119 lines
70 KiB
Text
119 lines
70 KiB
Text
<!DOCTYPE html>
|
|
<html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" class="no-js no-jr">
|
|
<head>
|
|
<!-- For pinger, set start time and add meta elements. -->
|
|
<script type="text/javascript">var ncbi_startTime = new Date();</script>
|
|
|
|
<!-- Logger begin -->
|
|
<meta name="ncbi_db" content="books">
|
|
<meta name="ncbi_pdid" content="book-part">
|
|
<meta name="ncbi_acc" content="NBK548016">
|
|
<meta name="ncbi_domain" content="livertox">
|
|
<meta name="ncbi_report" content="reader">
|
|
<meta name="ncbi_type" content="fulltext">
|
|
<meta name="ncbi_objectid" content="">
|
|
<meta name="ncbi_pcid" content="/NBK548016/?report=reader">
|
|
<meta name="ncbi_pagename" content="Insulin - LiverTox - NCBI Bookshelf">
|
|
<meta name="ncbi_bookparttype" content="chapter">
|
|
<meta name="ncbi_app" content="bookshelf">
|
|
<!-- Logger end -->
|
|
|
|
<!--component id="Page" label="meta"/-->
|
|
<script type="text/javascript" src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.boots.min.js"> </script><title>Insulin - LiverTox - NCBI Bookshelf</title>
|
|
<meta charset="utf-8">
|
|
<meta name="apple-mobile-web-app-capable" content="no">
|
|
<meta name="viewport" content="initial-scale=1,minimum-scale=1,maximum-scale=1,user-scalable=no">
|
|
<meta name="jr-col-layout" content="auto">
|
|
<meta name="jr-prev-unit" content="/books/n/livertox/InotuzumabOzogamicin/?report=reader">
|
|
<meta name="jr-next-unit" content="/books/n/livertox/InterferonGamma/?report=reader">
|
|
<meta name="bk-toc-url" content="/books/n/livertox/?report=toc">
|
|
<meta name="robots" content="INDEX,FOLLOW,NOARCHIVE">
|
|
<meta name="citation_inbook_title" content="LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]">
|
|
<meta name="citation_title" content="Insulin">
|
|
<meta name="citation_publisher" content="National Institute of Diabetes and Digestive and Kidney Diseases">
|
|
<meta name="citation_date" content="2018/04/26">
|
|
<meta name="citation_pmid" content="31643348">
|
|
<meta name="citation_fulltext_html_url" content="https://www.ncbi.nlm.nih.gov/books/NBK548016/">
|
|
<link rel="schema.DC" href="http://purl.org/DC/elements/1.0/">
|
|
<meta name="DC.Title" content="Insulin">
|
|
<meta name="DC.Type" content="Text">
|
|
<meta name="DC.Publisher" content="National Institute of Diabetes and Digestive and Kidney Diseases">
|
|
<meta name="DC.Date" content="2018/04/26">
|
|
<meta name="DC.Identifier" content="https://www.ncbi.nlm.nih.gov/books/NBK548016/">
|
|
<meta name="description" content="Insulin is a pancreatic hormone that plays an essential role in regulation of blood glucose as well as lipid and carbohydrate metabolism. Both natural and recombinant forms of insulin are used therapeutically to treat type 1 diabetes. While insulin itself is not hepatotoxic and has not been linked to serum enzyme elevations or instances of clinically apparent liver injury, high doses including overdoses of insulin and glucose can result in hepatic glycogenosis and serum aminotransferase elevations.">
|
|
<meta name="og:title" content="Insulin">
|
|
<meta name="og:type" content="book">
|
|
<meta name="og:description" content="Insulin is a pancreatic hormone that plays an essential role in regulation of blood glucose as well as lipid and carbohydrate metabolism. Both natural and recombinant forms of insulin are used therapeutically to treat type 1 diabetes. While insulin itself is not hepatotoxic and has not been linked to serum enzyme elevations or instances of clinically apparent liver injury, high doses including overdoses of insulin and glucose can result in hepatic glycogenosis and serum aminotransferase elevations.">
|
|
<meta name="og:url" content="https://www.ncbi.nlm.nih.gov/books/NBK548016/">
|
|
<meta name="og:site_name" content="NCBI Bookshelf">
|
|
<meta name="og:image" content="https://www.ncbi.nlm.nih.gov/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-livertox-lrg.png">
|
|
<meta name="twitter:card" content="summary">
|
|
<meta name="twitter:site" content="@ncbibooks">
|
|
<meta name="bk-non-canon-loc" content="/books/n/livertox/Insulin/?report=reader">
|
|
<link rel="canonical" href="https://www.ncbi.nlm.nih.gov/books/NBK548016/">
|
|
<link href="https://fonts.googleapis.com/css?family=Archivo+Narrow:400,700,400italic,700italic&subset=latin" rel="stylesheet" type="text/css">
|
|
<link rel="stylesheet" href="/corehtml/pmc/jatsreader/ptpmc_3.22/css/libs.min.css">
|
|
<link rel="stylesheet" href="/corehtml/pmc/jatsreader/ptpmc_3.22/css/jr.min.css">
|
|
<meta name="format-detection" content="telephone=no">
|
|
<link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books.min.css" type="text/css">
|
|
<link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css//books_print.min.css" type="text/css" media="print">
|
|
<link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books_reader.min.css" type="text/css">
|
|
<style type="text/css">p a.figpopup{display:inline !important} .bk_tt {font-family: monospace} .first-line-outdent .bk_ref {display: inline} .body-content h2, .body-content .h2 {border-bottom: 1px solid #97B0C8} .body-content h2.inline {border-bottom: none} a.page-toc-label , .jig-ncbismoothscroll a {text-decoration:none;border:0 !important} .temp-labeled-list .graphic {display:inline-block !important} .temp-labeled-list img{width:100%}</style>
|
|
|
|
<link rel="shortcut icon" href="//www.ncbi.nlm.nih.gov/favicon.ico">
|
|
<meta name="ncbi_phid" content="CE8B62F17D7D9B410000000000400032.m_5">
|
|
<meta name='referrer' content='origin-when-cross-origin'/><link type="text/css" rel="stylesheet" href="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/css/3852956/3849091.css"></head>
|
|
<body>
|
|
<!-- Book content! -->
|
|
|
|
|
|
<div id="jr" data-jr-path="/corehtml/pmc/jatsreader/ptpmc_3.22/"><div class="jr-unsupported"><table class="modal"><tr><td><span class="attn inline-block"></span><br />Your browser does not support the NLM PubReader view.<br />Go to <a href="/pmc/about/pr-browsers/">this page</a> to see a list of supported browsers<br />or return to the <br /><a href="/books/NBK548016/?report=classic">regular view</a>.</td></tr></table></div><div id="jr-ui" class="hidden"><nav id="jr-head"><div class="flexh tb"><div id="jr-tb1"><a id="jr-links-sw" class="hidden" title="Links"><svg xmlns="http://www.w3.org/2000/svg" version="1.1" x="0px" y="0px" viewBox="0 0 70.6 85.3" style="enable-background:new 0 0 70.6 85.3;vertical-align:middle" xml:space="preserve" width="24" height="24">
|
|
<style type="text/css">.st0{fill:#939598;}</style>
|
|
<g>
|
|
<path class="st0" d="M36,0C12.8,2.2-22.4,14.6,19.6,32.5C40.7,41.4-30.6,14,35.9,9.8"></path>
|
|
<path class="st0" d="M34.5,85.3c23.2-2.2,58.4-14.6,16.4-32.5c-21.1-8.9,50.2,18.5-16.3,22.7"></path>
|
|
<path class="st0" d="M34.7,37.1c66.5-4.2-4.8-31.6,16.3-22.7c42.1,17.9,6.9,30.3-16.4,32.5h1.7c-66.2,4.4,4.8,31.6-16.3,22.7 c-42.1-17.9-6.9-30.3,16.4-32.5"></path>
|
|
</g>
|
|
</svg> Books</a></div><div class="jr-rhead f1 flexh"><div class="head"><a href="/books/n/livertox/InotuzumabOzogamicin/?report=reader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M75,30 c-80,60 -80,0 0,60 c-30,-60 -30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Prev</text></svg></a></div><div class="body"><div class="t">Insulin</div><div class="j">LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]</div></div><div class="tail"><a href="/books/n/livertox/InterferonGamma/?report=reader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M25,30c80,60 80,0 0,60 c30,-60 30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Next</text></svg></a></div></div><div id="jr-tb2"><a id="jr-bkhelp-sw" class="btn wsprkl hidden" title="Help with NLM PubReader">?</a><a id="jr-help-sw" class="btn wsprkl hidden" title="Settings and typography in NLM PubReader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 512 512" preserveAspectRatio="none"><path d="M462,283.742v-55.485l-29.981-10.662c-11.431-4.065-20.628-12.794-25.274-24.001 c-0.002-0.004-0.004-0.009-0.006-0.013c-4.659-11.235-4.333-23.918,0.889-34.903l13.653-28.724l-39.234-39.234l-28.72,13.652 c-10.979,5.219-23.68,5.546-34.908,0.889c-0.005-0.002-0.01-0.003-0.014-0.005c-11.215-4.65-19.933-13.834-24-25.273L283.741,50 h-55.484l-10.662,29.981c-4.065,11.431-12.794,20.627-24.001,25.274c-0.005,0.002-0.009,0.004-0.014,0.005 c-11.235,4.66-23.919,4.333-34.905-0.889l-28.723-13.653l-39.234,39.234l13.653,28.721c5.219,10.979,5.545,23.681,0.889,34.91 c-0.002,0.004-0.004,0.009-0.006,0.013c-4.649,11.214-13.834,19.931-25.271,23.998L50,228.257v55.485l29.98,10.661 c11.431,4.065,20.627,12.794,25.274,24c0.002,0.005,0.003,0.01,0.005,0.014c4.66,11.236,4.334,23.921-0.888,34.906l-13.654,28.723 l39.234,39.234l28.721-13.652c10.979-5.219,23.681-5.546,34.909-0.889c0.005,0.002,0.01,0.004,0.014,0.006 c11.214,4.649,19.93,13.833,23.998,25.271L228.257,462h55.484l10.595-29.79c4.103-11.538,12.908-20.824,24.216-25.525 c0.005-0.002,0.009-0.004,0.014-0.006c11.127-4.628,23.694-4.311,34.578,0.863l28.902,13.738l39.234-39.234l-13.66-28.737 c-5.214-10.969-5.539-23.659-0.886-34.877c0.002-0.005,0.004-0.009,0.006-0.014c4.654-11.225,13.848-19.949,25.297-24.021 L462,283.742z M256,331.546c-41.724,0-75.548-33.823-75.548-75.546s33.824-75.547,75.548-75.547 c41.723,0,75.546,33.824,75.546,75.547S297.723,331.546,256,331.546z"></path></svg></a><a id="jr-fip-sw" class="btn wsprkl hidden" title="Find"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 550 600" preserveAspectRatio="none"><path fill="none" stroke="#000" stroke-width="36" stroke-linecap="round" style="fill:#FFF" d="m320,350a153,153 0 1,0-2,2l170,170m-91-117 110,110-26,26-110-110"></path></svg></a><a id="jr-rtoc-sw" class="btn wsprkl hidden" title="Table of Contents"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M20,20h10v8H20V20zM36,20h44v8H36V20zM20,37.33h10v8H20V37.33zM36,37.33h44v8H36V37.33zM20,54.66h10v8H20V54.66zM36,54.66h44v8H36V54.66zM20,72h10v8 H20V72zM36,72h44v8H36V72z"></path></svg></a></div></div></nav><nav id="jr-dash" class="noselect"><nav id="jr-dash" class="noselect"><div id="jr-pi" class="hidden"><a id="jr-pi-prev" class="hidden" title="Previous page"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M75,30 c-80,60 -80,0 0,60 c-30,-60 -30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Prev</text></svg></a><div class="pginfo">Page <i class="jr-pg-pn">0</i> of <i class="jr-pg-lp">0</i></div><a id="jr-pi-next" class="hidden" title="Next page"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M25,30c80,60 80,0 0,60 c30,-60 30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Next</text></svg></a></div><div id="jr-is-tb"><a id="jr-is-sw" class="btn wsprkl hidden" title="Switch between Figures/Tables strip and Progress bar"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><rect x="10" y="40" width="20" height="20"></rect><rect x="40" y="40" width="20" height="20"></rect><rect x="70" y="40" width="20" height="20"></rect></svg></a></div><nav id="jr-istrip" class="istrip hidden"><a id="jr-is-prev" href="#" class="hidden" title="Previous"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M80,40 60,65 80,90 70,90 50,65 70,40z M50,40 30,65 50,90 40,90 20,65 40,40z"></path><text x="35" y="25" textLength="60" style="font-size:25px">Prev</text></svg></a><a id="jr-is-next" href="#" class="hidden" title="Next"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M20,40 40,65 20,90 30,90 50,65 30,40z M50,40 70,65 50,90 60,90 80,65 60,40z"></path><text x="15" y="25" textLength="60" style="font-size:25px">Next</text></svg></a></nav><nav id="jr-progress"></nav></nav></nav><aside id="jr-links-p" class="hidden flexv"><div class="tb sk-htbar flexh"><div><a class="jr-p-close btn wsprkl">Done</a></div><div class="title-text f1">NCBI Bookshelf</div></div><div class="cnt lol f1"><a href="/books/">Home</a><a href="/books/browse/">Browse All Titles</a><a class="btn share" target="_blank" rel="noopener noreferrer" href="https://www.facebook.com/sharer/sharer.php?u=https://www.ncbi.nlm.nih.gov/books/NBK548016/"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 33 33" style="vertical-align:middle" width="24" height="24" preserveAspectRatio="none"><g><path d="M 17.996,32L 12,32 L 12,16 l-4,0 l0-5.514 l 4-0.002l-0.006-3.248C 11.993,2.737, 13.213,0, 18.512,0l 4.412,0 l0,5.515 l-2.757,0 c-2.063,0-2.163,0.77-2.163,2.209l-0.008,2.76l 4.959,0 l-0.585,5.514L 18,16L 17.996,32z"></path></g></svg> Share on Facebook</a><a class="btn share" target="_blank" rel="noopener noreferrer" href="https://twitter.com/intent/tweet?url=https://www.ncbi.nlm.nih.gov/books/NBK548016/&text=Insulin"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 33 33" style="vertical-align:middle" width="24" height="24"><g><path d="M 32,6.076c-1.177,0.522-2.443,0.875-3.771,1.034c 1.355-0.813, 2.396-2.099, 2.887-3.632 c-1.269,0.752-2.674,1.299-4.169,1.593c-1.198-1.276-2.904-2.073-4.792-2.073c-3.626,0-6.565,2.939-6.565,6.565 c0,0.515, 0.058,1.016, 0.17,1.496c-5.456-0.274-10.294-2.888-13.532-6.86c-0.565,0.97-0.889,2.097-0.889,3.301 c0,2.278, 1.159,4.287, 2.921,5.465c-1.076-0.034-2.088-0.329-2.974-0.821c-0.001,0.027-0.001,0.055-0.001,0.083 c0,3.181, 2.263,5.834, 5.266,6.438c-0.551,0.15-1.131,0.23-1.73,0.23c-0.423,0-0.834-0.041-1.235-0.118 c 0.836,2.608, 3.26,4.506, 6.133,4.559c-2.247,1.761-5.078,2.81-8.154,2.81c-0.53,0-1.052-0.031-1.566-0.092 c 2.905,1.863, 6.356,2.95, 10.064,2.95c 12.076,0, 18.679-10.004, 18.679-18.68c0-0.285-0.006-0.568-0.019-0.849 C 30.007,8.548, 31.12,7.392, 32,6.076z"></path></g></svg> Share on Twitter</a></div></aside><aside id="jr-rtoc-p" class="hidden flexv"><div class="tb sk-htbar flexh"><div><a class="jr-p-close btn wsprkl">Done</a></div><div class="title-text f1">Table of Content</div></div><div class="cnt lol f1"><a href="/books/n/livertox/?report=reader">Title Information</a><a href="/books/n/livertox/toc/?report=reader">Table of Contents Page</a></div></aside><aside id="jr-help-p" class="hidden flexv"><div class="tb sk-htbar flexh"><div><a class="jr-p-close btn wsprkl">Done</a></div><div class="title-text f1">Settings</div></div><div class="cnt f1"><div id="jr-typo-p" class="typo"><div><a class="sf btn wsprkl">A-</a><a class="lf btn wsprkl">A+</a></div><div><a class="bcol-auto btn wsprkl"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 200 100" preserveAspectRatio="none"><text x="10" y="70" style="font-size:60px;font-family: Trebuchet MS, ArialMT, Arial, sans-serif" textLength="180">AUTO</text></svg></a><a class="bcol-1 btn wsprkl"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M15,25 85,25zM15,40 85,40zM15,55 85,55zM15,70 85,70z"></path></svg></a><a class="bcol-2 btn wsprkl"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M5,25 45,25z M55,25 95,25zM5,40 45,40z M55,40 95,40zM5,55 45,55z M55,55 95,55zM5,70 45,70z M55,70 95,70z"></path></svg></a></div></div><div class="lol"><a class="" href="/books/NBK548016/?report=classic">Switch to classic view</a><a href="/books/NBK548016/pdf/Bookshelf_NBK548016.pdf">PDF (170K)</a><a href="/books/NBK548016/?report=printable">Print View</a></div></div></aside><aside id="jr-bkhelp-p" class="hidden flexv"><div class="tb sk-htbar flexh"><div><a class="jr-p-close btn wsprkl">Done</a></div><div class="title-text f1">Help</div></div><div class="cnt f1 lol"><a id="jr-helpobj-sw" data-path="/corehtml/pmc/jatsreader/ptpmc_3.22/" data-href="/corehtml/pmc/jatsreader/ptpmc_3.22/img/bookshelf/help.xml" href="">Help</a><a href="mailto:info@ncbi.nlm.nih.gov?subject=PubReader%20feedback%20%2F%20NBK548016%20%2F%20sid%3ACE8B5AF87C7FFCB1_0191SID%20%2F%20phid%3ACE8B62F17D7D9B410000000000400032.4">Send us feedback</a><a id="jr-about-sw" data-path="/corehtml/pmc/jatsreader/ptpmc_3.22/" data-href="/corehtml/pmc/jatsreader/ptpmc_3.22/img/bookshelf/about.xml" href="">About PubReader</a></div></aside><aside id="jr-objectbox" class="thidden hidden"><div class="jr-objectbox-close wsprkl">✘</div><div class="jr-objectbox-inner cnt"><div class="jr-objectbox-drawer"></div></div></aside><nav id="jr-pm-left" class="hidden"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 40 800" preserveAspectRatio="none"><text font-stretch="ultra-condensed" x="800" y="-15" text-anchor="end" transform="rotate(90)" font-size="18" letter-spacing=".1em">Previous Page</text></svg></nav><nav id="jr-pm-right" class="hidden"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 40 800" preserveAspectRatio="none"><text font-stretch="ultra-condensed" x="800" y="-15" text-anchor="end" transform="rotate(90)" font-size="18" letter-spacing=".1em">Next Page</text></svg></nav><nav id="jr-fip" class="hidden"><nav id="jr-fip-term-p"><input type="search" placeholder="search this page" id="jr-fip-term" autocorrect="off" autocomplete="off" /><a id="jr-fip-mg" class="wsprkl btn" title="Find"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 550 600" preserveAspectRatio="none"><path fill="none" stroke="#000" stroke-width="36" stroke-linecap="round" style="fill:#FFF" d="m320,350a153,153 0 1,0-2,2l170,170m-91-117 110,110-26,26-110-110"></path></svg></a><a id="jr-fip-done" class="wsprkl btn" title="Dismiss find">✘</a></nav><nav id="jr-fip-info-p"><a id="jr-fip-prev" class="wsprkl btn" title="Jump to previuos match">◀</a><button id="jr-fip-matches">no matches yet</button><a id="jr-fip-next" class="wsprkl btn" title="Jump to next match">▶</a></nav></nav></div><div id="jr-epub-interstitial" class="hidden"></div><div id="jr-content"><article data-type="main"><div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><div class="fm-sec"><h1 id="_NBK548016_"><span class="title" itemprop="name">Insulin</span></h1><p class="fm-aai"><a href="#_NBK548016_pubdet_">Publication Details</a></p></div></div><div class="body-content whole_rhythm" itemprop="text"><div id="Insulin.OVERVIEW"><h2 id="_Insulin_OVERVIEW_">OVERVIEW</h2><div id="Insulin.Introduction"><h3>Introduction</h3><p>Insulin is a pancreatic hormone that plays an essential role in regulation of blood glucose as well as lipid and carbohydrate metabolism. Both natural and recombinant forms of insulin are used therapeutically to treat type 1 diabetes. While insulin itself is not hepatotoxic and has not been linked to serum enzyme elevations or instances of clinically apparent liver injury, high doses including overdoses of insulin and glucose can result in hepatic glycogenosis and serum aminotransferase elevations.</p></div><div id="Insulin.Background"><h3>Background</h3><p>Insulin (in' su lin) is a polypeptide hormone produced by pancreatic islet β cells that is primarily responsible for regulation of blood glucose and storage of carbohydrates and lipids. Type 1 diabetes is due to inadequate production of insulin caused by destruction and loss of insulin producing pancreatic islet β cells. Type 2 diabetes is due to relative insulin resistance. Initial forms of insulin were isolated from pancreas tissue harvested from swine and cattle, and thus referred to as pork and beef insulins. More recently, human insulins have been produced by recombinant techniques. Since its first use in the 1930s, insulin has been the mainstay of therapy of type 1 diabetes. Insulin is also used in patients with type 2 diabetes that is refractory to lifestyle interventions (diet, physical activity, weight loss) and use of oral hypoglycemic agents. Multiple formulations of insulin are available including short-acting (regular), rapid-acting (aspart, glulisine, lispro) and medium- or long-acting (NPH, glargine, detemir) forms generically and under brand names such as Apidra, Basaglar, Humalog, Humulin, Lantus, Levemir, Novolin, Novolog and Tresiba. Commercial combination products with several forms of insulin or insulin with other agents are also available. Insulin can be given intravenously, intramuscularly and subcutaneously and the dose and frequency of administration varies by formulation and the individual being treated. Adverse events from insulin are largely due to hypoglycemia. Insulin therapy often results in weight gain. Local injection reactions (lipoatrophy) and hypersensitivity reactions are uncommon, particularly with newer recombinant forms of insulin.</p></div><div id="Insulin.Hepatotoxicity"><h3>Hepatotoxicity</h3><p>Insulin in typical therapeutic doses is not associated with serum enzyme elevations or with episodes of clinically apparent liver injury. However, use of insulin in poorly controlled type 1 diabetes can result in a clinical syndrome known as glycogenosis or glycogenic hepatopathy, marked by varying degrees of hepatomegaly, abdominal pain and serum aminotransferase elevations. Serum ALT and AST levels range from normal to 20 to 30 times the upper limit or normal. Alkaline phosphatase and bilirubin levels are minimally increased or normal. Serum glucose and hemoglobin A1c levels are invariably elevated, and the liver and metabolic abnormalities resolve rapidly with better glycemic control. A severe form of glycogenosis associated with hepatomegaly, growth retardation, delayed puberty and Cushingoid facies in children is known as Mauriac syndrome. Glycogenosis with serum enzyme elevations can also occur in patients with insulin overdose during treatment with high doses of intravenous glucose (Case 1). Glycogenosis has also been reported in patients recieving short-term, high-dose corticosteroids..</p><p>The diagnosis of glycogenosis can be confirmed by liver biopsy which typically shows slightly swollen hepatocytes with pale cytoplasm and accentuated cell membranes, which with periodic acid Schiff (PAS) staining demonstrates intracytoplasmic accumulation of glycogen. Imaging by CT usually shows an enlarged and hyper-dense liver in contrast to hepatic steatosis which generally causes a hypo-dense pattern. The condition can be relapsing, accompanying repeated episodes of hyperglycemia, but it does not appear to result in chronic liver injury, fibrosis or cirrhosis. Thus, the serum enzyme elevations are due to the combination of marked hyperglycemia and intermittent or high levels of insulin and not to intrinsic hepatotoxicity or an idiosyncratic reaction to insulin. The syndrome occurs most commonly in children or young adults with poorly controlled type 1 diabetes.</p><p>Likelihood score: A[H] (known cause of liver injury, but only when administered in high or intermittent doses and in the presence of hyperglycemia).</p></div><div id="Insulin.Mechanism_of_Liver_Injury"><h3>Mechanism of Liver Injury</h3><p>Insulin acts to increase uptake of glucose in the liver, decreasing gluconeogenesis and promoting glycogen synthesis. Thus, the hyperglycemia in the presence of high doses of insulin cause excessive production and storage of glycogen in the liver. Glycogenosis can cause serum enzyme elevations, but does not seem to injure hepatocytes and is not associated with permanent liver damage or fibrosis. Glycogenosis reverses rapidly when insulin and glucose are discontinued. Glycogenosis can also result from hyperglycemia caused by high doses of corticosteroids.</p></div><div id="Insulin.Outcome_and_Management"><h3>Outcome and Management</h3><p>The liver injury associated with insulin use or overdose is likely due to glycogenosis rather than inherent injury from insulin, and reverses rapidly when insulin and glucose are discontinued.</p><p>Drug Class: Hormonal Agents; <a href="/books/n/livertox/Antidiabetic/?report=reader">Antidiabetic Agents</a></p></div></div><div id="Insulin.CASE_REPORT"><h2 id="_Insulin_CASE_REPORT_">CASE REPORT</h2><div id="Insulin.Case_1._Hepatic_glycogenosis_dev"><h3>Case 1. Hepatic glycogenosis developing after overdose of insulin and high doses of intravenous glucose.</h3><p>[Modified from: Tsujimoto T, Takano M, Nishiofuku M, Yoshiji H, Matsumura Y, Kuriyama S, Uemura M, et al. Rapid onset of glycogen storage hepatomegaly in a type-2 diabetic patient after a massive dose of long-acting insulin and large doses of glucose. Intern Med 2006; 45: 469-73. <a href="https://www.ncbi.nlm.nih.gov/pubmed/16679704" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PubMed Citation</a>]</p><p>A 41 year old man with poorly controlled type 2 diabetes took an overdose of insulin (~180 units) and was admitted to hospital in coma with severe hypoglycemia (glucose 9 mg/dL). He was given continuous infusions of glucose, but hypoglycemia persisted for 36 hours. On day 3 after admission he developed upper abdominal pain and was found to have tender hepatomegaly and marked elevations in serum enzymes with ALT 1024 U/L, AST 1064 U/L, LDH 1751 U/L, alkaline phosphatase 202 U/L, GGT 181 U/L and total bilirubin 2.3 mg/dL. His serum enzymes had been normal on admission immediately after the overdose (Table). Abdominal CT scanning demonstrated marked hepatomegaly and increased attenuation (hyper-dense liver compared to spleen and kidneys). A liver biopsy showed glycogenosis with minimal cellular infiltration and no necrosis, mild steatosis and no fibrosis. The presence of glycogen was documented by PAS staining with and without diastase. Doses of glucose were decreased and he was switched to oral intake only. Serum enzymes improved rapidly and were normal 2 weeks later. Repeat CT scanning showed a decrease in liver size and in hepatic attenuation. Repeat liver biopsy showed slight ballooning of hepatocytes and minimal residual intracytoplasmic glycogen accumulation.</p><div id="Insulin.Key_Points"><h4>Key Points</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figInsulinT1"><a href="/books/NBK548016/table/Insulin.T1/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figInsulinT1" rid-ob="figobInsulinT1"><img class="small-thumb" src="/books/NBK548016/table/Insulin.T1/?report=thumb" src-large="/books/NBK548016/table/Insulin.T1/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="Insulin.T1"><a href="/books/NBK548016/table/Insulin.T1/?report=objectonly" target="object" rid-ob="figobInsulinT1">Table</a></h4></div></div></div><div id="Insulin.Laboratory_Values"><h4>Laboratory Values</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figInsulinT2"><a href="/books/NBK548016/table/Insulin.T2/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figInsulinT2" rid-ob="figobInsulinT2"><img class="small-thumb" src="/books/NBK548016/table/Insulin.T2/?report=thumb" src-large="/books/NBK548016/table/Insulin.T2/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="Insulin.T2"><a href="/books/NBK548016/table/Insulin.T2/?report=objectonly" target="object" rid-ob="figobInsulinT2">Table</a></h4></div></div></div><div id="Insulin.Comment"><h4>Comment</h4><p>The sudden onset of hepatomegaly with abdominal pain and marked serum aminotransferase elevations within days of starting glucose infusions after an overdose of insulin is typical of acute glycogenosis and dramatically demonstrates how rapidly the condition can develop and how rapidly it resolves. The clinical features resemble those of the hepatic glycogenosis that occurs in poorly controlled type 1 diabetes when insulin is being administered at a time that significant hyperglycemia is present. The diagnosis can be made based upon the clinical history and the finding of a hyper-dense liver by CT scanning. However, similar serum enzyme elevations can occur due to shock or ischemia and some degree of liver test abnormalities are common in patients with diabetes and fatty liver. The histologic findings of slightly swollen hepatocytes with pale cytoplasm and accentuation of plasma membranes suggests glycogenosis, which can be proven by PAS staining with and without diastase (an enzyme that digests glycogen demonstrating that the PAS-positive granules are composed of glycogen). Thus, insulin is not the direct cause of the liver abnormalities, but does allow for the excess circulating glucose to be taken up by hepatocytes producing amounts of intracytoplasmic glycogen that cause hepatocyte swelling, liver enlargement and release of hepatic enzymes.</p></div></div></div><div id="Insulin.PRODUCT_INFORMATION"><h2 id="_Insulin_PRODUCT_INFORMATION_">PRODUCT INFORMATION</h2><div id="Insulin.BPI" class="box boxed-text-box whole_rhythm hide-overflow"><p>
|
|
<b>REPRESENTATIVE TRADE NAMES</b>
|
|
</p><p>Insulin – Generic, Lantus, Humulin®</p><p>
|
|
<b>DRUG CLASS</b>
|
|
</p><p>Hormonal Agents; Antidiabetic Agents</p><p>
|
|
<a href="https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&query=insulin" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">COMPLETE LABELING</a>
|
|
</p><p>Product labeling at DailyMed, National Library of Medicine, NIH</p></div></div><div id="Insulin.CHEMICAL_FORMULA_AND_STRUCTURE"><h2 id="_Insulin_CHEMICAL_FORMULA_AND_STRUCTURE_">CHEMICAL FORMULA AND STRUCTURE</h2><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figInsulinT3"><a href="/books/NBK548016/table/Insulin.T3/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figInsulinT3" rid-ob="figobInsulinT3"><img class="small-thumb" src="/books/NBK548016/table/Insulin.T3/?report=thumb" src-large="/books/NBK548016/table/Insulin.T3/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="Insulin.T3"><a href="/books/NBK548016/table/Insulin.T3/?report=objectonly" target="object" rid-ob="figobInsulinT3">Table</a></h4></div></div></div><div id="Insulin.ANNOTATED_BIBLIOGRAPHY"><h2 id="_Insulin_ANNOTATED_BIBLIOGRAPHY_">ANNOTATED BIBLIOGRAPHY</h2><p>References updated: 26 April 2018</p><ul class="first-line-outdent"><li><div class="bk_ref" id="Insulin.R1">Zimmerman HJ. Hepatic injury from the treatment of infectious and parasitic diseases. In, Zimmerman HJ. Hepatotoxicity: the adverse effects of drugs and other chemicals on the liver. 2nd ed. Philadelphia: Lippincott, 1999, pp. 589-637.<div><i>(Expert review of liver injury due to medications published in 1999; does not discuss insulin).</i></div></div></li><li><div class="bk_ref" id="Insulin.R2">Kleiner DE. Histopathological evaluation of drug-induced liver disease. In, Kaplowitz N, DeLeve LD, eds. Drug-induced liver disease. 3rd edition. Amsterdam: Elsevier, 2013, pp. 241-63.<div><i>(Multi-authored text book on drug induced liver injury discusses the histologic features of glycogenosis that can occur in type 1 diabetes and in patients receiving high doses of corticosteroids).</i></div></div></li><li><div class="bk_ref" id="Insulin.R3">Powers AC, D’Alessio D. Endocrine pancreas and pharmacotherapy of diabetes mellitus and hypoglycemia. In, Brunton LL, Chabner BA, Knollman BC, eds. Goodman & Gilman’s the pharmacological basis of therapeutics. 12th ed. New York: McGraw-Hill, 2011, pp. 1237-73.<div><i>(Textbook of pharmacology and therapeutics).</i></div></div></li><li><div class="bk_ref" id="Insulin.R4">Mauriac P. Gros ventre, hepatomegalie, troubles de las croissance chez les enfants diabetiques traits depuis plusieurs annes par l’insuline. Gaz Hebd Med Bordeaux 1930; 26: 402-10. Not in PubMed.<div><i>(Initial description of “Mauriac syndrome” occurring in children with type 1 diabetes on insulin therapy and marked by hepatomegaly, cushingoid features, growth retardation, delay in puberty and hepatic glycogenosis).</i></div></div></li><li><div class="bk_ref" id="Insulin.R5">Goodman JI. Hepatomegaly and diabetes mellitus. Ann Intern Med 1953; 39: 1077-87. [<a href="https://pubmed.ncbi.nlm.nih.gov/13105180" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 13105180</span></a>]<div><i>(Among 459 diabetic patients examined carefully by percussion, 9% with stable diabetes had hepatomegaly compared to 60% with uncontrolled diabetes and 100% with ketoacidosis, usually ascribed to fatty liver or cirrhosis).</i></div></div></li><li><div class="bk_ref" id="Insulin.R6">Kaminer Y, Robbins DR. Attempted suicide by insulin overdose in insulin-dependent diabetic adolescents. Pediatrics 1988; 81: 526-8. [<a href="https://pubmed.ncbi.nlm.nih.gov/3281128" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3281128</span></a>]<div><i>(13- and 16-year old girls with insulin dependent diabetes attempted suicide with overdoses of insulin [150 and 600 units] and recovered with conservative management; no mention of liver test abnormalities).</i></div></div></li><li><div class="bk_ref" id="Insulin.R7">Chatila R, West AB. Hepatomegaly and abnormal liver tests due to glycogenosis in adults with diabetes. Medicine (Baltimore) 1996; 75: 327-33. [<a href="https://pubmed.ncbi.nlm.nih.gov/8982149" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8982149</span></a>]<div><i>(Clinical descriptions of 8 adults and 3 children with poorly controlled diabetes and hepatic glycogenosis manifested by hepatomegaly [7 patients, 3 with tenderness] and serum ALT [45-910 U/L] and Alk P [1-10 times ULN] elevations, but normal bilirubin levels, liver biopsies showing glycogenosis, resolving rapidly with diabetes control).</i></div></div></li><li><div class="bk_ref" id="Insulin.R8">Shimizu H, Ohtani KI, Kudoh T, Tsuchiya T, Takahashi H, Sato N, Iriuchijima T, et al. Possible liver damage by biosynthetic human insulin. Diabetes Obes Metab 1999; 1: 179-80. [<a href="https://pubmed.ncbi.nlm.nih.gov/11220297" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11220297</span></a>]<div><i>(Two patients, ages 53 and 51 years with type 2 diabetes developed liver test abnormalities shortly after starting a recombinant human insulin produced in yeast [Penfill] [ALT 330 U/L and 213 U/L], which fell to normal on stopping and did not increase on switching to an E. coli derived recombinant insulin [Humacart R]).</i></div></div></li><li><div class="bk_ref" id="Insulin.R9">Munns CF, McCrossin RB, Thomsett MJ, Batch J. Hepatic glycogenosis: reversible hepatomegaly in type 1 diabetes. J Paediatr Child Health 2000; 36: 449-52. [<a href="https://pubmed.ncbi.nlm.nih.gov/11036799" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11036799</span></a>]<div><i>(Three adolescents with poorly controlled type 1 diabetes presented with hepato-splenomegaly and elevations in ALT [135, 147 and 316 U/L] and HgA1c [12.2-14.1], but normal bilirubin and Alk P, all 3 children improving rapidly with better glycemic control).</i></div></div></li><li><div class="bk_ref" id="Insulin.R10">Jolliet P, Leverve X, Pichard C. Acute hepatic steatosis complicating massive insulin overdose and excessive glucose administration. Intensive Care Med 2001; 27: 313-6. [<a href="https://pubmed.ncbi.nlm.nih.gov/11280657" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11280657</span></a>]<div><i>(48 year old woman who injected 2000 IU of insulin in a suicide attempt and was admitted to a hospital in coma, developed abdominal pain and ALT elevations by day 3 of intravenous glucose infusions [ALT rising from normal to 610 U/L, Alk P 178 U/L, and bilirubin 8.7 mg/dL], with rapid resolution on stopping glucose infusions; assumed to be fatty liver, but without histologic confirmation).</i></div></div></li><li><div class="bk_ref" id="Insulin.R11">von Mach MA, Meyer S, Omogbehin B, Kann PH, Weilemann LS. Epidemiological assessment of 160 cases of insulin overdose recorded in a regional poisons unit. Int J Clin Pharmacol Ther 2004; 42: 277-80. [<a href="https://pubmed.ncbi.nlm.nih.gov/15176650" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15176650</span></a>]<div><i>(Among 160 cases of insulin overdose, 89% were of suicidal intent, 5% accidental; full recovery occurred in 95%, 2.7% died, 2.7% had residual neurological deficits).</i></div></div></li><li><div class="bk_ref" id="Insulin.R12">Tsujimoto T, Takano M, Nishiofuku M, Yoshiji H, Matsumura Y, Kuriyama S, Uemura M, et al. Rapid onset of glycogen storage hepatomegaly in a type-2 diabetic patient after a massive dose of long-acting insulin and large doses of glucose. Intern Med 2006; 45: 469-73. [<a href="https://pubmed.ncbi.nlm.nih.gov/16679704" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16679704</span></a>]<div><i>(A 41 year old man with type 2 diabetes developed marked serum ALT and AST elevations 2-3 days after admission for hypoglycemia due to an overdose of insulin glargine [180 units] and while receiving intravenous glucose [ALT rising from 23 to 1024 U/L, ALK P 125 to 202 U/L, bilirubin 0.4 to 2.3 mg/dL], liver biopsy showing glycogenosis, abnormalities resolving within 1-2 weeks: Case 1).</i></div></div></li><li><div class="bk_ref" id="Insulin.R13">Torbenson M, Chen YY, Brunt E, Cummings OW, Gottfried M, Jakate S, Liu YC, Yeh MM, Ferrell L. Glycogenic hepatopathy: an underrecognized hepatic complication of diabetes mellitus. Am J Surg Pathol 2006; 30: 508-13. [<a href="https://pubmed.ncbi.nlm.nih.gov/16625098" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16625098</span></a>]<div><i>(Among 14 cases of hepatic glycogenosis, all had diabetes and poor glycemic control, ages 8-34 years, ALT levels varying [normal to 1544 U/L], Alk P mildly elevated in 6, hepatomegaly, abdominal pain and nausea in most, biopsies showing cytoplasmic glycogen and minimal fat, responding to glycemic control).</i></div></div></li><li><div class="bk_ref" id="Insulin.R14">Mahesh S, Karp RJ, Castells S, Quintos JB. Mauriac syndrome in a 3-year-old boy. Endocr Pract 2007; 13: 63-6. [<a href="https://pubmed.ncbi.nlm.nih.gov/17360304" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17360304</span></a>]<div><i>(A 3 year old boy with poorly controlled type 1 diabetes presented with protuberant abdomen, growth impairment, hepatomegaly and liver test abnormalities [ALT 146 U/L, HgA1c 14.2%], and liver, growth and metabolic features improved with better glycemic control).</i></div></div></li><li><div class="bk_ref" id="Insulin.R15">Cuthbertson DJ, Brennan G, Walsh S, Henry E. Hepatic glycogenosis: abnormal liver function tests in Type 1 diabetes. Diabet Med 2007; 24: 322-3. [<a href="https://pubmed.ncbi.nlm.nih.gov/17305792" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17305792</span></a>]<div><i>(A 19 year old woman on insulin for type 1 diabetes developed ketoacidosis and was found to have hepatomegaly and abnormal liver tests [bilirubin 0.4 mg/dL, ALT 205 U/L, Alk P 132 U/L, HgA1c 12.2%], biopsy showing glycogenosis).</i></div></div></li><li><div class="bk_ref" id="Insulin.R16">Sayuk GS, Elwing JE, Lisker-Melman M. Hepatic glycogenosis: an underrecognized source of abnormal liver function tests? Dig Dis Sci 2007; 52: 936-8. [<a href="https://pubmed.ncbi.nlm.nih.gov/17342391" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17342391</span></a>]<div><i>(Two patients, ages 19 and 36 years, with type 1 diabetes on insulin with persistently abnormal liver tests [bilirubin normal, ALT 33-49 and 366-844 U/L, Alk P 137-147 and 326-428 U/L, HbA1c 8.1%-9.5%] were found to have glycogenosis on liver biopsy).</i></div></div></li><li><div class="bk_ref" id="Insulin.R17">Abaci A, Bekem O, Unuvar T, Ozer E, Bober E, Arslan N, Ozturk Y, Buyukgebiz A. Hepatic glycogenosis: a rare cause of hepatomegaly in Type 1 diabetes mellitus. J Diabetes Complications 2008; 22: 325-8. [<a href="https://pubmed.ncbi.nlm.nih.gov/18413182" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18413182</span></a>]<div><i>(A 16 year old boy on insulin for type 1 diabetes developed hepatomegaly and abnormal liver tests [bilirubin 0.8 mg/dL, ALT 58 U/L, GGT 91 U/L, HbA1c 11%] and glycogenosis and steatosis on liver biopsy, resolving with better glycemic control).</i></div></div></li><li><div class="bk_ref" id="Insulin.R18">Guclu M, Ersoy C, Imamoglu S. Suicide attempt of a physician with 3600 units of insulin and rapid onset acute hepatitis. Intern Med J 2009; 39: e5-7. [<a href="https://pubmed.ncbi.nlm.nih.gov/20233236" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20233236</span></a>]<div><i>(A 29 year old man with type 1 diabetes admitted for an insulin overdose [3600 units] developed sudden ALT and AST elevations 5 days after admission and starting glucose infusions [ALT rising from normal to 1010 U/L], resolving within a week of stopping glucose].</i></div></div></li><li><div class="bk_ref" id="Insulin.R19">van den Brand M, Elving LD, Drenth JP, van Krieken JH. Glycogenic hepatopathy: a rare cause of elevated serum transaminases in diabetes mellitus. Neth J Med 2009; 67: 394-6. [<a href="https://pubmed.ncbi.nlm.nih.gov/20009116" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20009116</span></a>]<div><i>(A 29 year old woman on insulin for type 1 diabetes developed hepatomegaly and fluctuating serum ALT levels [peak values ~1500 U/L] with glycogenosis on liver biopsy and improvement with better glycemic control).</i></div></div></li><li><div class="bk_ref" id="Insulin.R20">Reuben A, Koch DG, Lee WM; Acute Liver Failure Study Group. Drug-induced acute liver failure: results of a U.S. multicenter, prospective study. Hepatology 2010; 52: 2065-76. [<a href="/pmc/articles/PMC3992250/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3992250</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/20949552" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20949552</span></a>]<div><i>(Among 1198 patients with acute liver failure enrolled in a US prospective study between 1998 and 2007, 133 were attributed to drug induced liver injury including 4 due to troglitazone, but none were attributed to insulin or other antidiabetic medications).</i></div></div></li><li><div class="bk_ref" id="Insulin.R21">Sweetser S, Kraichely RE. The bright liver of glycogenic hepatopathy. Hepatology 2010; 51: 711-2. [<a href="https://pubmed.ncbi.nlm.nih.gov/19957373" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19957373</span></a>]<div><i>(A 27 year old man with poorly controlled type 1 diabetes developed abdominal pain, hepatomegaly and abnormal liver tests [bilirubin 1.7 mg/dL, ALT 2549 U/L, Alk P 529 U/L, HgA1c 15%], with an enlarged and hyper-dense liver on CT and glycogenosis without fat or fibrosis on liver biopsy, resolving within 3 months with better glycemic control).</i></div></div></li><li><div class="bk_ref" id="Insulin.R22">Warriner D, Debono M, Gandhi RA, Chong E, Creagh F. Acute hepatic injury following treatment of a long-acting insulin analogue overdose necessitating urgent insulin depot excision. Diabet Med 2012; 29: 232-5. [<a href="https://pubmed.ncbi.nlm.nih.gov/21781150" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21781150</span></a>]<div><i>(A 26 year old man with type 1 diabetes developed marked abdominal pain and liver test abnormalities [ALT rising from 11 to 520 U/L, Alk P 98 to 203, bilirubin 0.7 to 1.0 mg/dL] 3 days after starting intravenous glucose for hypoglycemia caused by subcutaneous injection of 10 cartridges of glargine insulin, ultimately requiring surgical removal of cartridges).</i></div></div></li><li><div class="bk_ref" id="Insulin.R23">Imtiaz KE, Healy C, Sharif S, Drake I, Awan F, Riley J, Karlson F. Glycogenic hepatopathy in type 1 diabetes: an underrecognized condition. Diabetes Care 2013; 36: e6-7. [<a href="/pmc/articles/PMC3526232/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3526232</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/23264308" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23264308</span></a>]<div><i>(A 19 year old woman with type 1 diabetes and poor glycemic control was found to have tender hepatomegaly during treatment of ketoacidosis [bilirubin not given, ALT 199 U/L, Alk P 139 U/L, HbA1c 14.6%], biopsy showing glycogenosis without fat or fibrosis).</i></div></div></li><li><div class="bk_ref" id="Insulin.R24">Cha JH, Ra SH, Park YM, Ji YK, Lee JH, Park SY, Baik SK, et al. Three cases of glycogenic hepatopathy mimicking acute and relapsing hepatitis in type I diabetes mellitus. Clin Mol Hepatol 2013; 19: 421-5. [<a href="/pmc/articles/PMC3894443/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3894443</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/24459648" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24459648</span></a>]<div><i>(Three patients with type 1 diabetes, ages 20-26 years, were referred for evaluation of liver test abnormalities [ALT 169, 213 and 346 U/L, Alk P 346, 189 and 132 U/L, bilirubin 0.5, 0.5 and 0.2 mg/dL, HgA1c 13.8%, 12.9% and 13.6%], liver biopsies showing glycogenosis, liver tests improving, but fluctuating during follow up).</i></div></div></li><li><div class="bk_ref" id="Insulin.R25">Björnsson ES, Bergmann OM, Björnsson HK, Kvaran RB, Olafsson S. Incidence, presentation and outcomes in patients with drug-induced liver injury in the general population of Iceland. Gastroenterology 2013; 144: 1419-25. [<a href="https://pubmed.ncbi.nlm.nih.gov/23419359" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23419359</span></a>]<div><i>(In a population based study of drug induced liver injury from Iceland, 96 cases were identified over a 2 year period, but none were attributed to insulin or other antidiabetic medications).</i></div></div></li><li><div class="bk_ref" id="Insulin.R26">Dias J, Martins S, Carvalho S, Marques O, Antunes A. Mauriac syndrome still exists. Endocrinol Nutr 2013; 60: 245-8. [<a href="https://pubmed.ncbi.nlm.nih.gov/23540612" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23540612</span></a>]<div><i>(Among 91 children with type 1 diabetes followed in a Portuguese pediatric endocrine clinic between 2005 and 2011, 6 had Mauriac syndrome, ages 13-17 years with known diabetes for 4-14 years, all had elevations in HbA1c, 5 had cushingoid features and delayed puberty, 5 hepatomegaly and ALT elevations [64 to 684 U/L]; and in follow up, improved glycemic control was difficult to achieve and clinical improvement varied).</i></div></div></li><li><div class="bk_ref" id="Insulin.R27">Fitzpatrick E, Cotoi C, Quaglia A, Sakellariou S, Ford-Adams ME, Hadzic N. Hepatopathy of Mauriac syndrome: a retrospective review from a tertiary liver centre. Arch Dis Child 2014; 99: 354-7. [<a href="https://pubmed.ncbi.nlm.nih.gov/24412980" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24412980</span></a>]<div><i>(Retrospective survey from a large pediatric center in London identified 31 children with suspected Mauriac syndrome over a 10 year period, average age 15 years, 48% boys, mean ALT 76 U/L, and liver biopsies in 19 children showed glycogenosis is all).</i></div></div></li><li><div class="bk_ref" id="Insulin.R28">Hernández N, Bessone F, Sánchez A, di Pace M, Brahm J, Zapata R, A Chirino R, et al. Profile of idiosyncratic drug induced liver injury in Latin America. An analysis of published reports. Ann Hepatol 2014; 13: 231-9. [<a href="https://pubmed.ncbi.nlm.nih.gov/24552865" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24552865</span></a>]<div><i>(Systematic review of literature of drug induced liver injury in Latin American countries published from 1996 to 2012 identified 176 cases, the most common implicated agents being nimesulide [n=53: 30%], cyproterone [n=18] and nitrofurantoin [n=17]; no case was attributed to insulin or other antidiabetic medications).</i></div></div></li><li><div class="bk_ref" id="Insulin.R29">Giordano S, Martocchia A, Toussan L, Stefanelli M, Pastore F, Devito A, Risicato MG, et al. Diagnosis of hepatic glycogenosis in poorly controlled type 1 diabetes mellitus. World J Diabetes 2014; 5: 882-8. [<a href="/pmc/articles/PMC4265875/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4265875</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25512791" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25512791</span></a>]<div><i>(Review of the pathophysiology, clinical features, diagnosis and management of hepatic glycogenosis).</i></div></div></li><li><div class="bk_ref" id="Insulin.R30">Martin J, Tomlinson P. Hepatic complications in poorly controlled type 1 diabetes mellitus: a case report. N Z Med J 2014; 127: 95-7. [<a href="https://pubmed.ncbi.nlm.nih.gov/24806252" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24806252</span></a>]<div><i>(13 year old boy with poorly controlled type 1 diabetes developed rising serum aminotransferase levels shortly after an episode of diabetic ketoacidosis, biopsy showing glycogenic hepatopathy, perhaps complicated by ischemic hepatitis).</i></div></div></li><li><div class="bk_ref" id="Insulin.R31">Parmar N, Atiq M, Austin L, Miller RA, Smyrk T, Ahmed K. Glycogenic hepatopathy: thinking outside the box. Case Rep Gastroenterol 2015; 9: 221-6. [<a href="/pmc/articles/PMC4520193/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4520193</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26269698" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26269698</span></a>]<div><i>(21 year old woman with poorly controlled type 1 diabetes [HbA1c 13.3%] developed tender hepatomegaly [ALT 590 U/L, AST 3161 U/L, bilirubin and Alk P normal] and ultrasound suggested fatty liver, but biopsy showed glycogenosis and better control of diabetes was followed by fall of serum enzymes to normal).</i></div></div></li><li><div class="bk_ref" id="Insulin.R32">Irani NR, Venugopal K, Kontorinis N, Lee M, Sinniah R, Bates TR. Glycogenic hepatopathy is an under-recognised cause of hepatomegaly and elevated liver transaminases in type 1 diabetes mellitus. Intern Med J 2015; 45: 777-9. [<a href="https://pubmed.ncbi.nlm.nih.gov/26134697" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26134697</span></a>]<div><i> (19 year old man with poorly controlled type 1 diabetes developed nausea and tender hepatomegaly [bilirubin 0.6 mg/dL, ALT 345 rising to 1180 U/L, Alk P 145 U/L, INR 1.0], biopsy showing glycogenosis, and symptoms and enzymes improving with better diabetic control).</i></div></div></li><li><div class="bk_ref" id="Insulin.R33">Jung IA, Cho WK, Jeon YJ, Kim SH, Cho KS, Park SH, Jung MH, Suh BK. Hepatic glycogenosis in type 1 diabetes mellitus mimicking Mauriac syndrome. Korean J Pediatr 2015; 58: 234-7. [<a href="/pmc/articles/PMC4510358/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4510358</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26213553" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26213553</span></a>]<div><i>(16 year old girl with poorly controlled diabetes presented with hepatomegaly, liver test abnormalities, cushingoid features, growth retardation and delayed puberty [ALT 459 U/L, GGT 430 U/L, HbA1c 14.3%], and glycogenosis on liver biopsy, and subsequently responded to better glycemic control with resolution of liver abnormalities followed by menarche and normal menses).</i></div></div></li><li><div class="bk_ref" id="Insulin.R34">Chalasani N, Bonkovsky HL, Fontana R, Lee W, Stolz A, Talwalkar J, Reddy KR, et al.; United States Drug Induced Liver Injury Network. Features and outcomes of 899 patients with drug-induced liver injury: The DILIN Prospective Study. Gastroenterology 2015; 148: 1340-52.e7. [<a href="/pmc/articles/PMC4446235/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4446235</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25754159" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25754159</span></a>]<div><i>(Among 899 cases of drug induced liver injury enrolled in a US prospective study between 2004 and 2013, 4 were attributed to an antidiabetic agent [2 metformin, 1 sitagliptin, 1 glibenclamide], but none were attributed to insulin).</i></div></div></li><li><div class="bk_ref" id="Insulin.R35">Julián MT, Alonso N, Ojanguren I, Pizarro E, Ballestar E, Puig-Domingo M. Hepatic glycogenosis: An underdiagnosed complication of diabetes mellitus? World J Diabetes 2015; 6: 321-5. [<a href="/pmc/articles/PMC4360425/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4360425</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25789113" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25789113</span></a>]<div><i>(Review of the definition, pathogenesis, and clinical and histological features of glycogenosis).</i></div></div></li><li><div class="bk_ref" id="Insulin.R36">Ikarashi Y, Kogiso T, Hashimoto E, Yamamoto K, Kodama K, Taniai M, Torii N, et al. Four cases of type 1 diabetes mellitus showing sharp serum transaminase increases and hepatomegaly due to glycogenic hepatopathy. Hepatol Res 2017; 47 (3): E201-E209. [<a href="https://pubmed.ncbi.nlm.nih.gov/27027269" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27027269</span></a>]<div><i>(Four patients with poorly controlled type 1 diabetes, ages 19-29 years, developed marked increases in serum ALT [216-956 U/L] and AST [469-2763 U/L] and hepatomegaly with liver biopsies showing glycogenosis; in follow up, serum enzyme elevations improved with better glycemic control, but often worsened again with subsequent episodes of hyperglycemia).</i></div></div></li><li><div class="bk_ref" id="Insulin.R37">Deemer KS, Alvarez GF. A rare case of persistent lactic acidosis in the ICU: glycogenic hepatopathy and Mauriac syndrome. Case Rep Crit Care 2016; 2016: 6072909. [<a href="/pmc/articles/PMC5035668/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5035668</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/27699071" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27699071</span></a>]<div><i> (18 year old woman with poorly controlled type 1 diabetes [HbA1c 11.3%] receiving intravenous glucose and insulin developed hepatomegaly and lactic acidemia [bilirubin 0.2 mg/dL, ALT 36 U/L, Alk P 120 U/L], liver biopsy showing glycogenosis, lactate levels decreasing with better diabetic control).</i></div></div></li><li><div class="bk_ref" id="Insulin.R38">Umpaichitra V. Unusual glycogenic hepatopathy causing abnormal liver enzymes in a morbidly obese adolescent with well-controlled type 2 diabetes: resolved after A1c was normalized by metformin. Clin Obes 2016; 6: 281-4. [<a href="https://pubmed.ncbi.nlm.nih.gov/27400632" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27400632</span></a>]<div><i>(15 year old boy with severe obesity [BMI 44] and diabetes but not on insulin had raised serum ALT levels [330 rising to 467 U/L], while bilirubin and Alk P were normal and liver biopsy showed glycogenosis; enzymes improving with metformin therapy).</i></div></div></li><li><div class="bk_ref" id="Insulin.R39">Satyarengga M, Zubatov Y, Frances S, Narayanswami G, Galindo RJ. Glycogenic hepatopathy: a complication of uncontrolled diabetes. AACE Clin Case Rep 2017; 3: e255-e259. [<a href="/pmc/articles/PMC5580824/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5580824</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28868358" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28868358</span></a>]<div><i>(18 year old man with poorly controlled type 1 diabetes developed marked hepatomegaly [bilirubin normal, peak ALT 1049 U/L, AST 3725 U/L, glucose 1,162 mg/dL, lactate 2.4 mmol/L], biopsy showing glycogenosis and enzymes improving with better diabetic control).</i></div></div></li><li><div class="bk_ref" id="Insulin.R40">Chandel A, Scarpato B, Camacho J, McFarland M, Mok S. Glycogenic hepatopathy: resolution with minimal glucose control. Case Reports Hepatol 2017; 2017: 7651387. [<a href="/pmc/articles/PMC5424186/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5424186</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28529811" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28529811</span></a>]<div><i>(12 year old girl with poorly controlled type 1 diabetes developed tender hepatomegaly [bilirubin 0.2 mg/dL, ALT 356 U/L, Alk P 158 U/L], biopsy showing glycogenosis and aminotransferase levels improving with better control of diabtes).</i></div></div></li><li><div class="bk_ref" id="Insulin.R41">
|
|
|
|
<div>
|
|
<i>Sherigar JM, Castro J, Yin YM, Guss D, Mohanty SR. Glycogenic hepatopathy: a narrative review. World J Hepatol 2018; 10: 172-85. <a href="https://www.ncbi.nlm.nih.gov/pubmed/29527255" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">PubMed Citation</a> (Review of the incidence, pathogenesis, clinical features, histology, diagnosis and management of glycogenic hepatopathy, mentions that imaging by ultrasound resembles changes of nonalcoholic fatty liver disease [NAFLD], but the two conditions differ by CT, glycogenosis yielding a dense and NAFLD a bright liver image).</i>
|
|
</div></div></li></ul></div><div id="bk_toc_contnr"></div></div></div><div class="fm-sec"><h2 id="_NBK548016_pubdet_">Publication Details</h2><h3>Publication History</h3><p class="small">Last Update: <span itemprop="dateModified">April 26, 2018</span>.</p><h3>Copyright</h3><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright Notice</a></div></div><h3>Publisher</h3><p><a href="https://www.niddk.nih.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Institute of Diabetes and Digestive and Kidney Diseases</a>, Bethesda (MD)</p><h3>NLM Citation</h3><p>LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. Insulin. [Updated 2018 Apr 26].<span class="bk_cite_avail"></span></p></div><div class="small-screen-prev"><a href="/books/n/livertox/InotuzumabOzogamicin/?report=reader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M75,30 c-80,60 -80,0 0,60 c-30,-60 -30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Prev</text></svg></a></div><div class="small-screen-next"><a href="/books/n/livertox/InterferonGamma/?report=reader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M25,30c80,60 80,0 0,60 c30,-60 30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Next</text></svg></a></div></article><article data-type="table-wrap" id="figobInsulinT1"><div id="Insulin.T1" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK548016/table/Insulin.T1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__Insulin.T1_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="vertical-align:top;">Medication:</td><td rowspan="1" colspan="1" style="vertical-align:top;">Insulin glargine overdose treated with glucose infusions</td></tr><tr><td rowspan="1" colspan="1" style="vertical-align:top;">Pattern:</td><td rowspan="1" colspan="1" style="vertical-align:top;">Hepatocellular (R=~16.5)</td></tr><tr><td rowspan="1" colspan="1" style="vertical-align:top;">Severity:</td><td rowspan="1" colspan="1" style="vertical-align:top;">1+ (enzyme elevations without jaundice)</td></tr><tr><td rowspan="1" colspan="1" style="vertical-align:top;">Latency:</td><td rowspan="1" colspan="1" style="vertical-align:top;">3 days</td></tr><tr><td rowspan="1" colspan="1" style="vertical-align:top;">Recovery:</td><td rowspan="1" colspan="1" style="vertical-align:top;">2 weeks</td></tr><tr><td rowspan="1" colspan="1" style="vertical-align:top;">Other medications:</td><td rowspan="1" colspan="1" style="vertical-align:top;">Voglibose (alpha glucosidase inhibitor)</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobInsulinT2"><div id="Insulin.T2" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK548016/table/Insulin.T2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__Insulin.T2_lrgtbl__"><table><thead><tr><th rowspan="1" colspan="1" style="vertical-align:top;">Time After Overdose (days)</th><th rowspan="1" colspan="1" style="vertical-align:top;">Therapy</th><th rowspan="1" colspan="1" style="vertical-align:top;"><b>ALT</b><br /> (U/L)</th><th rowspan="1" colspan="1" style="vertical-align:top;">Alk P<br /> (U/L)</th><th rowspan="1" colspan="1" style="vertical-align:top;">Bilirubin (mg/dL)</th><th rowspan="1" colspan="1" style="vertical-align:top;">Other</th></tr></thead><tbody><tr><td rowspan="1" colspan="1" style="vertical-align:top;">1</td><td rowspan="1" colspan="1" style="vertical-align:top;">iv Glucose [326 g]</td><td rowspan="1" colspan="1" style="vertical-align:top;">23</td><td rowspan="1" colspan="1" style="vertical-align:top;">125</td><td rowspan="1" colspan="1" style="vertical-align:top;">0.4</td><td rowspan="1" colspan="1" style="vertical-align:top;">Coma</td></tr><tr><td rowspan="1" colspan="1" style="vertical-align:top;">2</td><td rowspan="1" colspan="1" style="vertical-align:top;">iv Glucose [811 g]</td><td rowspan="1" colspan="1" style="vertical-align:top;">18</td><td rowspan="1" colspan="1" style="vertical-align:top;"></td><td rowspan="1" colspan="1" style="vertical-align:top;"></td><td rowspan="1" colspan="1" style="vertical-align:top;"></td></tr><tr><td rowspan="1" colspan="1" style="vertical-align:top;">3</td><td rowspan="1" colspan="1" style="vertical-align:top;">iv Glucose [926 g]</td><td rowspan="1" colspan="1" style="vertical-align:top;">1064</td><td rowspan="1" colspan="1" style="vertical-align:top;">202</td><td rowspan="1" colspan="1" style="vertical-align:top;">2.3</td><td rowspan="1" colspan="1" style="vertical-align:top;">Abdominal Pain</td></tr><tr><td rowspan="1" colspan="1" style="vertical-align:top;">4</td><td rowspan="1" colspan="1" style="vertical-align:top;">iv Glucose [531 g]</td><td rowspan="1" colspan="1" style="vertical-align:top;">708</td><td rowspan="1" colspan="1" style="vertical-align:top;"></td><td rowspan="1" colspan="1" style="vertical-align:top;"></td><td rowspan="1" colspan="1" style="vertical-align:top;"></td></tr><tr><td rowspan="1" colspan="1" style="vertical-align:top;">5</td><td rowspan="1" colspan="1" style="vertical-align:top;">iv Glucose [200 g]</td><td rowspan="1" colspan="1" style="vertical-align:top;">274</td><td rowspan="1" colspan="1" style="vertical-align:top;"></td><td rowspan="1" colspan="1" style="vertical-align:top;"></td><td rowspan="1" colspan="1" style="vertical-align:top;">Liver biopsy (1)</td></tr><tr><td rowspan="1" colspan="1" style="vertical-align:top;">6</td><td rowspan="1" colspan="1" style="vertical-align:top;">iv Glucose [52 g]</td><td rowspan="1" colspan="1" style="vertical-align:top;">214</td><td rowspan="1" colspan="1" style="vertical-align:top;"></td><td rowspan="1" colspan="1" style="vertical-align:top;"></td><td rowspan="1" colspan="1" style="vertical-align:top;"></td></tr><tr><td rowspan="1" colspan="1" style="vertical-align:top;">7</td><td rowspan="1" colspan="1" style="vertical-align:top;">Oral intake only</td><td rowspan="1" colspan="1" style="vertical-align:top;">135</td><td rowspan="1" colspan="1" style="vertical-align:top;"></td><td rowspan="1" colspan="1" style="vertical-align:top;"></td><td rowspan="1" colspan="1" style="vertical-align:top;"></td></tr><tr><td rowspan="1" colspan="1" style="vertical-align:top;">10</td><td rowspan="1" colspan="1" style="vertical-align:top;"></td><td rowspan="1" colspan="1" style="vertical-align:top;">41</td><td rowspan="1" colspan="1" style="vertical-align:top;"></td><td rowspan="1" colspan="1" style="vertical-align:top;"></td><td rowspan="1" colspan="1" style="vertical-align:top;"></td></tr><tr><td rowspan="1" colspan="1" style="vertical-align:top;">14</td><td rowspan="1" colspan="1" style="vertical-align:top;"></td><td rowspan="1" colspan="1" style="vertical-align:top;">24</td><td rowspan="1" colspan="1" style="vertical-align:top;"></td><td rowspan="1" colspan="1" style="vertical-align:top;"></td><td rowspan="1" colspan="1" style="vertical-align:top;"></td></tr><tr><td rowspan="1" colspan="1" style="vertical-align:top;">18</td><td rowspan="1" colspan="1" style="vertical-align:top;"></td><td rowspan="1" colspan="1" style="vertical-align:top;">16</td><td rowspan="1" colspan="1" style="vertical-align:top;"></td><td rowspan="1" colspan="1" style="vertical-align:top;"></td><td rowspan="1" colspan="1" style="vertical-align:top;"></td></tr><tr><td rowspan="1" colspan="1" style="vertical-align:top;">21</td><td rowspan="1" colspan="1" style="vertical-align:top;"></td><td rowspan="1" colspan="1" style="vertical-align:top;">19</td><td rowspan="1" colspan="1" style="vertical-align:top;"></td><td rowspan="1" colspan="1" style="vertical-align:top;"></td><td rowspan="1" colspan="1" style="vertical-align:top;">Liver biopsy (2)</td></tr><tr><td colspan="2" rowspan="1" style="vertical-align:top;">
|
|
<b>Standard Normal Values</b>
|
|
</td><td rowspan="1" colspan="1" style="vertical-align:top;">
|
|
<b><40</b>
|
|
</td><td rowspan="1" colspan="1" style="vertical-align:top;">
|
|
<b><130</b>
|
|
</td><td rowspan="1" colspan="1" style="vertical-align:top;">
|
|
<b><1.2</b>
|
|
</td><td rowspan="1" colspan="1" style="vertical-align:top;"></td><td rowspan="1" colspan="1" style="vertical-align:top;"></td></tr></tbody></table></div></div></article><article data-type="boxed-text" id="figobInsulinBPI"><div id="Insulin.BPI" class="box boxed-text-box whole_rhythm hide-overflow"><p>
|
|
<b>REPRESENTATIVE TRADE NAMES</b>
|
|
</p><p>Insulin – Generic, Lantus, Humulin®</p><p>
|
|
<b>DRUG CLASS</b>
|
|
</p><p>Hormonal Agents; Antidiabetic Agents</p><p>
|
|
<a href="https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&query=insulin" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">COMPLETE LABELING</a>
|
|
</p><p>Product labeling at DailyMed, National Library of Medicine, NIH</p></div></article><article data-type="table-wrap" id="figobInsulinT3"><div id="Insulin.T3" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK548016/table/Insulin.T3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__Insulin.T3_lrgtbl__"><table><thead><tr><th id="hd_h_Insulin.T3_1_1_1_1" rowspan="1" colspan="1" style="vertical-align:top;">DRUG</th><th id="hd_h_Insulin.T3_1_1_1_2" rowspan="1" colspan="1" style="vertical-align:top;">CAS REGISTRY NUMBER</th><th id="hd_h_Insulin.T3_1_1_1_3" rowspan="1" colspan="1" style="vertical-align:top;">MOLECULAR FORMULA</th><th id="hd_h_Insulin.T3_1_1_1_4" rowspan="1" colspan="1" style="vertical-align:top;">STRUCTURE</th></tr></thead><tbody><tr><td headers="hd_h_Insulin.T3_1_1_1_1" rowspan="1" colspan="1" style="vertical-align:top;">Insulin</td><td headers="hd_h_Insulin.T3_1_1_1_2" rowspan="1" colspan="1" style="vertical-align:top;">
|
|
<a href="https://pubchem.ncbi.nlm.nih.gov/substance/134989413" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubchem">11061-68-0</a>
|
|
</td><td headers="hd_h_Insulin.T3_1_1_1_3" rowspan="1" colspan="1" style="vertical-align:top;">C257-H383-N65-O77-S6</td><td headers="hd_h_Insulin.T3_1_1_1_4" rowspan="1" colspan="1" style="vertical-align:top;">
|
|
<div class="graphic"><img src="/books/NBK548016/bin/Insulin_Structure.jpg" alt="Insulin Chemical Structure" /></div>
|
|
</td></tr></tbody></table></div></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
|
|
|
|
|
|
|
|
|
|
<!-- Book content -->
|
|
|
|
<script type="text/javascript" src="/portal/portal3rc.fcgi/rlib/js/InstrumentNCBIBaseJS/InstrumentPageStarterJS.js"> </script>
|
|
|
|
|
|
<!-- CE8B5AF87C7FFCB1_0191SID /projects/books/PBooks@9.11 portal104 v4.1.r689238 Tue, Oct 22 2024 16:10:51 -->
|
|
<span id="portal-csrf-token" style="display:none" data-token="CE8B5AF87C7FFCB1_0191SID"></span>
|
|
|
|
<script type="text/javascript" src="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/js/3968615.js" snapshot="books"></script></body>
|
|
</html>
|