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The binding of insulin with IR causes autophosphorylation of IR [20, 21], activating downstream phosphoinositide-3-kinase (PI3-K)/Akt and mitogen activated protein kinase (MAPK) pathways, which affect the differentiation, energy metabolism and activity of osteocytes [22, 23]

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Also, GLP-1 patients should be monitored for a rare thyroid disease. GLP-1s can cause nausea, vomiting, diarrhea or constipation

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