Natural tubulysins are generally linear tetrapeptides consisting of N-methyl pipecolic acid (Mep), isoleucine (He), an unnatural aminoacid called tubuvaline (Tuv), and either an unnatural aminoacid called tubutyrosine (Tut, an analog of tyrosine) or an unnatural aminoacid called tubuphenylalanine (Tup, an analog of phenylalanine)
Neither medication typically causes hypoglycaemia when used alone or together (unless combined with insulin or sulphonylureas), as their glucose-lowering effects are largely glucose-dependent or insulin-independent
However, individual variation is significantsome patients reduce intake by 300 calories, while others exceed 1,000-calorie daily reductions
Chronically elevated glucose damages the walls of cerebral blood vessels, increasing the risk of clot formation and cerebral infarction
For example, GI symptoms are more commonly reported when patients are evaluated at a tertiary referral centre compared with a community setting, but allowing for this, estimates suggest up to 70% of people with diabetes are affected
