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Increased AMP levels activate Adenosine Monophosphate-Activated Protein Kinase (AMPK), which contributes to lowering of glucose production by at least 2 pathways: i) increased AMPK phosphorylates CBP & CRTC2 transcription factors, which inhibits genes involved in the production of glucose (gluconeogenic genes)

This mechanism operates entirely independently of GLP-1 pathways

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In most cases, surgery will be required to make a full recovery