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The insulinotropic action of GIP was subsequently demonstrated to be due to direct action on the pancreas, where it enhances glucose-stimulation of insulin secretion, as demonstrated in isolated rat islets [[72], [73], [74], [75]], and in the perfused pancreas of dogs [76] and humans [77]

Neurological symptoms often develop gradually and may include: Paraesthesia : tingling or 'pins and needles' sensations, typically starting in the feet and hands Numbness : reduced sensation in the extremities, which may affect balance and coordination Burning pain : particularly in the feet, often worse at night Weakness : muscle weakness and difficulty walking Balance problems : unsteady gait and increased fall risk due to proprioceptive impairment Cognitive changes : memory problems, confusion, difficulty concentrating, and mood disturbances Haematological signs may accompany neurological symptoms and include fatigue, weakness, pallor, and shortness of breath due to megaloblastic anaemia

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