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Under normal conditions, the Notch signaling pathway is relatively inhibited and is activated when ischemic changes occur, playing an active role in immune inflammation, neurogenesis, and apoptosis (45)

Clinically meaningful responses in insulin-resistant patients typically include a reduction in fasting insulin of 20-40% and an improvement in HOMA-IR within 8-12 weeks at therapeutic doses, though individual variability is wide [1]

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Patients should be cautioned that they might experience worsening symptoms during the first 24 to 48 hours, related to a possible steroid flare, which can be treated with ice and NSAIDs

Families should request peer-reviewed references for any protocol being proposed