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Concerns include reports of adverse events, some requiring hospitalization, that may be related to dosing errors or doses beyond what is in the FDA-approved drug label, which means using more product in a single dose, taking doses more frequently or increasing the amount more quickly (titration schedule)

The answer is that such large clinically-verified doses of berberine come with problems

Wadden TA, Chao AM, Moore M, Tronieri JS, Gilden A, Amaro A, Leonard S, Jakicic JM

Int J Surg 110(3):15461555 Coelho C et al (2023) Laparoscopic adjustable gastric banding with liraglutide in adults with obesity and type 2 diabetes (GLIDE): a pilot randomised placebo controlled trial

Chronic elevation in insulin signaling molecules is a feature of insulin resistance [94], thus it is possible that results reflect insulin signaling dysfunction in participants treated with exenatide