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It can take up to 5 years before you start to see symptoms of pernicious anemia

At a price, of course, but developing diabetes or hypertension is more expensive in the long run, I guess

However, from the surgerys perspective, this can create administrative complexity

rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, and trouble breathing

In clinical trials it produced some of the largest weight-loss and glycemic results of any incretin therapy, with a long half-life that supports a single weekly subcutaneous injection and a stepwise titration that keeps gastrointestinal effects manageable