2. At present, for patients who are unaware of hypoglycemia and who require antihypertensive or nephroprotective treatment, we would recommend caution concerning treatment with losartan. Insulin lispro is indicated to improve glycemic control in adults and children with diabetes mellitus. Type 3 diabetes, atypical causes, such as pancreatomy, drug induced, pancreatic disease. Delaying the excretion of glucose. Pharmacology (mechanism of action) of insulin. Glucose-elevating agents exert their actions by: A. Indications: Relieve pain, fever, and inflammation Selected Interventions Instruct the client to take the medication with a full glass of water and just after food Warn the client that GI symptoms (nausea, vomiting, bleeding, ulceration) can occur when taking these . Pharmacology of Diabetes Medications Krista Dominguez-Salazar PharmD, PhC Associate Professor of Clinical Pharmacy . Search Google Scholar for this author. All articles were assessed for bias using the Cochrane Risk of Bias Assessment Tool and Newcastle-Ottawa scales for randomized prospective trials and . Build, train, & validate machine-learning . Minor (1) maitake increases effects of insulin NPH by pharmacodynamic synergism. See all articles by this author. 30 mg/dL. It is released when you eat food and the glucose level increases in blood. •Treatment of DM in people > 18 years old: •14% use insulin only •14.7% use both insulin and oral medication •56.9% use oral medication only •14.4% . Increase insulin sensitivity of the body cells and reduce the production of glucose by the liver. Address correspondence and reprint requests to Lutz Heinemann, PhD, Department of Nutrition and Metabolic Diseases, Heinrich-Heine-University of Dusseldorf, P.O. However, when the NPH insulin cohort was compared with each long-acting analog cohort, slight differences were noted, including a higher proportion of NPH insulin users who were Black (13% for NPH insulin vs 9% for analogs), fewer physician visits and glycated hemoglobin tests before the index date in NPH insulin users than analog users, and a . A. 5, 40001 Dusseldorf, Germany. D. Therefore, beta-blockers are sympatholytic drugs. 5 to 60 minutes. In more recent years, the human insulins produced by recombinant DNA technology, have been further modified by subtle molecular . The Comprehensive Pharmacology Reference, 2007. "I'll try to consume about 20% carbs and 40% fats on a daily basis.". Top 5 Symptoms of Hypoglycemia Top 5 Symptoms of Hyperglycemia Top 5 Symptoms of Ketoacidosis-Anxiety -Restlessness -Tingling in hands, feet, lips, tongue -Chills; Cold sweats -Confusion-Drowsiness -Flushed dry skin -Fruity breathy odor -Rapid and deep breath -Polyuria Box 10 10 07, Moorenstr. Therefore, if a patient with diabetes has a low blood sugar the symptoms of hypoglycemia may not appear due to the presence of beta blockers. It mimics the normal first phase insulin reaction. Insulin lispro begins to exert its effects within 15 minutes of subcutaneous administration, and peak levels occur 30 to 90 minutes after administration. Insulin promotes glucose and amino acid uptake into muscle and adipose tissues, and other tissues except brain and liver. Insulin is a hormone secreted by the pancreas. Peak: 3-9 hours (insulin detemir only) Duration: ~ 24 hours. 1. PDF | On Aug 1, 2007, Shashank R Joshi and others published Insulin--history, biochemistry, physiology and pharmacology | Find, read and cite all the research you need on ResearchGate Signs and symptoms include shaking, irritability, loss of focus. Severe hypoglycemia with coma, seizure, or neurological impairment can be treated with glucagon or intravenous glucose. The efficacy of insulin glargine can also be decreased by corticosteroids, stimulants, antipsychotics, or transplant medications. Pharmacology Indication. The primary activity of insulin is the regulation of glucose metabolism. The risk of hypoglycemia generally increases with intensity of glycemic control. Previous studies have suggested a potential relationship between angiotensin-converting enzyme inhibitors (ACEIs) used with sulfonylureas and serious hypoglycemia, and widely used drug compendia warn of this potential drug-drug interaction. HYPOGLYCEMIA, lipodystrophy, pruritus, erythema, swelling, ANAPHYLAXIS. B. • Pancreas stores about 10 mg of Insulin - roughly 2 mg ( 50 U) is released into portal vein daily. Types of diabetes: Type 1 diabetes, basic cause: absence of natural insulin due to beta cell destruction. The risk of hypoglycemia after an injection is related to the duration of action of the insulin [see CLINICAL PHARMACOLOGY] and, in general, is highest when the glucose lowering effect of the insulin is maximal. New proposed classification of diabetes: (original article at . This inhibits normal sympathetic effects that act through these receptors. It is an intermediate acting antihyperglycaemic drug. Hypoglycemia; Allergy or hypersensitivity to insulin glargine. Beta-blockers are drugs that bind to beta-adrenoceptors and thereby block the binding of norepinephrine and epinephrine to these receptors. If you have a drop of white blood cells - then take another 1's before using insulin - Take two 1's in a cup of water - use more than one cup of water - and then take insulinPharmacology Insulin Quizlet - All Practicios Positifos As an article regarding the future and if so, eek, eek. Insulin is used for the following indications: To replace insulin in patients with type 1 diabetes; To control blood glucose levels in type 2 diabetes; To treat diabetic emergencies, such as ketoacidosis; Insulin can be used to treat hyperkalemia because, by its very nature, insulin sequesters potassium inside cells. Bushra Ahmad. Start studying Insulin Pharmacology. Department of Diabetes, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, OX3 7LJ, UK, bushra.ahmad@orh.nhs.uk. Type I Diabetes Mellitus: 1-2 units change. Assess for symptoms of hypoglycemia Monitor body weight periodically. Lutz Heinemann, Bernd Richter; Clinical Pharmacology of Human Insulin. Hence once-daily sulfonylureas will produce a greater effect on basal glycemic levels throughout the day, compared to meglitinides that are given with meals and have a selective effect . As with all insulin preparations, the glucose . Glimepiride Description Insulin also promotes growth and is required for the actions of growth hormone (e.g. NCLEX Pharmacology Practice Question on Insulin. Unformatted text preview: INSULIN ASSIGNMENT INSULIN PHARMACOLOGY Insulin is a hormone produced by Beta cells in pancreatic islets of Langerhans.It consists of 2 polypeptide chains A and B of 21 and 30 amino-acids respectively, linked by disulfide linkage. It is released into circulation when the levels of glucose . The hyperinsulinemic euglycemic clamp (HEC) study is the "gold standard" of PK/PD evaluation of the investigated biosimilar and . Combines intermediate- and short-acting insulin. Signs and symptoms include shaking, irritability, loss of focus. Not valid for SOLIQUA 100/33 (insulin glargine and lixisenatide) injection 100 Units/mL and 33 mcg/mL. Insulin is a high molecular weight (human insulin 5808 Da) polypeptide hormone composed of 110 amino acids. Drugs . The four types of insulin. It regulates the movement of glucose from blood into cells. Gene ral measures to consider. Insulin is the hormone produced by the pancreatic beta cells of the islets of Langerhans. Glucose-elevating agents raise blood level of glucose when severe hypoglycemia occurs at <40 mg/dL. When using the Insulins Val you Savings Card, prices are guaranteed for 12 consecutive monthly fills. Epidemiology. Which information should the nurse teach when carrying out plans for discharge? Both inpatient and outpatient trials have shown that the risk of hypoglycemia limits the achievement of blood glucose control (1-7).In addition to causing distress for patients, severe hypoglycemia is associated with cardiac arrhythmias, cardiac ischemia, seizures, brain damage . This will be accomplished within a broader contextual discussion of the normal physiologic patterns of insulin secretion, which consist of sustained levels of basal insulin production throughout the day, superimposed with bursts of insulin secretion following a meal (termed bolus or prandial insulin secretion) that slowly decay over 1 to 3 hours. Delaying the excretion of glucose. Insulin acts on specific receptors located on the cell membrane of practically every cell, but their density depends on the cell type: liver and fat cells are very rich. , 2014 •9.3% (29.1 million) of the US Population have diabetes. Usually taken 10 to 30 minutes before breakfast and dinner. In this study, we explored clinical drug-drug interactions that result in hypoglycemia by analyzing the Japanese Adverse Drug Event Report (JADER) database. Your patient's blood glucose level is 215 mg/dL. In the last 30 years, insulin pharmacology has been revolutionized by the introduction of recombinant DNA technology and genetically engineered human insulin, which has replaced the animal-derived insulin preparations. protein synthesis, cell division, DNA synthesis). Insulin is a drug that is used to control glucose in patients with diabetes mellitus. The main goal of clinical pharmacology assessment of biosimilar insulin analogues is to demonstrate the similarity of PK/PD profiles and, in consequence, the comparable efficacy of biosimilar and original products. We review early academic insights . Reduce drug development failure rates. B. Decreasing insulin release. 1. Answer: A. Insulin therapies are now able to more closely mimic physiologic insulin secretion and thus achieve better glycemic control in patients with diabetes. Drugs used to treat Hypoglycemia The following list of medications are in some way related to or used in the treatment of this condition. Medications for Cardiovascular Disorders Analgesic/Antipyretic/NSAIDs Acetaminophen Acetylsalicylic Acid Ibuprofen. Insulin Types (Open Table in a new window) Ultra short acting: insulin lispro, insulin aspart, insulin glulisine [ 2] Usually taken before a meal to cover the blood glucose elevation from eating Used with longer-acting insulin. Chapter: Essential pharmacology : Insulin, Oral Hypoglycaemic Drugs and Glucagon. Insulin dose adjustment and increased frequency of glucose monitoring may be required. Insulin is a medication used to treat clients with diabetes mellitus.Now, there are two main types of diabetes mellitus. Chapter: Essential pharmacology : Insulin, Oral Hypoglycaemic Drugs and Glucagon. Only studies that evaluated hypoglycemia (serum glucose <70 mg/dl), severe hypoglycemia (serum glucose <50 mg/dl), and potassium reduction post-treatment were included in the meta-analysis. These include rapid-acting insulins like insulin lispro and insulin aspart, short-acting (regular) insulin, intermediate-acting insulin (NPH), and long-acting insulins like insulin glargine and . Glucose-elevating agents exert their actions by: A. Insulin is an essential hormone in the human body and Pharmacology of insulin is a vast area, and there are many advancements going on in the Clinical and Pharmacological aspects of insulin, as insulin deficiency is a major threat to human kind nowadays. Monitor blood glucose every 6 hr during therapy. [] with great interest, and would like to share our observations of hypoglycemia the following tramadol in our cases of head injury and highlight the probable mechanisms for hypoglycemia induced by tramadol.. We have noticed rapid fall in blood sugar (as low as 50 mg/dl) within 60-90 min after intravenous administration of tramadol in some cases of . Type 4 diabetes, gestational diabetes. As the nurse, you know the patient is most at risk for hypoglycemia at what time? In patients with Diabetes, hypoglycemia is defined as : All episodes of an abnormally low plasma glucose . As with all insulin preparations, the . Glucose-elevating agents raise blood level of glucose when severe hypoglycemia occurs at <40 mg/dL. Type II Diabetes Mellitus: 2-4 units change. C. Slow the absorption of carbohydrates (sugar) ingested, decrease PP hyperglycemia. Mechanism of Action of Insulin Isophane NPH. Browse. Insulin mnemonic for nursing students & nurses on how to remember insulin onset, peak, duration times of rapid acting insulin, short acting insulin, intermed. Premixed. C. Delaying the breakdown of glycogen in the liver to release more glucose. 30 mg/dL. Start studying Pharmacology Chapter 24 (Insulin and oral hypoglycemia drugs). Insulin acts through binding to a subunit of insulin receptors located on the cell membrane of all cells (highest densities are seen in muscle, liver, and adipose tissue).This binding induces aggregation and internalization of the receptor along . 1. The pharmacology of lispro insulin is . Medications. Type 2 diabetes, basic cause: insulin resistance. Insulin lowers blood glucose by stimulating peripheral glucose uptake primarily by skeletal muscle cells and fat, and by inhibiting glucose production and release by the liver. Insulin acts on specific receptors located on the cell membrane of practically every cell, but their density depends on the cell type: liver and fat cells are very rich. C. Delaying the breakdown of glycogen in the liver to release more glucose. A. Oral hypoglycemic drugs are used only in the treatment of type 2 diabetes which is a disorder involving resistance to secreted insulin. It is the only parenteral antidiabetic agent available for exogenous replacement of low levels of insulin. These … Type 1 diabetes involves a lack of insulin and requires insulin for treatment. The term insulin shock is used to describe severe hypoglycemia that results in unconsciousness. Keep insulin vials refrigerated at all times. According to the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP), and based on a sample examined between 2004 and 2005, an . Glucagon, the predominant product of α-cells within islets, was originally identified in 1923 during efforts to purify insulin, where it was identified as a contaminant hyperglycemic factor ().Further research determined that the hyperglycemic action of glucagon was mediated by increased hepatic glycogenolysis and gluconeogenesis, thereby increasing endogenous glucose production (). Show all authors. Most patients with diabetes mellitus take multiple medications. Since the introduction of insulin analogs in 1996, insulin therapy options for type 1 and type 2 diabetics have expanded. The primary outcome was the report of hypoglycemia. It is released into circulation when the levels of glucose . The danger is that the patient will have a dangerously low blood sugar and . The risk of hypoglycemia after an injection is related to the duration of action of the insulin [see Clinical Pharmacology (12.2)] and, in general, is highest when the glucose lowering effect of the insulin is maximal. Per sliding scale, you administer 4 units of Insulin Lispro (Humalog) subcutaneously at 1130. Insulin is a dimer and consists of a 21-amino acid A chain and a 30-amino acid B chain linked by disulfide bonds. "Foods that are high in mono and poly fats are avocadoes, olives, and nuts.". The risk of hypoglycemia generally increases with intensity of glycemic control. Depending on the cause, treatment may involve: Nutrition counseling. B. Inhibits breakdown of glucagon-like peptide-1 secreted during meals, increase insulin release/synthesis, decrease glucagon levels. Clinical Pharmacology of Human Insulin. In cases of overdose, because of the pharmacology of insulin glargine, hypoglycemia is common. Type 1 diabetes mellitus arises when the pancreas is unable to produce insulin in order to maintain normal blood glucose levels.. On the other hand, type 2 diabetes mellitus is characterized by insulin resistance, which is when tissue cells have trouble responding to insulin . Insulin: Insulin is a hormone produced by the islets of Langerhans beta cells in the . For more information about types of insulin and when to take them, talk to your doctor or diabetes educator. Want study notes for this presentation? 2. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Pharmacology Exam 1 Galen. INSULIN HORMONE Pharmacology Sem V Pharmacology II Mr. Avinash Suryawanshi Insulin was the first human protein to be sequenced (by Frederick Sanger in 1955). PHARMACOLOGY OF INSULIN AND IT'S ANALOGUES • An endocrine hormone • Synthesized by β cells of pancreatic islets( of langerhans) , stored in intracellular granules as PROINSULIN. Hypoglycemia is the most important complication of antidiabetic medications. Insulin lispro is a modified form of fast-acting insulin used to control hyperglycemia in diabetes mellitus. Which of the following patient statements about the diabetic diet regime is correct? Pharmacology. The insulin receptor is a hetero-tetrameric glycoprotein consisting of 2 extracellular α and . If a medication is the cause of your hypoglycemia, your health care provider will likely suggest adding, changing or stopping the medication or adjusting the dosage. Coadministration of insulin with high doses of salicylates (3 g/day or more) may increase risk for hypoglycemia. Continued observation and additional carbohydrate intake may be necessary because hypoglycemia may recur after apparent clinical recovery [see Warnings and Precautions (5.1)]. The landscape of diabetes treatment has evolved significantly in recent years. Long Acting: Onset: 2 hours. Long Acting: Onset: 2 hours. Mechanism of action. The life-saving discovery of insulin in Toronto in 1921 is one of the most impactful achievements in medical history, at the time being hailed as a miracle treatment for diabetes. 10 to 16 hours. Peaks vary. Answer: A. To pay $99 per month, you must fill all your Sanofi Insulin prescriptions at the same time, together each month. The insulin receptor is a hetero-tetrameric glycoprotein consisting of 2 extracellular α and . Review: Pharmacology of insulin. Insulin is the hormone produced by the pancreatic beta cells of the islets of Langerhans. Learn vocabulary, terms, and more with flashcards, games, and other study tools. This chapter reviews the pharmacology of available insulins, types of insulin regimens, and principles of dosage selection . Indications for exogenous insulin therapy in patients with this condition include acute illness or surgery, pregnancy, glucose . There are now four classes of hypoglycemic drugs: Alpha-glucosidase inhibitors. Insulin . Insulin therapies are now able to more closely mimic physiologic insulin secretion and thus achieve better glycemic control in patients with diabetes. Hypoglycemia occurs when your body's blood sugar, or glucose, is abnormally low. Usually taken about 30 minutes before a meal to cover blood glucose elevation from eating. NG360 Pharmacology Insulin Worksheet. Some beta-blockers, when they bind to the beta-adrenoceptor . INSULIN PHARMACOLOGY Dr. D. K. Brahma Associate Professor Department of Pharmacology NEIGRIHMS, Shillong 2. Diabetic hypoglycemia is a low blood glucose level occurring in a person with diabetes mellitus. Drugs used to treat Hypoglycemia The following list of medications are in some way related to or used in the treatment of this condition. There are four types of insulin medications you will need to know for your Pharmacology exams and in your nursing practice. It is the only parenteral antidiabetic agent available for exogenous replacement of low levels of insulin. Sir, We read the article by Mahmood et al. B. Decreasing insulin release. Severe hypoglycemia creates low blood glucose levels in which a person has an altered mental status or physical symptoms that require assistance from another individual to treat the hypoglycemia. Serious hypoglycemia is a major adverse event associated with insulin secretagogues. Hypoglycemia, defined as a blood glucose level <70 mg/dL (3.9 mmol/L), occurs frequently in hospitalized patients. 1. General Pharmacology. Treatment of severe hypoglycemia is a medical emergency and prompt treatment is important for the well-being of students with diabetes. The insulin molecule itself, however, is poorly amenable as a pharmacological intervention, and the formidable challenge of optimizing insulin therapy has been ongoing for a century. Insulin dose 10-20 units: Adjust by 2 units. FINAL: Pharmacology NCLEX Questions 2022 A client who has been newly diagnosed with diabetes mellitus has been stabilized with daily insulin injections. Insulin dose >20 units: Adjust by 10% Insulin dose. That means that they are due to increases in the adrenergic hormone epinephrine. This chapter reviews the pharmacology of available insulins, types of insulin regimens, and principles of dosage selection and adjustment, and provides an overview of insulin pump therapy. Type 2 diabetes is characterized by progressive beta-cell failure. Join Patreon at https://www.patreon.com/speedpharmacologyAntidiabetic drugs are medications used to treat diabete. Note that once daily doses of a sulfonylurea produce a more sustained increase in insulin levels compared to a meglitinide given 3 times daily before each meal. Correction protocol for Hypoglycemia. Clinical Pharmacology & Therapeutics (2001) 70, 362-369; doi: 10.1016/S0009-9236(01)26448- Side Effects: Hypoglycemia: Injecting too much insulin or insulin without carbohydrate intake can lead to hypoglycemia defined as blood glucose (BG) < 70 mg/dL. •Treatment of DM in people > 18 years old: •14% use insulin only •14.7% use both insulin and oral medication •56.9% use oral medication only •14.4% . Beta blockers block the adrenergic receptor. HYPOGLYCEMIA Hypoglycemia: is a clinical syndrome with diverse causes in which low plasma glucose concentrations lead to symptoms and signs, and there is resolution of the symptoms/signs when the plasma glucose concentration is raised . Side Effects: Hypoglycemia: Injecting too much insulin or insulin without carbohydrate intake can lead to hypoglycemia defined as blood glucose (BG) < 70 mg/dL. Minor/Significance Unknown. Hypoglycemia secondary to insulin therapy in diabetics is very common Fishbein and Palumbo . Online. Your diabetic patient is to receive 8 units of regular insulin AND sliding scale insulin as follows: for BS (blood sugar) less than 80: give sugar, for BS 81-140: give no insulin, for BS 141-200 give 2 units regular insulin, for BS 201-250 give 4 units regular insulin, for BS 251-300 give 6 . • Release is controlled concentration of glucose in the plasma . Background Discovered by Banting and Best - 1921 Fredrick G. Banting & Charles H. Best - Canadian Scientist - Extracted Insulin from Dog pancreas 2 chain Polypeptide - 51 amino acids & MW 6000 Chain-A has 21 and Chain-B has 30 amino . Insulin is a drug that is used to control glucose in patients with diabetes mellitus. The milder cases of hypoglycemia can be treated with oral carbohydrates, and simply adjusting the dose, meal patterns, or . Quiz on Diabetes Mellitus Pharmacology & Nursing Management NCLEX. Provides steady insulin for long periods. Pharmacology of Diabetes Medications Krista Dominguez-Salazar PharmD, PhC Associate Professor of Clinical Pharmacy . The patient is about to eat lunch. Insulin pharmacology. Peak: 3-9 hours (insulin detemir only) Duration: ~ 24 hours. A review of eating habits and food planning with a registered dietitian may help reduce hypoglycemia. • PROINSULIN PROTEOLYSIS INSULIN. Control of hyperglycemia in diabetic patients. It is one of the most common types of hypoglycemia seen in emergency departments and hospitals. The term insulin shock is used to describe severe hypoglycemia that results in unconsciousness. Hypoglycemia occurs when your body's blood sugar, or glucose, is abnormally low. While metformin remains first-line for the treatment of type 2 diabetes, 2 new classes of medications (sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide agonists) are becoming mainstays in therapy. , 2014 •9.3% (29.1 million) of the US Population have diabetes. Adjustment steps based on diabetes type. Internal Medicine DepartmentBoulder Medical Center. The latter insulin-related products are absent infactitious hypoglycemia from exogenous administration of insulin as a form of child abuse . Bushra Ahmad. Hypoglycemia that results in unconsciousness information about types of insulin Lispro is indicated improve!: ( original article at Humalog ) subcutaneously at 1130 from exogenous administration of insulin medications you will to! Emergency departments and hospitals ( 50 U ) is released into circulation when the of... Regimens, and other study tools hypoglycemia seen in emergency departments and hospitals B chain linked disulfide! 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Games, and other study tools information about types of hypoglycemia Monitor weight..., 2014 •9.3 % ( 29.1 million ) of the most common types insulin... ) injection 100 Units/mL and 33 mcg/mL ) is released into circulation when the of. To know for your Pharmacology exams and in your Nursing practice: insulin is a high molecular weight ( insulin! To beta-adrenoceptors and thereby block the binding of norepinephrine and epinephrine to these receptors condition include illness! Secreted during meals, increase insulin release/synthesis, decrease PP hyperglycemia nurse, you know patient! Increases effects of insulin Lispro is indicated to improve glycemic control in adults and children with diabetes, is! Fishbein and Palumbo is most at risk for hypoglycemia at what time meal patterns or... Pharmacodynamic synergism patient is most at risk for hypoglycemia at what time acid.. Insulin is a medical emergency and prompt treatment is important for the well-being students. Is a disorder involving resistance to secreted hypoglycemia pharmacology regime is correct into circulation when levels. Cardiovascular Disorders Analgesic/Antipyretic/NSAIDs Acetaminophen Acetylsalicylic acid Ibuprofen Start studying insulin Pharmacology human insulin 5808 Da polypeptide! Million ) of the US Population have diabetes level of glucose Start studying insulin Pharmacology further modified by subtle.... Fats are avocadoes, hypoglycemia pharmacology, and principles of dosage selection that act through these.... In some way related to or used in the liver to release more glucose technology, have been further by. Indicated to improve glycemic control in patients with diabetes mellitus //ascpt.onlinelibrary.wiley.com/doi/10.1002/cpt.2377 '' Repositioning! Way related to or used in the by the pancreatic beta cells of the most common types insulin... Correspondence and reprint requests to Lutz Heinemann, Bernd Richter ; Clinical Pharmacology of human insulin 5808 Da ) hormone. - roughly 2 mg ( 50 U ) is released hypoglycemia pharmacology circulation the... Surgery, pregnancy, glucose important for the well-being of students with diabetes mellitus Foods that are high mono! Scales for randomized prospective trials and 40 mg/dL the dose, meal,!: //pubmed.ncbi.nlm.nih.gov/35595485/ '' > hypoglycemia - SlideShare < /a > 1 is controlled concentration of glucose monitoring may required!
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hypoglycemia pharmacology