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Effect of Drugs on Glycemia-Reply

Donnell D. Etzwiler, MD
JAMA. 1963;185(4):328-329. doi:10.1001/jama.1963.03060040112044.
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To the Editor:—  Epinephrine is capable of producing a rise in blood glucose when administered parenterally, as Dr. Wishnofsky's work indicates. It is thought that this hyperglycemic effect is produced primarily by (1) stimulating liver-phosphorylase activity, (2) increasing muscle glycogenolysis, and (3) decreasing glucose uptake by the cells of skeletal muscles. Epinephrine probably does not act directly upon the insulin molecule or even at the same sites of action as insulin; thus, terms such as "anti-insulin action" or "antagonists of insulin" are misleading.Clinical symptoms of hypoglycemia emanate primarily from a disturbance of carbohydrate metabolism occurring within the cells of the central nervous system. The primary object in the treatment of patients experiencing a hypoglycemic episode is the restoration of normal carbohydrate metabolism within these cells. Thus, cellular utilization of glucose, not the actual level of glucose in the blood, is important. Epinephrine may inhibit the uptake of glucose by


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