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For sulfonylureas, dose reduction or discontinuation should be strongly considered before initiating tirzepatide, as these medications provide diminishing benefit when combined with more effective agents and substantially increase hypoglycemia risk

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If a protocol makes exercise feel easier and more sustainable, it supports better long-term outcomes

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Neurological symptoms such as paraesthesia, ataxia, and cognitive impairment can occur before haematological changes and may become irreversible if treatment is delayed