Persistent Hypoglycemia, Newborn, N/IICU — Glucagon Stimulation Test — Clinical Pathway: ICU

Newborn Persistent Hypoglycemia Clinical Pathway — N/IICU

Glucagon Stimulation Test

  • Glucagon is a peptide hormone that stimulates glycogenolysis to release glucose from the liver.
  • It is inappropriate to have glycogen stores at the time of hypoglycemia.
  • Insulin inhibits glycogenolysis; a positive glycemic response to glucagon suggests that insulin excess is the cause of hypoglycemia.

Performing the Test

  1. Check bedside glucose to confirm a glucose of < 50 mg/dL
  2. Give Glucagon 1 mg IV/IM/SQ
    • If given IV, must be given IV push and flushed with NSS
    • Do not flush with dextrose, as this will confound results
  3. Follow bedside glucoses q 10 minutes times 4
  4. If no significant rise in blood glucose (up by 20 mg/dL) by 20 min post glucagon, or you have completed the 4 bedside studies (40 min), feed patient and/or resume IV dextrose at pre-testing rate.
  • Note: the effect of glucagon lasts approximately 60 minutes; rebound hypoglycemia can occur following glucagon administration.
    • Main side effect is vomiting

Interpreting the Results

  • The test is considered diagnostic of hyperinsulinism if:
    • Blood glucose post glucagon rises by at least 30 mg/dL
    • Generally occurs in the first 20-40 minutes post glucagon