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For example, GSH-supported formation of Cu + or Fe 2+ can promote Fenton-like reactions that convert H 2 O 2 into highly reactive radicals, thereby damaging cellular macromolecules and promoting multiple forms of cell death 181,182

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When to seek medical advice : Patients should contact their GP or diabetes specialist nurse if they experience: Severe, persistent vomiting preventing adequate fluid intake (risk of dehydration and acute kidney injury) Severe abdominal pain, particularly if radiating to the back (potential pancreatitisrare but serious) Right upper abdominal pain, fever, or yellowing of skin/eyes (potential gallbladder disease) Sudden vision changes (particularly with semaglutide, which may worsen diabetic retinopathy, especially with rapid HbA1c reduction) [40] [41] Signs of hypoglycaemia when used with insulin or sulphonylureas Allergic reactions (rash, difficulty breathing, facial swelling)call 999 or go to A&E for severe allergic reactions Patients should report suspected side effects via the MHRA Yellow Card scheme (yellowcard.mhra.gov.uk or the Yellow Card app)

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High levels of ROS can directly stimulate platelet activation and aggregation or can activate platelets through the cell adhesion factor P-selectin [213]