Glucose hyperinsulinism. Medical search. Frequent questions

Congenital hyperinsulinism, also known as persistent hyperinsulinemic hypoglycemia of infancy, is the most frequent cause of severe, recurrent and persistent hypoglycemia in children. (spp.pt)
Continuous glucose monitoring provides real-time information about interstitial fluid glucose levels throughout the day and has proven to be useful in preventing hypoglycemia. (spp.pt)
Despite this, there are only a few studies in the literature describing the use of continuous glucose monitoring systems in neonatal hypoglycemia, particularly in children with congenital hyperinsulinism. (spp.pt)
Hyperinsulinism (HI) is the most common cause of severe, persistent hypoglycemia in infants and children. (medscape.com)
Conversely, hypoglycemia associated with ketonuria makes hyperinsulinism less likely. (medscape.com)
problems, low blood glucose (hypoglycemia), and abnormally high levels of insulin (hyperinsulinism). (medlineplus.gov)
Congenital hyperinsulinism (HI) is a disorder that causes low blood sugar (hypoglycemia) in infants and children. (chop.edu)
Evaluation, Medical Therapy, and Course of Adult Persistent Hyperinsulinemic Hypoglycemia After Roux-en-Y Gastric Bypass Surgery: A Case Series. (umassmed.edu)
Hypoglycemia is difficult to define in neonates but is generally considered a serum glucose concentration 40 mg/dL ( 2.2 mmol/L) in symptomatic term neonates, 45 mg/dL ( 2.5 mmol/L) in asymptomatic term neonates between 24 hours and 48 hours of life, or 30 mg/dL ( 1.7 mmol/L) in preterm neonates in the first 48 hours. (merckmanuals.com)
Hypoglycemia Hypoglycemia, or low plasma glucose level can result in sympathetic nervous system stimulation, and central nervous system dysfunction. (merckmanuals.com)
A sustained input of exogenous glucose is therefore important to prevent hypoglycemia. (merckmanuals.com)
Congenital hyperinsulinism (H.I.), also referred to as persistent hyperinsulinemic hypoglycemia of infancy (PHHI), or less commonly as nesidioblastosis, is a rare autosomal recessive genetic defect occurring in the Ashkenazic Jewish population, among others. (forward.com)
Hypoglycemia is a general term used to describe a mixed bag of symptoms that are due to a derangement of glucose metabolism . (digitalnaturopath.com)
Dextrose monohydrate injection (25%) is a sterile intravenous solution that is FDA approved for the treatment of acute symptomatic episodes of hypoglycemia in the neonate or older infant to restore depressed blood glucose levels and control symptoms. (wikidoc.org)
Primary hyperinsulinism is a rare but important cause of hypoglycemia in infants and children. (medscape.com)
An investigational glucagon-like peptide-1 (GLP-1) antagonist, exendin-(9-39), prevents fasting and protein-induced hypoglycemia among children with congenital hyperinsulinism, new data suggest. (medscape.com)
Babies are diagnosed shortly after birth because they have severe hypoglycemia and require high glucose infusion rates to maintain normal glucose levels," senior author Diva D. De León, MD, told Medscape Medical News . (medscape.com)
Exendin-(9-39) has been granted an orphan drug designation by the European Medicines Agency for the treatment of congenital hyperinsulinism and by the US Food and Drug Administration for the treatment of hyperinsulinemic hypoglycemia (which includes congenital hyperinsulinism). (medscape.com)
The current study involved 16 children (6 girls, 10 boys), aged 10 months through 15 years with persistent hypoglycemia due to congenital hyperinsulinism. (medscape.com)
Congenital Hyperinsulinism (CHI) is the most frequent cause of severe, persistent hypoglycemia in children. (eurospe.org)
A familial, nontransient HYPOGLYCEMIA with defects in negative feedback of GLUCOSE-regulated INSULIN release. (bvsalud.org)

Beta-cell specific Insr deletion promotes insulin hypersecretion and improves glucose tolerance prior to global insulin resistance. (umassmed.edu)
The study shows that exenatide, a treatment that targets the pancreas to improve glucose absorption, enhances glucose uptake and reduces insulin resistance in the liver and in adipose tissue. (sciencedaily.com)
A type 2 diabetes treatment has been found to also have 'off-label' benefits for glucose control in the liver and in fatty cells known as adipose.1 Presented at The International Liver CongressTM 2016 in Barcelona, Spain, today, the study shows that exenatide, a treatment that targets the pancreas to improve glucose absorption, enhances glucose uptake and reduces insulin resistance in the liver and in adipose tissue. (sciencedaily.com)
The results showed that acute exenatide administration (5mcg) decreased glucose production and insulin resistance (p=0.02) in the liver tissue when blood sugars were low. (sciencedaily.com)
The main cause is either insulin deficiency or insulin resistance, which leads to the accumulation of glucose in the blood and hence elevated blood glucose levels. (online-sciences.com)
Perhaps more obscurely, any condition resulting in chronic insulin resistance results in hyperinsulinism that may lead to so called 'islet exhaustion' in susceptible individuals. (vin.com)
However, especially in dogs, in many cases the clinically significant glucose intolerance will not resolve with the reduction in insulin resistance-inducing factors and the clinician will have to consider alternative management strategies such as oral hypoglycemics or insulin. (vin.com)
HYPERINSULINISM is a measurable consequence of the presence of Insulin Resistance - IR. (diabet2.rs)
In type 2 diabetes (late stage), beta cells fail to secrete insulin for maintaining the blood glucose level, owing to insulin resistance and genetic defect. (medscape.com)

The first step in glycolysis (ie, conversion of glucose to glucose-6-phosphate [G6P] by glucokinase) is the rate-limiting step in glucose metabolism. (medscape.com)
The present article discusses how accumulation of triacylglycerol in adipocytes can lead to deterioration of the responsiveness of glucose metabolism in other tissues. (cambridge.org)
To date, there have been few effective modalities in the treatment of cardiovascular disease and/or disorder subsequent to stroke, including in subjects with a glucose metabolism disorder. (justia.com)
It is a disease characterized by impaired carbohydrate metabolism, namely glucose metabolism. (online-sciences.com)
The β-cell ATP-sensitive potassium (K ATP ) channel controls insulin secretion by linking glucose metabolism to membrane excitability. (elsevierpure.com)
Whole blood-based transcriptional risk score for nonobese type 2 diabetes predicts dynamic changes in glucose metabolism. (medscape.com)

Glucose and several amino acids stimulate insulin secretion under physiologic conditions, and the sequence of events leading to insulin secretion is well delineated. (medscape.com)
Hyperinsulinism is a congenital disorder of regulation of insulin secretion. (chop.edu)
The first line of therapy is Diazoxide, a medication that is used in an oral preparation is very effective in suppressing insulin secretion in milder forms of hyperinsulinism. (chop.edu)
The disease affects the body's sulfonylurea receptors in the pancreas, which control the secretion of insulin to regulate the levels of glucose in the bloodstream. (forward.com)
Thus, glucokinase regulates the rate of glucose oxidation and subsequent insulin secretion. (medscape.com)
However, children with persistent hyperinsulinism may have a genetic defect that results in inappropriate secretion of insulin. (medscape.com)
The most common and severe form of congenital hyperinsulinism is due to inactivating mutations of two genes that encode subunits of the beta-cell K ATP channel, leading to dysregulated insulin secretion. (medscape.com)
Truncating the protein by removing the first nine amino acids turns it into an antagonist with the opposite effect, that is, it reduces insulin secretion and increases blood glucose, De León explained. (medscape.com)
They are essential for glucose-stimulated insulin secretion from pancreatic beta-cells, contribute to the mechanisms by which hypoglycaemia stimulates glucagon release from pancreatic alpha-cells, and are involved in glucose uptake into skeletal muscle, glucose production and release from the liver, and feeding behaviour. (ox.ac.uk)

Medication didn't raise them, and when a PET scan indicated Max had diffuse hyperinsulinism (HI) disease, the doctors at the HI Center recommended a pancreatectomy. (chop.edu)
By doing genetic screening and finding out what gene is defective in these children we can very-with high accuracy-determine who has focal hyperinsulinism and who would have diffuse hyperinsulinism. (chop.edu)
The remainder of patients, with diffuse hyperinsulinism, "are the most severe and most difficult group to treat. (medscape.com)

An understanding of glucose homeostasis can help narrow the differential diagnosis. (medscape.com)
The role of the KATP channel in glucose homeostasis in health and disease: more than meets the islet. (ox.ac.uk)
ATP-sensitive potassium (K(ATP)) channels are critical for the maintenance of glucose homeostasis. (ox.ac.uk)
This symposium review focuses on our current understanding of the role of the K(ATP) channel in glucose homeostasis in health and disease. (ox.ac.uk)
In addition, insulin is the most important factor in the regulation of plasma glucose homeostasis, as it counteracts glucagon and other catabolic hormones-epinephrine, glucocorticoid, and growth hormone. (medscape.com)

Background and Aims: In patients with congenital hyperinsulinism (CHI), recurrent hypoglycaemia can lead to longstanding neurological impairments. (eurospe.org)
Background & Aims: Hypoglycaemia is a constant threat for all patients with congenital hyperinsulinism (CHI) and, left untreated, can lead to neurological damage and impaired development. (eurospe.org)

Since October 1998 the Congenital Hyperinsulinism Center at Children's Hospital of Philadelphia has evaluated and treated more than 400 patients - making it the largest program of its kind in North America. (chop.edu)
Even today with all we know, that's the frequency," said De León, chief of the Division of Endocrinology and Diabetes and director of the Congenital Hyperinsulinism Center at Children's Hospital of Philadelphia (CHOP). (medscape.com)

0.1 mU/l), but insulin concentrations were very high (table 1) and glucose concentrations were consistent with impaired glucose tolerance by WHO criteria. (bmj.com)

In insulin resistant tissues, a threshold concentration of insulin is reached causing the cells to uptake glucose and therefore decreases blood glucose levels. (wikipedia.org)
The test measured glucose uptake in liver tissue and abdominal adipose tissue glucose uptake. (sciencedaily.com)
The treatment also improved liver tissue uptake of glucose when it is eaten (p=0.039). (sciencedaily.com)
Insulin is an anabolic hormone that promotes glucose uptake, glycogenesis, lipogenesis, and protein synthesis of skeletal muscle and fat tissue through the tyrosine kinase receptor pathway. (medscape.com)

Diagnostic criteria include plasma glucose levels less than 3 mmol/L with detectable serum insulin and C-peptide, low serum ketone bodies, and low serum fatty acids. (medscape.com)
However, the ma glucose 7 mmol/L or random plasma prevalence of DM2 in the paediatric popu- glucose 11.1 mmol/L [ 12 ]. (who.int)

At The Children's Hospital of Philadelphia Hyperinsulinism Center, we see approximately two-thirds of all the cases that are born in this country with hyperinsulinism. (chop.edu)

There are two types of hyperinsulinism. (chop.edu)
One drug, diazoxide, is a K ATP channel agonist that suppresses insulin release in some types of hyperinsulinism but not in the majority of patients who have those two particular K ATP channel mutations. (medscape.com)

We have different treatment options for children with hyperinsulinism. (chop.edu)
Some children with Hyperinsulinism do not show any symptoms even when their sugars are dangerously low. (sibs.org.uk)
Children with Hyperinsulinism need to check their blood sugars by using a handheld blood sugar monitor. (sibs.org.uk)
Some children with Hyperinsulinism may need to take their medicine and feeds regularly on time to help them control their blood sugars. (sibs.org.uk)

The patient comes fasting and a blood sample is withdrawn for determination of fasting serum glucose level. (online-sciences.com)
Serum glucose level is determined in each sample and urine is checked for the presence of glucose and the results are plotted against time. (online-sciences.com)
Frequent monitoring of serum glucose concentrations is required when intravenous dextrose is given to pediatric patients, particularly neonates and low birth weight infants. (wikidoc.org)

The clinical characteristics were: pubertal onset, female preponderance, obesity, strong family history of type 2 diabetes mellitus, high plasma glucose at presentation, adequate cell reserve and serum pancreatic islet cell antibody negativity. (who.int)
The guidelines recommend insulin treatment in all patients who present with ketosis or extremely high blood glucose levels because it may not be clear initially whether these patients have type 2 or type 1 diabetes. (medscape.com)
A type 2 diabetes treatment has been found to also have 'off-label' benefits for glucose control in the liver and in fatty cells known as adipose. (sciencedaily.com)
When a mother has diabetes, her fetus is exposed to increased levels of glucose because of the elevated maternal blood glucose levels. (merckmanuals.com)
Diabetes mellitus is a disease of inadequate control of blood levels of glucose , It has many subclassifications, including type 1, type 2, maturity-onset diabetes of the young (MODY), gestational diabetes, neonatal diabetes, and steroid-induced diabetes. (online-sciences.com)
Transient hyperinsulinism usually results from environmental factors such as maternal diabetes and birth asphyxia. (medscape.com)
Exendin-(9-39) is a modified form of the GLP-1 receptor agonist exendin-4, better known as exenatide (Byetta), a widely used drug for lowering blood glucose in type 2 diabetes. (medscape.com)
Gastric Bypass is best indicated in patients with high rates of obesity, particularly patients with Morbid Obesity (BMI ≥ 40) or Super Morbid Obesity (BMI ≥ 50) who have some associated metabolic diseases such as Diabetes Mellitus type II or Metabolic Syndrome (glucose intolerance, hyperinsulinism, hypertension, high triglycerides). (readrad.com)
Diabetes mellitus is perhaps best defined as clinically significant glucose intolerance caused by an absolute or relative lack of insulin. (vin.com)
For instance in cats, if megestrol acetate is suspected to be the cause of the diabetes, withdrawal of this medication may be sufficient to ameliorate glucose intolerance and clinical signs of diabetes. (vin.com)
It is because of the phenomenon of 'islet exhaustion' that insulin therapy should be considered as a front-line treatment option in most patients with clinically significant glucose intolerance or diabetes mellitus. (vin.com)

In this case report, the authors present their experience with real-time continuous glucose monitoring system in a neonate with congenital hyperinsulinism, associated with a novel missense variant in ABCC8 gene. (spp.pt)
Following birth, the hyperglycemic maternal blood is no longer accessible to the neonate resulting in a rapid drop in the newborn's blood glucose levels. (wikipedia.org)
To treat the condition, high concentration doses of glucose are given to the neonate as required maintaining normal blood glucose levels. (wikipedia.org)
When the umbilical cord is cut, the infusion of glucose to the neonate ceases, and it may take hours or even days for the neonate to decrease its insulin production. (merckmanuals.com)

If these drugs are going to improve glucose intolerance, they generally have significantly lowered fasting hyperglycaemia within 10-14 days. (vin.com)

They may also have a continuous glucose monitor (CGM) system inserted, which can alert them if their sugar is too low. (sibs.org.uk)
Continuous Glucose Monitoring (CGM) shows promise but current accuracy is insufficient for acute hypoglycaemia detection and data review services are complex and generic. (eurospe.org)
Continuous glucose monitoring (CGM) is a promising alternative method which has the utility to identify risk and patterns of hypoglycaemia. (eurospe.org)
Background and Objective: Continuous Glucose Monitoring (CGM) is gaining in popularity for patients with paediatric hypoglycaemia disorders such as Congenital Hyperinsulinism (CHI), but no standard measures of accuracy or associated clinical risk are available. (eurospe.org)
To improve glycaemic monitoring, self-monitoring-blood-glucose (SMBG) is increasingly being replaced by Continuous Glucose Monitoring (CGM) with potential to identify illness patterns and treatment responses although with unproven benefit for patients and families. (eurospe.org)
Continuous Glucose Monitor (CGM) time. (who.int)
Average daily percent time with hyperglycemia = 5% of the monitored screening continuous glucose monitoring (CGM) time. (who.int)
OGTT metrics surpass continuous glucose monitoring data for T1D prediction in multiple-autoantibody-positive individuals. (medscape.com)

An intravenous glucose infusion rate greater than 8 mg/kg/min (normally, 4-6 mg/kg/min) strongly supports the diagnosis. (medscape.com)
Subsequent continuous intravenous infusion of 10% dextrose injection may be needed to stabilize blood glucose levels. (wikidoc.org)

To compensate for the increased blood glucose levels, fetal pancreatic beta cells can undergo hyperplasia. (wikipedia.org)

Maternal diet apparently does not have a significant role on neonatal cord blood insulin, C-peptide, or plasma glucose levels although a lower maternal glycemic load appears to be associated with lower adiposity in infants born to these women. (medscape.com)
Hyperinsulinemia is a condition in which there are excess levels of insulin circulating in the blood relative to the level of glucose. (wikipedia.org)
With a reduced response to insulin, the beta cells of the pancreas secrete increasing amounts of insulin in response to the continued high blood glucose levels resulting in hyperinsulinemia. (wikipedia.org)
If the mother of the infant is a diabetic and is not able to properly control her blood glucose levels, the hyperglycemic maternal blood can create a hyperglycemic environment in the fetus. (wikipedia.org)
The rapid division of beta cells results in increased levels of insulin being secreted to compensate for the high blood glucose levels. (wikipedia.org)
controls the amount of glucose that moves from the blood into cells for conversion to energy. (medlineplus.gov)
Children that have hyperinsulinism produce too much insulin and that causes severe low blood glucose. (chop.edu)
Hemoglobin A1c (HbA 1c ) levels should be measured every 3 months and treatment adjusted if goals for both HbA 1c and blood glucose are not met. (medscape.com)
After blood glucose levels are normalized, efforts to taper insulin with progressive substitution of an oral agent are undertaken. (medscape.com)
Hyperinsulinism is where the body produces too much insulin, causing blood sugar levels to drop too low. (sibs.org.uk)
However, in Hyperinsulinism the pancreas makes too much insulin, removing too much sugar from the blood causing low blood sugar (hypoglycaemia). (sibs.org.uk)
2-Chronically elevated BLOOD GLUCOSE levels DO cause kidney damage. (robbwolf.com)
In situations such as blood sugar highs in diabetics we can see glucose in the urine as a coping mechanism to bring blood glucose levels down, but that situation is bad, bad business. (robbwolf.com)
In individuals with congenital hyperinsulinism, the sulfonylurea receptor system is impaired, so the beta cells of the pancreas keep secreting insulin, regardless of the blood sugar level. (forward.com)
When the blood-glucose levels fall too low, an infant may become lethargic, suddenly turn blue or experience seizures. (forward.com)
A blood-glucose test will show very low levels of sugar and intravenous dextrose solution may be sufficient to raise the concentration to stable levels. (forward.com)
This type results in a rapid rise in blood glucose within the first hour followed by a pronounced or precipitous drop in blood glucose in the second hour. (digitalnaturopath.com)
After ingestion of glucose the blood sugar rises for the first three hours followed by a hypoglycemic rebound at 4 to 6 hours. (digitalnaturopath.com)
In this case the blood glucose does not deviate more than +/- 15% from fasting level through the whole test. (digitalnaturopath.com)
Blood Glucose level estimation: fasting blood glucose , post prandial, random blood glucose , Oral glucose tolerance test (OGTT). (online-sciences.com)
Glycogenolysis: Free blood glucose can be derived from the liver stores of glycogen. (online-sciences.com)
Blood glucose is derived through its endogenous synthesis from non-carbohydrate sources e.g. from amino acids , lactate, and glycerol . (online-sciences.com)
A specimen for blood glucose determination should be taken before injecting the dextrose. (wikidoc.org)
Introduction Hyperglycaemia is a state of high blood glucose level. (sunzek.com)
Hypoglycaemia is an abnormally low level of glucose in the blood (less than 4 millimoles per litre or 40 mg/dl) irrespective of age and gestational age. (sunzek.com)
This is called hyperinsulinism in blood and is a direct indicator. (diabet2.rs)
Both Low Blood Glucose and Insufficient Treatment Confer Risk of Neurodevelopmental Impairment in Congenital Hyperinsulinism: A Multinational Cohort Study. (cdc.gov)

Congenital hyperinsulinism (HI) is the most common cause of persistent hypoglycaemia in infants. (biomedcentral.com)
Normal glucose utilization rate is 4-6mg/kg/minute but high-risk infants require 6-10mg/kg/minute. (sunzek.com)

[ 2 ] The patient is instructed to fast, and plasma glucose, insulin, proinsulin, and C-peptide levels are measured every 6 hours until the plasma glucose level is less than 65 mg/dL, after which the testing frequency is increased to every 1-2 hours. (medscape.com)

Several genetic causes of persistent hyperinsulinism have been identified. (medscape.com)
A rare disorder, occurring in 1 in 20,000 to 1 in 50,000 US live births, congenital hyperinsulinism is caused by several different genetic mutations. (medscape.com)
An established clinical diagnosis of congenital HI (hyperinsulinism), with or without identification of a known monogenic variant by genetic testing. (who.int)

Neonatal hypoglycaemia can be transient and yet pose a significant risk of neuroglycopaenia, especially with severe and recurrent hypoglycaemia in Congenital Hyperinsulinism. (eurospe.org)

A Glucose Tolerance Test (ideally lasting 5-6 hours) can confirm a diagnosis, but more alternative doctors are forgoing the inconvenience and shock to the system because symptoms alone are reliable enough. (digitalnaturopath.com)

In the fasting state, glucose is provided through glycogenolysis in the liver. (medscape.com)
Possible cause of this response is gastric dumping, too large an insulin response (pancreatic problems) and glucose tolerance factor problems (liver problems). (digitalnaturopath.com)
The remaining 25% of glucose is either newly synthesised by the liver, or broken down from within the small portions of carbohydrate eaten on keto. (ketonis.eu)

When possible, glucose concentrations of greater than 12% should be administered by central vein to reduce the risk for phlebitis and thrombosis. (wikidoc.org)
Initial rates of adipocyte 3-0-methyl glucose transport were decreased in the absence of insulin (basal) and at submaximally effective (33.3pmol/l) but not at maximally effective insulin concentrations. (elsevierpure.com)

Congenital hyperinsulinism is a condition in which the beta cells of the pancreas make too much insulin, and more importantly, have lost the ability to regulate insulin based on the plasma glucose levels. (cookchildrens.org)

Other drugs, such as epinephrine and glucagon , should be considered in patients unresponsive or intolerant to dextrose (glucose). (wikidoc.org)

Background: Congenital Hyperinsulinism (CHI) is the most common cause of recurrent and severe hypoglycaemia in childhood and can be broadly categorised into two subtypes. (eurospe.org)

Obesity is characterized by an excess of adipose tissue - insulin increases the synthesis of fatty acids from glucose, facilitates the entry of glucose into adipocytes and inhibits breakdown of fat in adipocytes. (wikipedia.org)

Max arrived at CHOP's Congenital Hyperinsulism Center with extremely low glucose levels. (chop.edu)
Although, traditionally, oral hypoglycaemic agents were most likely to be effective in diabetic animals with some insulin secreting capacity, the possibility of glucose toxicity means they may be effective in cases which do not have significant insulin levels at presentation. (vin.com)

Loss of K ATP channel function due to mutations in ABCC8 or KCNJ11, genes that encode the sulfonylurea receptor 1 or the inward rectifier Kir6.2 subunit of the channel, is a major cause of congenital hyperinsulinism. (elsevierpure.com)

In both cases, the hyperinsulinism is transient. (merckmanuals.com)

4-Glucose in the urine: Five Alarm No Bueno. (robbwolf.com)

A number of these so-called 'oral hypoglycemics' improve glucose tolerance by increasing the rate and amount of insulin released, as well as increasing peripheral insulin sensitivity. (vin.com)

And so the real danger about this condition is that the brain needs glucose lactate and ketones for energy. (cookchildrens.org)

And in congenital hyperinsulinism, none of those fuels are available, and hence a very high risk of 20 to 40% of brain damage that can occur in this condition. (cookchildrens.org)

The rate of glucose entry into the beta cell is facilitated by a glucose transporter, and the entry rate exceeds the oxidation rate of glucose. (medscape.com)
0.05), whereas rates of glucose oxidation were unaffected. (elsevierpure.com)

Anatomy4

Diseases18

Chemicals and Drugs34

Analytical, Diagnostic and Therapeutic Techniques and Equipment6

Psychiatry and Psychology1

Phenomena and Processes11

Named Groups1

Hypoglycemia21

Insulin resistance9

Metabolism6

Secretion9

Diffuse Hyperinsulinism3

Homeostasis5

Patients with congenital hyperinsulinism2

Congenital Hyperinsulinism Center2

Impaired glucose t1

Uptake4

Mmol2

Children's Hospital of1

Types of hyperinsulinism2

Children with hyperinsulinism4

Serum glucose3

Diabetes11

Neonate4

Intolerance1

Continuous glucose8

Infusion2

Pancreatic beta cells1

Blood27

Infants2

Plasma glucose level1

Genetic3

Neonatal1

Symptoms1

Liver3

Concentrations2

Beta cells of the pancreas1

Glucagon1

Hypoglycaemia1

Adipose tissue1

Levels2

Sulfonylurea1

Transient1

Urine1

Improve glucose1

Lactate1

High1

Oxidation2