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It appears that the anaplerotic enzyme pyruvate carboxylase participates directly or indirectly in several metabolic pathways which are important for glucose-induced insulin secretion, including: the pyruvate/malate cycle, the pyruvate/citrate cycle, the pyruvate/isocitrate cycle and glutamate-dehydrogenase-catalysed -ketoglutarate production

Roughly 11 percent of those taking Semaglutide experienced these symptoms in clinical trials

Biological Chemistry, 390(3), 191214

10.1055/s-2005-915647 81 PiglionicaM.CarielloM.MoschettaA

Some patients taking semaglutide experience more pronounced side effects due to its sole GLP-1 action