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According to Genevieve Parker, a research assistant in Benjamin Bikmans cell biology lab at BYU, one of those concerns is muscle loss

GLP-1 and ghrelin inversely regulate insulin secretion and action in pancreatic islets, vagal afferents, and hypothalamus

In contrast, 11.2% of the untreated diabetic animals died within 4 days after confirmation of diabetes, and 33.3% of those treated once daily with insulin died within 7 days (Fig

There's actually data out there that shows that once you get to the OOP around $100, the first-fill adherence for a drug drops precipitously

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Risk factors include the speed and magnitude of weight loss, pre-existing nutritional deficiencies, age, sex (women are more commonly affected), and individual genetic susceptibility