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Gallbladder Issues: Such as gallstones or cholecystitis

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While it is a first-generation secretagogue, it remains a focal point in research for its rapid and potent physiological effects

It usually goes something like this: Start with diet, exercise, and metformin Increase the metformin dose and/or add another medication like an SGLT2 inhibitor (Jardiance, Farxiga, Invokana), DPP-4 inhibitor (Januvia, Tradjenta), or sulfonylurea (Glucotrol, Glipizide) Try a third medication Add a GLP-1 or start insulin This step-by-step process can take years, leaving blood sugar levels elevated and allowing complications to quietly develop

But the shift can feel disorienting, especially if you're used to planning meals around consistent hunger