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[8] [1] Rotating injection sites with each dose, as recommended by the American Association of Clinical Endocrinology (AACE) and the American Diabetes Association, helps prevent lipohypertrophy (fatty lumps) and reduces localized tenderness from repeated injections in the same area

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These changes likely represent adaptive, non-pathological responses to reduced carbohydrate availability, but may become clinically relevant in individuals with existing thyroid dysfunction or impaired deiodinase activity (Figure 1)