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ABC News' Katie Kindelan and Nicole Wetsman contributed to this report.

Whether its a high-grade cream, suppository, or another specialized formulation

Adding keto to this pair can produce excellent blood sugar control and weight loss, but it also increases the risk of lactic acidosis (rare but serious with metformin) and hypoglycemia (low blood sugar) because three separate mechanisms are all working to lower blood glucose simultaneously

When she went to her annual appointment this year, she and her physician now believe that her side effects were unfortunately exacerbated by acid reflux that was not well controlled

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Teaching patients to spot early signs of serious side effects is crucial