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The difference between acetyl L-carnitine (ALC) and L-carnitine AcetylLcarnitine (ALC) and Lcarnitine are related compounds with different roles

Experimental and Clinical Endocrinology & Diabetes: Official Journal, German Society of Endocrinology [and] German Diabetes Association, 125 (7), 441448

Diabetic Ketoacidosis and Ketosis: In individuals with T1DM, GLP-1 RAs were associated with an increased risk of ketosis, including diabetic ketoacidosis (DKA) (Class IV

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Check your medication Confirm the drug and that it is a compounded vial, not a pre-filled pen

Each subsequent increase activates the receptors more strongly