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Metabolic issues: Feeling constantly cold, chills, or a low body temperature (signs of metabolic acidosis) Severe gastrointestinal changes: Persistent diarrhea, vomiting, or a total loss of appetite Systemic changes: Unexplained tiredness, a fever or other signs of infection, unusual bleeding, bruising, or long-term concerns like osteoporosis In general, higher doses of topiramate are associated with an increased risk of adverse reactions

Medically reviewed by Dr Sultan Linjawi, Endocrinologist & Diabetes Specialist January 2026 What is Trulicity (Dulaglutide)

In addition, some people may find that digestive enzymes or probiotic supplements help improve digestion and keep their gut healthy

Making positive lifestyle changes is important for staying healthy and managing weight

The standard advice is to encourage patients to build a routine of strength training and a diet with adequate protein quantity and quality