A reasonable monitoring schedule: IGF-1 at baseline, then every 6 to 12 months Fasting glucose and HbA1c at the same intervals TSH and free T4 annually An honest annual reassessment of clinical goals (are you still getting what you wanted, or just continuing out of habit?) There's no published upper limit on the number of cycles
Older adults People over 65 may be more susceptible to dehydration from GI side effects, and the consequences of dehydration (falls, kidney injury, confusion) are more serious in older populations
If the code indicates obesity (E66.x) rather than diabetes (E11.x) or sleep apnea (G47.33), the claim auto-rejects with "Reject Code 88: Use is not medically accepted." You can, but it's unlikely to succeed for plan exclusions
Darpo B, Sager P, Macconell L, Cirincione B, Mitchell M, Han J, Huang W, Malloy J, Schulteis C, Shen L, Porter L