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The right approach to dosing on restart depends largely on how long you have been off treatment
Severe kidney disease (eGFR below 30 mL/min/1.73m) or active diabetic ketoacidosis eliminates metformin use
A consistent pattern emerges in phenotypes with a high metabolic burden, such as obesity and IGT or pre-diabetes, improvements in fasting glucose, OGTT curves, and HbA1c are more pronounced, with some subjects even reverting from IGT to normoglycemia
Cons needles, refrigeration/storage, injection site care
These are the situations where semaglutide is not safe
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