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During acute illness or dehydration, metformin should be temporarily stopped (follow 'sick day rules') and restarted when eating and drinking normally

[DOI] [PubMed] [Google Scholar] Sterne 2011 Sterne JA, Sutton AJ, Ioannidis JP, Terrin N, Jones DR, Lau J, et al

This small molecule compound demonstrates exceptional ability to block nicotinamide N-methyltransferase enzyme activity, preventing NAD+ depletion while activating sirtuin pathways associated with healthy aging and metabolic optimization

Baseline laboratory testing before starting the peptide might include comprehensive metabolic panel, lipid profile, glucose and insulin levels, thyroid function, and body composition analysis