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If the HbA1c goal is not achieved, promptly increase the dose of existing medication or implement combination therapy with other drug classes

During energy deprivation such as in hypoglycemia, astrocytes metabolize fatty acids by -oxidation to produce ketone bodies and transfer them to neuronal mitochondria for ATP synthesis

The occurrence of dumping symptoms within a typical fixed timeframe after meal ingestion combined with objective signs of hypovolemia for early dumping (060 minutes postprandially) and symptomatic hypoglycemia (60180 minutes postprandially) confirm the diagnosis

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