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Patients should not use the medication and should contact their healthcare provider or pharmacist if they observe any of the following: For clear solution products (Ozempic, Wegovy, Trulicity, Victoza, Saxenda, Mounjaro, Zepbound, Byetta): Discoloration : The solution appears yellow (beyond slight yellowish tint allowed in some products), brown, or any color other than clear and colorless to slightly yellow (per product-specific labeling) Cloudiness or turbidity : The medication appears hazy, milky, or cloudy rather than clear Visible particles : Any floating particles, crystals, flakes, or sediment are present in the solution For Bydureon BCise (exenatide extended-release): For all products: Frosting or ice crystals : Evidence that the medication has been frozen, even if subsequently thawed Damaged pen or cartridge : Cracks, leaks, or other physical damage to the delivery device Additional circumstances requiring medication disposal include: Exceeded in-use time limits : For multi-dose pens, the medication has been in use longer than the manufacturer's specified period after first use Past expiration date : The printed expiration date has passed Unknown storage history : Uncertainty about whether the medication was properly stored or exposed to temperature extremes Suspected freezing : The medication may have been exposed to freezing temperatures during storage or transport Patients experiencing unexpected hyperglycemia or reduced therapeutic effect should consider the possibility of degraded medication, particularly if storage conditions may have been compromised

Perform frequent blood glucose monitoring

Insulin resistance in SM is the primary defect of T2DM that facilitates the progression of fatty liver disease, deposition of fat in the liver (Figure 1) (110)