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Higher doses or additional medications Repeated injections without sustained improvement Increasing side effects with diminishing therapeutic return At this stage, pain is no longer simply a symptomit reflects underlying regulatory imbalance

Eur J Endocrinol 155:485493 Salinari S, Bertuzzi A, Asnaghi S, Guidone C, Manco M, Mingrone G (2009) First-phase insulin secretion restoration and differential response to glucose load depending on the route of administration in type 2 diabetic subjects after bariatric surgery