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Ann Intern Med 165:305315 Idilman R, Mizrak D, Corapcioglu D et al (2008) Clinical trial: insulin-sensitizing agents may reduce consequences of insulin resistance in individuals with non-alcoholic steatohepatitis

This is normal and not a sign of medication failureit's your signal that dose escalation or strategy adjustment may help

The most commonly reported side effects in clinical trials are gastrointestinal, including nausea, vomiting, diarrhoea, and constipation, which are typically most pronounced during the dose titration phase and tend to improve over time