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The cataplerotic reactions that involve conversion of PEP to pyruvate in the cytosol then pyruvate to oxaloacetate (OAA) then OAA to aspartate in the mitochondria then aspartate back to OAA in the cytosol and OAA back to PEP constitute what is referred to as pyruvate cycling

Significant Side Effects: While we employ physician-supervised strategies to mitigate them (like slow, customized titration), some patients find that the gastrointestinal side effects (nausea, vomiting, diarrhea, constipation, reflux) outweigh the benefits

The transition back involves a gradual readjustment process that affects appetite, blood sugar control, and weight management

It's worth noting that GLP-1 receptor agonists typically have a low risk of causing hypoglycaemia in adults when used alone, but any transfer to the infant could potentially influence blood sugar regulation in vulnerable newborns

GLP-1 (glucagon-like peptide-1) is a hormone your gut produces naturally after you eat