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Key domains requiring structured oversight include: Pancreatitis and gallbladder disease Progression of diabetic retinopathy Severe gastrointestinal intolerance Visual loss and rare opticnerve complications Nutritional/metabolic issues with rapid weight reduction In India, where continuity of care is variable and prescribing often occurs outside endocrinology, these risks can be underrecognised or misattributed

In this context, blood glucose remains normal, pH stays within the normal range (7.387.42), bicarbonate levels are normal (2228 mEq/L), ketones usually range between 0.5 and 3 mmol/L (sometimes higher during prolonged fasting), and there is no metabolic acidosis

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Van DerSchootA, Drysdale C, Whelan K,DimidiE. The effect offibersupplementation on chronic constipation in adults: An updated systematic review and meta-analysis of randomized controlled trials.AmJ ClinNutr.2022;116:953-969. doi:10.1093/ajcn/nqac184