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Any benefit tends to be temporary and potentially detrimental to the tendon and therefore should not be considered as a viable treatment option

The bilateral symmetric pattern, combined with the nocturnal worsening (less competing sensory input at rest), is highly characteristic

GLP-1 receptor agonists work by mimicking the naturally occurring incretin hormone GLP-1, which enhances glucose-dependent insulin secretion, suppresses glucagon release, and slows gastric emptying

If you normally absorb 20% of your oral dose and then one day absorb 40% (perhaps due to oral pH changes, a small cut under the tongue, or a different holding technique), you effectively received double your usual dose

When you will notice changes