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This paradoxical worsening of nerve symptoms can occur when glucose control improves too rapidly (typically a significant drop in HbA1c over a short period), leading to temporary metabolic stress on peripheral nerves

Tapering is often recommended to help your body ease off the medication and reduce the risk of rapid appetite return

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Dose-dependent effects: Safety concerns increase substantially at doses exceeding 5060 mcg/day

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Four months later, he was doing well