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In rats, combined administration of dexamethasone and exendin-4 leads to a greater anorexigenic effect and greater weight loss relative to treatment with exendin-4 alone [819]

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[2] Sima AA, Calvani M, Mehra M, Amato A | Acetyl-L-Carnitine Improves Pain, Nerve Regeneration, and Vibratory Perception in Patients With Chronic Diabetic Neuropathy

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It typically appears during the first few weeks of treatment or after a dose increase , as the digestive system adapts to slower gastric emptying