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[7] Blood glucose should be monitored, and medication doses may require adjustment Skin reactions : Rash or itching has been reported in some individuals Thiamine deficiency : Chronic high-dose ALA may theoretically interfere with thiamine (vitamin B1) metabolism, particularly in individuals with alcohol use disorder [20] [21] Insulin autoimmune syndrome : Rarely, ALA has been associated with this condition causing unexpected hypoglycaemia

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