhance warfarin's anticoagulant (blood-thinning) effect, increasing bleeding risk — monitor for unusual bruising or bleeding.
• Insulin: works against glucagon; blood sugar should be monitored when Gvoke VialDx is used in insulin-treated patients.
• Anticholinergic drugs: combining these with Gvoke VialDx adds to gut-slowing effects and increases the risk of gastrointestinal side effects — this combination is not recommended.

Not a complete list. The label covers the interactions the manufacturer studied or reported, and our own interaction database does not cover every medicine either. Bring your full medication list, including vitamins and herbal products, to your pharmacist.

• Do not use if you have pheochromocytoma — risk of a dangerous blood pressure surge.
• Do not use if you have insulinoma — risk of severe hypoglycemia after the dose.
• Do not use Gvoke VialDx as a diagnostic aid if you have glucagonoma.
• Do not use if you have had a prior allergic reaction to glucagon or any ingredient in these products.
• Tell your doctor if you are malnourished, have been fasting for a prolonged period, have adrenal insufficiency, or have chronic hypoglycemia — glucagon may not work to raise blood sugar.
• Tell your doctor if you have heart disease before receiving Gvoke VialDx — blood pressure and heart rate monitoring may be needed.
• Tell your doctor if you are pregnant: limited data in humans show no clear harm, but discuss with your provider. Glucagon does not appear to cross the placenta in early pregnancy based on available studies.
• Breastfeeding: glucagon is a protein and would be expected to break down in the infant's digestive tract; the risk to a breastfed baby is considered low, but discuss with your provider.
• Children: Subcutaneous glucagon is approved for children aged 2 and older for severe hypoglycemia. Gvoke VialDx has not been established as safe and effective in children.
• Older adults: Clinical studies did not include enough patients over 65 to confirm whether they respond differently — use with the same caution as younger adults.

If too much glucagon is given, the most likely effects are nausea, vomiting, and loose stools. High doses can temporarily raise blood pressure and heart rate, which may need treatment — especially in people with coronary artery disease or pheochromocytoma. Because glucagon is broken down quickly by the body, treatment is mainly focused on managing symptoms like nausea and monitoring potassium levels. Contact a Poison Control Center for guidance in a suspected overdose.

After injection, glucagon begins raising blood sugar within about 10 minutes, with peak blood glucose typically reached around 30 minutes after an intramuscular or subcutaneous injection. The blood-sugar-raising effect lasts roughly 60 to 90 minutes after intramuscular or intravenous injection. When used for diagnostic imaging, Gvoke VialDx given intravenously produces relaxation of the gut's smooth muscle rapidly — within about 45 seconds — with the effect lasting approximately 9 to 17 minutes.

After a subcutaneous injection of Gvoke in adults with type 1 diabetes, glucagon levels in the blood peak at around 50 minutes. Glucagon is broken down extensively in the liver, kidneys, and blood plasma. Its half-life — the time it takes for half the drug to be cleared from the body — is about 32 minutes, meaning it is eliminated from the body relatively quickly. Because it is a peptide (protein-based), glucagon is not absorbed if accidentally swallowed and would be digested in the gastrointestinal tract.

Before Reconstitution The package containing Glucagon for Injection vials may be stored up to 24 months at 20° to 25° C (68° to 77° F) prior to reconstitution. Do not freeze. Keep in the original package to protect from light.