Only two of the thirteen residues differ from the native human hormone: norleucine replaces the oxidation-prone methionine at position 4, and the phenylalanine at position 7 is inverted to its D-enantiomer inside the conserved His-Phe-Arg-Trp message tetrapeptide
Long-term risks of Trulicity include the potential worsening of or new onset kidney damage and severe digestive problems such as gastroparesis or ileus
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Sugimoto, K., Murakawa, Y
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However, this is a workaround for a pathological condition, not an optimal protocol