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After stopping, most people experience a return of appetite, potential weight gain and shifts in blood sugar, but these changes can be managed with the right strategies

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However, for patients with very high blood sugar at diagnosis (HbA1c above 10 percent) or symptoms of hyperglycemia, insulin may be started right away, bypassing the usual stepwise approach

A heart rate increase of 5 to 10 BPM without symptoms is expected and generally acceptable