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Subcutaneous injection protocol: Starting dose: 200 to 300 mcg daily Titration: Increase by approximately 100 mcg every 1 to 2 weeks as tolerated Target dose: 400 to 500 mcg daily by weeks 5 through 12 Frequency: Once daily, subcutaneous Cycle length: 8 to 12 weeks, with optional extension to 16 weeks Timing: Consistent daily timing, typically evening for sleep applications Oral/sublingual protocol: Duration: 30 days Frequency: 1 to 4 cycles per year Best combined with: Exercise and nutrient-rich diet Injection sites should be rotated between the abdomen, thighs, and upper arms to prevent lipohypertrophy and ensure consistent absorption

doi: 10.1136/gutjnl-2023-329969 180 PetersonLWArtisD