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As previously mentioned, because DPP-4 inhibitors can increase the risk of hypoglycemia when added to insulin or a sulfonylurea, a dose decrease of sulfonylurea and/or insulin should be considered prior to initiation of a DPP-4 inhibitor
A prescription is appropriate if you meet BMI criteria (30 or higher, or 27 or higher with a weight-related comorbidity), have no contraindications, and are prepared to continue the medication long-term given the regain data from STEP-4
However, there are especially high levels of NTS2 in areas associated with pain, where NT agonists have been shown to regulate pain through NTS2 independent of NTS1 (Dubuc et al., 1994
Reminder: Microdosing remains experimental with no clinical trial validation