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Bioavailability limitations require 2-3x higher doses for nasal versus injectable delivery , creating corresponding 2-3x cost increases that make nasal spray primarily appropriate for needle-phobic individuals or peptides specifically designed for nasal use

With the expanding use of GLP-1 RAs in both diabetic and non-diabetic populations, clinicians should remain vigilant for pancreatic structural abnormalities and maintain a high index of suspicion in patients developing new gastrointestinal symptoms while on therapy

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Intrinsic factor deficiency, or "congenital pernicious anemia," is a rare autosomal recessive disorder characterized by the lack of gastric intrinsic factor in the presence of normal gastric acid secretion and mucosal cytology (ie, without gastritis) and in the absence of intrinsic factor antibodies found in the acquired form of pernicious anemia

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