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ADVANTAGES & DISADVANTAGES OF TREATMENT OPTIONS CVD: Cardiovascular Death Management of Type 2 Diabetes American Diabetes Assn 2020 Update Based upon recent research findings, the American Diabetes Asson & Europiean Asson for the Study of Diabetes recently updated their consensus treatment recommendations (Buse et al, 2019) for the following subsets of patients with diabetes: High risk diabetic patients GLP-1 agonists & SGLT2 inhibitors to reduce CV & renal risk in high risk patients, without regard to patient HbA1c levels (baseline or target) High risk for atherosclerotic CV disease GLP-1 agonists GLP-1 agonists produce the greatest benefit against CV events Systolic heart failure (HFrEF) & chronic kidney disease (CKD) SGLT2 inhibitors SGLT2 inhibitors have the greatest benefit to prevent progression of CKD, reduce hospitalization for HF, and reduce CV events & CV death Patients with foot ulcers SGLT2 inhibitors a recommended treatment, after consideration of risk vs benefits 2021 ADA Treatment Guidelines Figure 10

Peptide integration: BPC-157 or Thymosin Beta-4 starting 1-2 weeks pre-surgery continuing 4-8 weeks post-operatively

Because Pendulum can increase GLP-1 production, and GLP-1 affects insulin secretion, combining the supplement with insulin or sulfonylureas could theoretically increase hypoglycemia risk

If you're experiencing troublesome side effects, your prescriber will likely suggest: Staying at your current dose longer before increasing Stepping back down to a lower dose temporarily Slowing down the escalation schedule The goal is to find the highest dose you can tolerate comfortably whilst still achieving meaningful weight loss