Patient description: The patient is a 35-year-old woman with myasthenia gravis, class IIa. She complains of diplopia and fatigue and weakness that affects mainly her upper limbs. She had a positive anti-AChR antibody test, and her single fiber electromyography (SFEMG) was positive. She takes pyridostigmine 60 mg three times a day. But she still has some symptoms that interfere with her job. She is a research coordinator and has 3 children. Her 70-year-old father has hypertension. She does not smoke or use illicit drugs. She drinks alcohol occasionally at social events. Her physical exam and lab studies were not remarkable for any other abnormalities. BP: 110/75 Hgb: 11 g/dl WBC: 8000 /mm3 Plt: 300000 /ml Creatinine: 0.5 mg/dl BUN: 10 mg/dl Beta hcg: negative for pregnancy

Clinical trial eligibility criteria: eligible ages (years): 21.0-55.0,  Healthy Volunteers Age 21-55 (Age restriction is used to remove age as a confounding factor because (beta) cells function and insulin resistance tend to deteriorate with age and may affect GLP-1 and GIP levels. 2. Screening laboratory evaluations with no clinically significant abnormal results (minor deviations from normal lab results will be at the discretion of the principal investigator): 1. fasting comprehensive metabolic panel 2. complete blood count with differential and platelet 3. thyroid function test (TSH) 4. urine drug screen 5. Point of care urine pregnancy test (for women who are not surgically sterile) 3. BMI < 30 (participants with BMI greater than or equal to 30 are excluded because obesity has been associated with attenuation in GLP-1 secretion. 4. Have had a history of stable weight (maintained weight within +/ ) over the past year 5. Have NOT participated in another clinical trial involving any pharmacologic agents within the past 30 days 6. Able to complete an inform consent 7. Agree to not participate in other clinical trials within the study period (at the discretion of the study investigator)  FPG greater than or equal to 100 mg/dl or 2-hr OGTT greater than or equal to 140 mg/dL (evidence of glucose intolerance or diabetes) 2. History of anemia, or Hemoglobin < 12.5 mg/dL for men and < 11.5 mg/dL for women during screening visit 3. Weight < 110 pounds (due to blood volume requirement) 4. Evidence of illicit drug use 5. History of substance abuse including marijuana within the past 6 months 6. History of smoking any tobacco products within six months prior to screening 7. Alcohol intake > 30 grams (drink more than 2 beers per day OR equivalent amount of alcohol) 8. History of Human Immunodeficiency Virus (HIV) infection 9. History of active or chronic Hepatitis B and/or C infection 10. History of psychiatric illnesses including major depressive disorder, schizophrenia, bipolar disorder 11. Any lifetime history of suicide attempt 12. History of any suicidal ideation of type 4 or 5 on the Columbia-Suicide Severity Rating Scale (C-SSRS) in the last year 13. Any suicidal ideation of type 4 or 5 on the C-SSRS during any follow-up visits. 14. Patient Health Questionnaire-9 (PHQ-9) score greater than or equal to 10 during screening visit or any follow-up study visits 15. Generalized Anxiety Disorder-7 (GAD-7) score greater than or equal to 10 during screening visit or any follow-up visits 16. History of pancreatitis 17. History of liver or renal diseases 18. History of gastrointestinal or endocrine disorders 19. History of malignancy (unless P.I. determines that there is no impact of the prior malignancy on study outcomes, i.e. basal cell skin cancer) 20. History of coronary disease or clinically significant abnormalities on electrocardiogram 21. History of seizures or other neurologic diseases 22. History of glucocorticoid use (over one month) or other immunosuppressive agents (any), i.e. Imuran, Neoral, Sandimmune, SangCya, basiliximab (Simulect), daclizumab (Zenapax), muromonab (Orthocolone OKT(3)) prednisone (Deltasone, Orasone) within the past six months 23. Use of proton pump inhibitors (PPI s), i.e. Prilosec, Prevacid, Achiphex, Protonix, Nexium, Zegarid 24. Women who are pregnant or nursing/breast-feeding a child 25. Any medical history that, in the opinion of the investigator(s), may make participation of the subject in the study unsafe