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How can we think that manipulating our GLP or GIP production in such drastic ways would not have a downstream impact somewhere else

In addition, the researchers propose, other factors also may contribute, such as certain medications, minor illnesses (especially gastrointestinal conditions) and perhaps changes in the microbiome that might deplete carnitine from the body

Symptomatic awareness of hypoglycemia may be less pronounced in patients with longstanding diabetes, in patients with diabetic neuropathy, in patients using drugs that block the sympathetic nervous system (e.g., beta-blockers) [see Drug Interactions (7)], or who experience recurrent hypoglycemia