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Apart from enhanced glucose/fatty acid cycling, it has been shown that GH induced insulin resistance is accompanied by reduced muscle glycogen synthase activity (91) and diminished glucose dependent glucose disposal (92)

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Comprehensive toxicological and pharmacological safety evaluations regarding the administration of NAD+ + MOTS-c indicate a generally favorable tolerability profile, though potential adverse effects typically stem from exaggerated pharmacodynamic responses at targeted cellular receptor sites, most notably manifesting as transient localized injection site reactions such as mild erythema, localized tissue tenderness, minor induration, and temporary pruritus that generally resolve spontaneously within hours without requiring clinical intervention