GLP-1 inhibitors in general.

[Annette&Bert]

I am on 2000mg of slow release Metformin for the past two years. Approx 18 months ago I started on Trulicity low mg then increased to 4.5mg very successfully with no side effects, weekly injection. Now it is unavailable since December 2023. While I was on this there was no difference to my weight but the difference it made to my BG was fantastic two years All my research I have discovered there is a manufacturing problem with all these inhibitors, and it is unlikely to be available to our pharmacies until December 2024.

My HbA1c should I continue, have been done in December but I think my practice forgot about me. I asked for a telephone consultation with my DN who rang me yesterday. She told me to ring the surgery today to arrange my bloods and when these come back to see her face to face to discuss options. I fear my results because I know my numbers have gone sky high for the first time since 2016 it terrifies me. She said there is an oral drug called Rybelsis with restrictions on taking it, it must be taken on an empty stomach and nothing else for at least 30 minutes. This is apparently excellent but she and I will discuss my options. Insulin has never been suggested to me, but I have heard you put weight on with it, and can be subject to hypos, this is why I don’t want it, I live totally alone and would be in fear if a hypoo.

Am I right in thinking this way?

 

[John Gray]

A Rybelsus tablet daily is recommended now that (almost) all the other GLP-1 inhibitors are unavailable for the foreseeable future. It starts at the 3mg dose, then after a month of acclimatisation you can move up to the 7mg dose then, perhaps, to the highest 14mg dose.

Insulin is usually very good, but being by yourself, you must have "hypo awareness" and be doing finger-prick tests for a blood glucose monitor (you don't mention if you use one).

I arrange my six-monthly diabetes 'consultations' with my surgery's diabetic nurse; the first one in the year is the full consultation / weight check / foot inspection etc with blood draw for several things including HbA1c; the second one is just the blood draw.

[Just for interest, before metformin (not SR) was deprecated for me because of another of my diseases, I used to take two 500mg tablets at each meal, thus a total of up to 3g per day.]

 

[Annette&Bert]

Thank you John, oh boy would I like to know if I could join your GP practice. If you get all that you are very lucky indeed. I get none of those I only get an HbA1c once every three month and that’s all, no foot inspection, no weight taken except very occasionally. My three month HbA1c was due in December but they were too busy, so my last one was 19th September, my next draw will be 27th March and nurse will give me those results when I go to see her on 2nd April.

My meds will be discussed on that appt. From what I have ascertained it is not just Trulicity that is affected by this manufacturing probkem, Ozempic too apparently because all if these drugs have been over subscribed by being given to people for weight loss, so it seems diabetics are less important. I feel very hard done by, and very angry.

Does it not amaze people that here we are in 2024 and there is no cure for type 2, it does me.

Yes I have a bg monitor since 2016

 

[John Gray]

You might want to show your doctor the List of Things to be expected for diabetes care!
Particularly apposite is the information after the paragraph head: Regular care to expect.
We have a particularly useful, since diabetologically knowledgeable and with doctoral influence, Community Diabetes Service, operating as part of the local hospital.

You might want to check whether you could be eligible for a continuous blood glucose monitor such as FreeStyle Libre 2 and/or Mounjaro = tirzepatide, an enhanced GLP-1 agonist.
Either and both can be life-changing if you can get them - I know mine was!

 

[Annette&Bert]

Thank you John ever since my diagnosis in 2016 I have had ups and downs, some months my bloods are very good, sonetimes too high, I don’t have an answer to it. I come from a family of Type 1 & 2 diabetics, none of the Type 2 were overweight, also on my father’s side heart problems. I have aortic valve problems which on ladt scan was severe needing surgery which I have opted not to have. I was always fit until now, and my cholesterol has never been higher than 3 as far back as the ‘ 80s. I shall look into your suggestions, I just get so down with it all plus I am not getting younger, more’s the pity