doi: 10.1007/978-1-4614-6093-0_23
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Carnitine regulatory abnormalities have been attributed to diabetic complications, trauma, hemodialysis, starvation, obesity, cardiomyopathy, fasting, endocrine imbalances, medication interactions, and other conditions (Guerra et al., 2021)
Bismuth subsalicylate does not have clinically significant interactions with semaglutide
They include the incretin effect, with the enhancement of insulin secretion by beta cells, improved insulin sensitivity, decrease in glucagon secretion, and reduced food intake due to induced satiety.11,45 The effect of this drug group on weight loss has had a worldwide impact due to its misuse through self-medication, and in turn, an increase in the number of cases of patients with adverse effects.12,4648 Approach to gastrointestinal symptoms in patients that are candidates for or receivers of antidiabetic treatment When evaluating patients with gastrointestinal symptoms that are going to start medical management for diabetes, it is important to ask if there are symptoms or diagnoses of functional dyspepsia, gastroparesis, intestinal bacterial overgrowth, irritable bowel syndrome, bloating, or chronic constipation, given that a large part of the therapeutic options can trigger or exacerbate symptomatology, such as early satiety, postprandial fullness, nausea, vomiting, bloating, diarrhea, and constipation.4951 In the case of patients that seek medical evaluation due to symptomatology that began after the start of pharmacologic management, the initial approach should focus on the symptoms and not associate them with the drugs as a first possibility, directly looking for alarm signs that merit endoscopy or colonoscopy.49 It is important to consider the drug group being utilized because different drugs among the different groups are associated with more symptoms than others, signifying that the molecule used can be modified, before suspending the drug group.5,42 Likewise, the initial dose and adequate drug titration should be evaluated, given that in some cases, adequate dose escalation of the drug can reduce or prevent gastrointestinal adverse effects, as occurs with the GLP-1 agonists.52 The temporality of the appearance of symptoms should be evaluated because in some cases the symptomatology tends to present in the first days of application
