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Top differentials to rule out first: pain/arthritis, thyroid disease, anemia, infection, diet inconsistency, and GI issues that limit absorption

Severe hypoglycaemia and DKA were rare

We showed that mice fed a high-fat diet (HFD) for 12 weeks developed hepatic steatosis and liver injuries, which were associated with not only TNF overproduction but also hepatic glutathione dysregulation, characterized by GSH reduction and GSSG elevation

Autonomic and Neurologic Symptoms The authors note that atypical clinical presentations of Lyme disease can occur, including gastrointestinal manifestations related to autonomic dysfunction , as was seen in this case

Other safety considerations include rare reports of pancreatitis and the unresolved concern regarding thyroid C-cell tumors, as reflected by boxed warnings (Espinosa et al., 2024