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3- Changes in Insulin and Glucose Homeostasis Affecting Nerve Function: As GLP-1 receptor agonists alter glucose metabolism, there is potential for downstream effects on neuronal excitability and peripheral nerve function

PMID 1731620

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The lysine-ketoglutarate reductase domain first catalyzes the conversion of lysine to saccharopine

Then the surgeon separates the intestine just past the stomach and reconnects it lower down