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22658 Glucagon, Plasma (GLP)

Glucagon, Plasma (GLP)
Test Code: GLUGASO
Synonyms/Keywords
​Ref Lab Code: 9358, Glucagon, P
Useful For
​Diagnosis and follow-up of glucagonomas and other glucagon-producing tumors
 
Assessing diabetic patients with problematic hyper- or hypoglycemic episodes (extremely limited utility)
 
Glucagon is routinely measured along with serum glucose, insulin, and C-peptide levels, during the mixed-meal test employed in the diagnostic workup of suspected postprandial hypoglycemia. However, it plays only a minor role in the interpretation of this test.
Specimen Requirements
Fasting Required Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
​Yes Plasma​ EDTA Lavender Top Tube (LTT)​ ​ 2 mL​ 0.45 mL​ ​
Collection Processing Instructions
​1. Fasting.
2. Prechill tube at 4 degrees C before drawing the specimen.
3. Draw the prechilled tube, and process as follows:
a. After drawing specimen, chill tube in wet ice for 10 minutes.
b. Centrifuge in a refrigerated centrifuge or in chilled centrifuge cup.
c. Immediately after centrifugation, remove plasma, place in a plastic transport vial, and freeze.
Specimen Stability Information
Specimen Type Temperature Time
Plasma Frozen​ ​90 days
Rejection Criteria
Gross hemolysis
Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
Mayo Medical Laboratories​
 Monday, Thursday​
2 days​
Immunoassay Following Extraction​
Reference Lab
Mayo Clinic Laboratories
Reference Range Information
< or =6 hours: 100-650 pg/mL
1-2 days: 70-450 pg/mL
2-4 days: 100-650 pg/mL
4-14 days: declining gradually to adult levels
>14 days: < or =80 pg/mL (range based on 95% confidence limits)
Glucagon levels are inversely related to blood glucose levels at all ages. This is particularly pronounced at birth and shortly thereafter, until regular feeding patterns are established. This explains the higher levels immediately after birth, which then first fall as the glucagon release mobilizes the infant's glucose stores, then rise again as stores are depleted, finally normalizing towards adult levels as regular feeding patterns are established.​
Interpretation
​Elevated glucagon levels in the absence of hypoglycemia may indicate the presence of a glucagon-secreting tumor. Successful treatment of a glucagon-secreting tumor is associated with normalization of glucagon levels.
 
Inappropriate elevations in glucagon levels in hyperglycemic type I diabetic patients indicate that paradoxical glucagon release may contribute to disease severity. This can be observed if insulin treatment is inadequate and patients are ketotic. However, glucagon measurement plays little, if any, role in the diagnostic workup of diabetic ketoacidosis, which is based on demonstrating significantly elevated plasma or serum glucose (>250 mg/dL), circulating ketones (beta-hydroxy butyrate), and acidosis (typically with increased anion gap).
 
In diabetic patients, low glucagon levels (undetectable or in the lower quartile of the normal range) in the presence of hypoglycemia indicate impairment of hypoglycemic counter-regulation. These patients may be particularly prone to recurrent hypoglycemia. This can be a permanent problem due to islet alpha-cell destruction or other, less well understood processes (eg, autonomous neuropathy). It can also be functional, most often due to over tight blood-glucose control, and may be reversible after decreasing insulin doses.
Outreach CPTs
CPT Modifier
(if needed)		 Quantity Description Comments
​82943 ​ ​ ​ ​
Synonyms/Keywords
​Ref Lab Code: 9358, Glucagon, P
Ordering Applications
Ordering Application Description
​Centricity ​Glucagon, Plasma
​Cerner ​Glucagon, Plasma (9358)
If the ordering application you are looking for is not listed, contact your local laboratory for assistance.
Specimen Requirements
Fasting Required Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
​Yes Plasma​ EDTA Lavender Top Tube (LTT)​ ​ 2 mL​ 0.45 mL​ ​
Collection Processing
​1. Fasting.
2. Prechill tube at 4 degrees C before drawing the specimen.
3. Draw the prechilled tube, and process as follows:
a. After drawing specimen, chill tube in wet ice for 10 minutes.
b. Centrifuge in a refrigerated centrifuge or in chilled centrifuge cup.
c. Immediately after centrifugation, remove plasma, place in a plastic transport vial, and freeze.
Specimen Stability Information
Specimen Type Temperature Time
Plasma Frozen​ ​90 days
Rejection Criteria
Gross hemolysis
Useful For
​Diagnosis and follow-up of glucagonomas and other glucagon-producing tumors
 
Assessing diabetic patients with problematic hyper- or hypoglycemic episodes (extremely limited utility)
 
Glucagon is routinely measured along with serum glucose, insulin, and C-peptide levels, during the mixed-meal test employed in the diagnostic workup of suspected postprandial hypoglycemia. However, it plays only a minor role in the interpretation of this test.
Reference Range Information
< or =6 hours: 100-650 pg/mL
1-2 days: 70-450 pg/mL
2-4 days: 100-650 pg/mL
4-14 days: declining gradually to adult levels
>14 days: < or =80 pg/mL (range based on 95% confidence limits)
Glucagon levels are inversely related to blood glucose levels at all ages. This is particularly pronounced at birth and shortly thereafter, until regular feeding patterns are established. This explains the higher levels immediately after birth, which then first fall as the glucagon release mobilizes the infant's glucose stores, then rise again as stores are depleted, finally normalizing towards adult levels as regular feeding patterns are established.​
Interpretation
​Elevated glucagon levels in the absence of hypoglycemia may indicate the presence of a glucagon-secreting tumor. Successful treatment of a glucagon-secreting tumor is associated with normalization of glucagon levels.
 
Inappropriate elevations in glucagon levels in hyperglycemic type I diabetic patients indicate that paradoxical glucagon release may contribute to disease severity. This can be observed if insulin treatment is inadequate and patients are ketotic. However, glucagon measurement plays little, if any, role in the diagnostic workup of diabetic ketoacidosis, which is based on demonstrating significantly elevated plasma or serum glucose (>250 mg/dL), circulating ketones (beta-hydroxy butyrate), and acidosis (typically with increased anion gap).
 
In diabetic patients, low glucagon levels (undetectable or in the lower quartile of the normal range) in the presence of hypoglycemia indicate impairment of hypoglycemic counter-regulation. These patients may be particularly prone to recurrent hypoglycemia. This can be a permanent problem due to islet alpha-cell destruction or other, less well understood processes (eg, autonomous neuropathy). It can also be functional, most often due to over tight blood-glucose control, and may be reversible after decreasing insulin doses.
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Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
Mayo Medical Laboratories​
 Monday, Thursday​
2 days​
Immunoassay Following Extraction​
Reference Lab
Mayo Clinic Laboratories
For billing questions, see Contacts
Outreach CPTs
CPT Modifier
(if needed)		 Quantity Description Comments
​82943 ​ ​ ​ ​
For most current information refer to the Marshfield Laboratory online reference manual.