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However, because higher insulin concentrations are required to suppress gluconeogenesis than to inhibit glycogenolysis (i.e., the breakdown of glycogen), or increase glycogen synthesis, gluconeogenically derived glucose-6-phosphate can be diverted into hepatic glycogen even during mild hyperinsulinemia [87,123]

The SmPC also notes that rodent studies showed C-cell thyroid tumours, though the human relevance is unknown

The nasal cavity is rich in blood vessels, providing a direct path to the brain and bloodstream, which allows for a much quicker uptake of NAD compared to oral supplements