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Preclinical animal studies raise concerns about reproductive toxicity, whereas emerging human data suggest no significant increase in major congenital malformations compared with insulin

JAMA ophthalmology , 142 (8), 732-739

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1999;277(5):E78491

Lancet 402(10402):613626

All these pathways eventually lead to an increase in the intracellular Ca 2+ concentration, thereby promoting the mitochondrial synthesis of ATP, and the release of insulin particles into the blood through exocytosis