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Increased Fermentation When food moves through the gut more slowly, it spends more time in contact with intestinal bacteria

Weeks 1 to 4: 20 units (0.2 mL) once weekly Weeks 5 to 8: 40 units (0.4 mL) once weekly Weeks 9 to 12: 70 units (0.7 mL) once weekly Weeks 13 to 16: 90 units (0.9 mL) once weekly These are unit measurements based on insulin syringe markings

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When insulin reaches the muscle layer, the onset is much more rapid, which can cause blood sugar to drop quickly and then rise later when it wears off prematurely

Consistent with Kidney Disease: Improving Global Outcomes (KDIGO) 2017and reaffirmed by the 2024 KDIGO Controversies Conferencecare should prioritize personalized management along bone (osteoporosis/fracture) and cardiovascular (calcification/left ventricular hypertrophy, LVH) axes: replete deficiency with nutritional vitamin D (D3 preferred