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In the STEP and SURMOUNT trials for semaglutide and tirzepatide respectively, weight loss curves generally began to flatten between weeks 36 and 60, reflecting the physiological set point adaptation that occurs as appetite suppression becomes partially offset by metabolic adaptation

Anisimov VN

A vitamin B12 deficiency can develop slowly and symptoms may include: Persistent tiredness or low energy Shortness of breath Pale skin Pins and needles Memory or concentration difficulties If left untreated, deficiency can lead to more serious neurological complications

They dose at 10 PM after an 8 PM dinner and wonder why results are inconsistent

Dial a small dose (usually 2 units or 0.02 mL, or as indicated by the package instructions) and push the button to expel the primer

Hydrodissection with normal saline (NS) 1 mL may help in confirming the position of the tip before injecting into the PM