Explain to your patient the importance of monitoring her blood glucose levels at home. Ideally, she should monitor blood glucose four or more times a day-before all meals and before a bedtime snack. Teach her how to use her glucose monitoring equipment . Explain that errors in technique can lead to inaccurate results, which can in turn lead to poor treatment decisions. Reevaluate her technique regularly.Encourage your patient to maintain a written log of blood glucose levels even if the meter on her machine stores information. She should also record her activity status and eating patterns. Instruct her to take her log to her regular physician appointments.

Your patient should monitor her urine for ketones when blood glucose levels are more than 250 mg/dl and when she feels unusually stressed. Tablets, strips, and tapes are available for urine ketone testing.

Glucagon

Glucagon is a drug used to treat hypoglycemia and a polypeptide hormone produced and secreted by the alpha cells of the pancreas in response to hypoglycemia. The action of glucagon opposes the action of insulin. When released, glucagon helps to maintain blood levels of glucose by accelerating liver glycogenolysis and gluconeogenesis and reducing glycogen synthesis.

Glucagon can be administered subcutaneously, intramuscularly (I.M.), or I.V. The onset of action is rapid: 5 to 20 minutes subcutaneously, 8 to 10 minutes I.M., and 1 minute I.V.

However, glucagon isn’t the first line of defense against hypoglycemia. At the first sign of hypoglycemia, your patient should eat 10 to 15 grams of carbohydrate. If this doesn’t resolve the hypoglycemia or the patient can’t take carbohydrates orally, teach the family to inject 0.5 to 1.0 mg of glucagon. Then they should monitor the patient’s blood glucose levels. Explain that the patient may experience nausea after a glucagon injection. If the patient doesn’t respond to the first dose in 20 minutes, a family member should administer another 0.5 to 1.0 mg of glucagon. Instruct the family to seek emergency treatment if the patient doesn’t respond after two glucagon injections.

Instruct the patient and her family to keep a glucagon emergency kit handy. Review with them when and how to use it. Teach them to check the expiration date at least once a month and to replace the kit with a new one when it expires.

Indications and Contraindications

Glucagon is used to treat severe hypoglycemia in patients with diabetes. People who are hypersensitive to glucagon shouldn’t use it. Pregnant women and nursing mothers should use glucagon cautiously because its effects in them aren’t known.

Adverse Effects and Interactions

Nausea and vomiting are common adverse effects of glucagon. Some patients experience generalized allergic reactions such as rash, urticaria, respiratory distress, or hypotension.

Patients who take oral anticoagulant drugs may be prone to bleeding because glucagon increases their hypoprothrombinemic effects. The interaction occurs several days after therapy begins and appears to be dose related. Monitor the patient’s prothrombin time, and adjust her dose accordingly. No food interactions are known.