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When you add room-temperature water to cold powder, the powder goes through a temperature shock that causes it to change shape

Study-related adverse events The adverse events most commonly reported in 5% of adult patients treated with Victoza 1.8 mg vs Januvia 100 mg, both in combination with metformin, were nausea (21.8% vs 7.8%), diarrhea (16.3% vs 9.3%), decreased appetite (8.9% vs 3.4%), vomiting (7.4% vs 4.9%), headache (6.4% vs 5.9%), nasopharyngitis (5.9% vs 3.4%), and increased lipase (5.5% vs 4.4%)