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Its not recommended to increase the dose by more than 6 IUs per day

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Complementing randomized trial evidence, extensive real-world observational data from large healthcare databases consistently demonstrate associations between GLP-1 receptor agonist utilization and decreased risks of MALOs involving cirrhosis, hepatic decompensation, HCC, and death from hepatic causes in patients with MASLD and type 2 diabetes

Nat Rev Drug Discov 2008

A deficiency in vitamin B12 can show up in several ways