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IRS-1 is an adaptor protein that provides a binding site for PI-3 kinase, whose activation stimulates Akt ( Figure 2 )

Adding cagrilintide to tirzepatide Theoretical protocol (not clinically studied): If on tirzepatide 10-15mg: Stable on tirzepatide for 4+ weeks Continue tirzepatide at current dose Add cagrilintide 0.6mg weekly Standard cagrilintide titration to 2.4mg Rationale: Tirzepatide is dual GIP/GLP-1 (very powerful alone) Adding amylin pathway could theoretically enhance No clinical data on this combination Uncertain if additional benefit over tirzepatide alone Concerns: GI side effects may be severe (both slow gastric emptying) Tirzepatide already produces 15-22% weight loss alone Unclear if cagrilintide adds meaningful benefit Expensive combination Verdict: Wait for clinical data

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