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These metabolites are involved in various metabolic pathways, including glucose metabolism, glutamine metabolism, lactate metabolism, pyruvate metabolism, ketone body and fatty acid metabolism, amino acid metabolism, etc [1]

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Traina G, Bernardi R, Cataldo E, Macchi M, Durante M, Brunelli M: In the Rat Brain Acetyl-L: -carnitine Treatment Modulates the Expression of Genes Involved in Neuronal Ceroid Lipofuscinosis

sustained GH elevation through chronic use of any secretagogue could push glucose handling in the wrong direction, particularly in people with pre-existing insulin resistance

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For those with significant deficiencies, this may be less efficient than the higher, less frequent doses provided by injections