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Conversely, if diabetes remains poorly controlled despite treatment, hyperglycemia itself causes significant fatigue

This is especially true for progestin-only pills (the 'mini-pill'), which have a narrower therapeutic window than combination pills

NAD+ : Supports cellular energy production and DNA repair, complementing glutathione's protective effects

Obesity and body composition

Vomiting may follow, leading to rapid fluid loss and electrolyte depletion

If you are running 20 or 30 grams short most days, a snack is easier to get down than a larger meal, and hunger is not a reliable signal on these medications anyway