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Clinical endocrinology 81 , 458466 (2014)

Staying well-hydrated is also important, especially if you experience diarrhea

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For patients with severe renal insufficiency (CrCl less than 30 mL/min, approximately corresponding to serum creatinine levels of greater than 3.0 mg/dL in men and greater than 2.5 mg/dL in women) or with end-stage renal disease (ESRD) requiring hemodialysis or peritoneal dialysis, the dose of Januvia is 25 mg once daily

And fortunately, there are a few signs you can look for: Fatigue and lethargy Excessive tiredness A general of energy Unexplained joint and muscle pain Brain fog and lack of mental clarity Getting sick often (low immunity) Difficulty getting to sleep Poor sleep quality While each of these will not definitively indicate you are glutathione deficient, they indicate you very well could be