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These reactions occur because semaglutide delays gastric emptying, meaning your stomach spends more time processing fatty meals, intensifying digestive distress

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Acute effects of glucagon-like peptide-1 on hypothalamic neuropeptide and AMP activated kinase expression in fasted rats

This is especially true when you are taking a powerful medication that alters your internal chemistry

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In patients in whom the major therapeutic goal is the compelling need to minimize the therapeutic risk pf hypoglycaemia, DPP-4 inhibitors are recommended as second line therapy after metformin failure at the same level as second line treatment options with GLP-1 receptor agonists, SGLT-2 inhibitors, or TZDs