I want to change my current meds (what are my chances)

[JeremySE18]

TL;DR - What are my chances of getting Ozempic or similar prescribed?

I have arranged a diabetic review with the goal of getting my meds changed. I had one a week or so ago but although the HCA is a nice bloke and all, he was not in a prescribing post and took a note of my concerns and suggested I book an appointment with the prescribing diabetic nurse.

The reason I am not happy with my current meds? I'm on Dapafligozin (Forxiga) which replaced the Gliclazide I had previously been taking. The Doctor did this as the Glic was not helping me to lose weight. Admittedly, I did did lose a few pounds, however that came to crashing halt as I experienced more and more of the side effects of the new meds. I am now in constant pain in the my joints, legs, hips and shoulders. My exercise regime has come to the same crashing halt. I find it difficult to walk much or use (the pretty expensive) exercise bike I have. Suffice to say I have also suffered from the more common side effects of the meds.

I have written and printed a long screed describing various aspects of my now very poor quality of life, together with the increasing glucose levels over the last months (I fund my own CGM) in preparation for my appointment on Tuesday.

All of this has taken place while sticking to the same diet regime (LCHF) I have had since diagnoses 5 years ago.

Ok so here is the question - Is Ozempic or other Sepeglutides still in short supply, leading the NHS to write to all GP's telling them to not prescribe these meds to new patients? I have seen very recent postings from other T2's saying they had just been put on Ozempic etc.
If you read this far, thanks I could have typed a lot more, but I don't want to come across as a complainer

 

[HSSS]

That sounds very reasonable to me. It certainly sounds like the current situation cannot continue.

What kinds of levels are you seeing?How much weight do you need to lose? And you say low carb but what does that mean to you as it can have a wide variety of realities depending who is talking. I ask because going low enough carb can achieve both glucose and weight control but that might mean really low for some of us. Much lower than the nhs guidance of 40g a meal. BUT going very low carb is not advisable whilst you are on a flozin (sglt2) medication as it can on rare occasions abuse a DKA but with normal’ish glucose levels rather than the usual high warning ones.

 

[JeremySE18]

Thanks for the reply HSSS

Previous levels were 5-6 mmol/L before meals and 8-10 after. Now 8-10 upon waking meaning following breakfast I can get above 12. Dinner is similar maybe higher up to 14-15. What is really annoying it the length of time it takes to drop to decent (still high) levels.I need to lose about 30 Kgs (currently 107, 5' 8")

Low carb to me is less than 20-30g per meal, mostly a lot lower. Typically protein and veg. Usually Steak, Chicken and Lamb always done in the air fryer and a salad or vegetables like cauli, broccoli etc. Stuffed peppers is a favorite.

I don't think my levels are ever approaching DKA (I fund my own CGM to keep a close eye on things)I know how high levels make me feel (from before I was diagnosed)

 

[Lamont D]

My first thoughts are of the side effects, you should not be taking meds that clearly not working, if not causing you to feel much worse, phone your doctors and tell them about the severe side effects.
Ozempic is a relatively new diabetic meds that according to my GP have had pretty good results from the trials and testing. Of course that is if a lot of your issues with your personal T2 requires ozempic. For that you need to speak again to your GP.
I believe that maybe you are not going low carb enough to help control your diabetes, could you give us an idea of what you are saying on a normal day? And if you can, give us some readings from your cgm. Before and after meals please?

But you do need to get sorted with your GP.

 

[JeremySE18]

Hi Lamont D thanks for the reply...

I have been low carbing since diagnosis 5 years or more ago. At diagnosis I was 103 mmol/L, 3 months later I was down to 46. I took my health very seriously and I know how to low carb Since going on Forxiga my results have come in at 55, 51, 71 TBH I was very sceptical about the 51. Diet regime has not changed. It just seems to me that the meds are no longer effective for me.

 

[Lamont D]

Hi Lamont D thanks for the reply...

I have been low carbing since diagnosis 5 years or more ago. At diagnosis I was 103 mmol/L, 3 months later I was down to 46. I took my health very seriously and I know how to low carb Since going on Forxiga my results have come in at 55, 51, 71 TBH I was very sceptical about the 51. Diet regime has not changed. It just seems to me that the meds are no longer effective for me.

There may be something that you do have that you might not be aware of that is causing the higher than normal spikes you should be getting with that amount of carbs for each meal.
Intolerance to carbs, means that you get a bigger spike than you can cope with.
That is why testing before and after gives you a better idea, the foods you are intolerant to.
If you know this already, I apologise.

 

[JeremySE18]

No problem Lamont D

I only gave limited info in my initial post. My CGM records pre meal and post meal levels. I also check calibration of the CGM with finger sticks.
As well as low carbing, I stick to low GI and GL foods. I am fairly convinced something is wrong and I am on the incorrect meds

 

[Rachox]

A friend of mine is on Victoza, a similar med. She said that you had to have a BMI above a certain level to qualify for these type of meds. according to NICE guidelines. Might be worth Googling before your appt. to check if you are likely to be able to have it prescribed.

 

[JeremySE18]

Rachox thanks for the reply

Yep, already done that, 35.8. My research shows that I am eligible for Ozempic as laid down by the NHS guidance. My main concern is availability and eligibility rom my local CCG.

 

[Lamont D]

No problem Lamont D

I only gave limited info in my initial post. My CGM records pre meal and post meal levels. I also check calibration of the CGM with finger sticks.
As well as low carbing, I stick to low GI and GL foods. I am fairly convinced something is wrong and I am on the incorrect meds

I was told by many, many medical practitioners, including my specialist endocrinologist, to eat GI, GL, complex carbs. And for a decade or more I did!
I was still eating porridge, no milk, no sugar, every morning, a baked potato for lunch and meat and two veg including new potatoes, with fruit for a snack.
my weight blossomed to eighteen stone! My health deteriorated, I was not well
it wasn't until I started a check on my blood glucose levels, and I discovered that porridge is not good, potatoes even worse and too much fruit was really bad!
what would happen was by one hours after eating, the spike was in double figures mmols! By three hours I was producing so much insulin, that I went hypo! Hence the hypoglycaemia diagnosis. But it was the low GI, that was producing the spike which was the trigger for those rollercoaster ride of spikes and lows.
I then went keto because of my carb intolerance and guess what?
I lost six stone, my health improved and I feel really good also no symptoms.

So, I would definitely have a look at what you believe is good for you.
Low GI is not healthy for me. Is it for you?

 

[HSSS]

Thanks for the reply HSSS

Previous levels were 5-6 mmol/L before meals and 8-10 after. Now 8-10 upon waking meaning following breakfast I can get above 12. Dinner is similar maybe higher up to 14-15. What is really annoying it the length of time it takes to drop to decent (still high) levels.I need to lose about 30 Kgs (currently 107, 5' 8")

Low carb to me is less than 20-30g per meal, mostly a lot lower. Typically protein and veg. Usually Steak, Chicken and Lamb always done in the air fryer and a salad or vegetables like cauli, broccoli etc. Stuffed peppers is a favorite.

I don't think my levels are ever approaching DKA (I fund my own CGM to keep a close eye on things)I know how high levels make me feel (from before I was diagnosed)

My point was that with sglt2 you don’t need a high glucose reading when low carbing to get dka. However as they very obviously don’t suit you anyway that should change when you see the nurse.

So 60-100g a day still leave a fair amount of scope to reduce levels still further. The rises of 3 or 4 mol after meals show me you are eating more carbs that your body is coping with in a normal amount of time. This alone will cause slow deterioration whether you rely on diet alone or do it with the help of medication.

Glic causes you to make more insulin and in type 2 that just adds to insulin resistance even whilst apparently working to reduce glucose for now. And even more insulin doesn’t help lose weight either as excess insulin is a fat storage hormone as one of its functions. So no surprise weight wasn’t helped by it.

You mention elsewhere you dropped a significant amount of hba1c when diagnosed. Was this low carb alone or with meds? Although you weren’t losing weight on glic how was the bgl control? When did that slip? How long ago did you swap from that to forxagia. I suspect increasing insulin resistance but it is a remote possibility if things keep deteriorating that you could be LADA, with the excess weight as a red herring

 

[JeremySE18]

Will get back to you in the morning - need to try and sleep now

 

[JeremySE18]

I was told by many, many medical practitioners, including my specialist endocrinologist, to eat GI, GL, complex carbs. And for a decade or more I did!
I was still eating porridge, no milk, no sugar, every morning, a baked potato for lunch and meat and two veg including new potatoes, with fruit for a snack.
my weight blossomed to eighteen stone! My health deteriorated, I was not well
it wasn't until I started a check on my blood glucose levels, and I discovered that porridge is not good, potatoes even worse and too much fruit was really bad!
what would happen was by one hours after eating, the spike was in double figures mmols! By three hours I was producing so much insulin, that I went hypo! Hence the hypoglycaemia diagnosis. But it was the low GI, that was producing the spike which was the trigger for those rollercoaster ride of spikes and lows.
I then went keto because of my carb intolerance and guess what?
I lost six stone, my health improved and I feel really good also no symptoms.

So, I would definitely have a look at what you believe is good for you.
Low GI is not healthy for me. Is it for you?

Lamont D J
Just to add that I have only been checking GI/GL values since getting a couple of books on the subject for my birthday (6th Feb) so the problems I have been experiencing predate this by a number of months. Take a look at this screen shot of the last 24 hours. As you can see I do not cycle between hypo and hyper, I have not seen anything near a hypo for months.

My main concern is what I would call my resting/fasting reading. I woke with a 9.3 reading and by the time I was able to eat breakfast I was already at 10.5 mmol/L. Overnight, I checked (as I usually do) from the app showing 8.5 to 9 mmol/L. Even I know that is not typical when on meds that are supposed to control BS. But again I need to stress that all this had occurred only since stopping glic and going on fligozin.

Anyhoo, I am having a good chat to the DN this afternoon to her view on it, and hopfully, get my meds changed.

 

[JeremySE18]

My point was that with sglt2 you don’t need a high glucose reading when low carbing to get dka. However as they very obviously don’t suit you anyway that should change when you see the nurse.

So 60-100g a day still leave a fair amount of scope to reduce levels still further. The rises of 3 or 4 mol after meals show me you are eating more carbs that your body is coping with in a normal amount of time. This alone will cause slow deterioration whether you rely on diet alone or do it with the help of medication.

Glic causes you to make more insulin and in type 2 that just adds to insulin resistance even whilst apparently working to reduce glucose for now. And even more insulin doesn’t help lose weight either as excess insulin is a fat storage hormone as one of its functions. So no surprise weight wasn’t helped by it.

You mention elsewhere you dropped a significant amount of hba1c when diagnosed. Was this low carb alone or with meds? Although you weren’t losing weight on glic how was the bgl control? When did that slip? How long ago did you swap from that to forxagia. I suspect increasing insulin resistance but it is a remote possibility if things keep deteriorating that you could be LADA, with the excess weight as a red herring

Hi HSSS

I agree with the first 4 paragraphs completely. To answer you next questions - The drop in levels on first diagnosis and 2nd blood test was on meds (metformin only) and diet (LCHF) I lost 15Kgs in the first 5 months, however that was because of the nausea and reduced appetite, I could barely eat a slice of toast. It wasn't until I had to go in to hospital for a minor procedure and I had to stop taking the metformin that suddenly my appetite returned and I was able to eat normally again. My GP took me off the metformin and put me on glic a couple of months later he suggested trying metformin again, which did and tolerated it normally. Coming more up to date, the glic was dropped about 5 months ago and on to Fligozin since then. BS on glic was pretty decent, again no hypos and significantly better overnight levels (5-6 mmol/L)
Anyway as previously posted, I will be having my appointment at 4PM today, hopefully will have an update following that.

 

[ickihun]

Remind me @JeremySE18 who has refused you your medication of choice? Your care is with the specialist. So are they not willing to prescribe it or is it just down to no availability of the drug (due to high demand for weight loss)?

 

[HSSS]

Remind me @JeremySE18 who has refused you your medication of choice? Your care is with the specialist. So are they not willing to prescribe it or is it just down to no availability of the drug (due to high demand for weight loss)?

Don’t think it’s been refused yet. He’s not happy with current ones and asking to change at some point today I think.

 

[JeremySE18]

Remind me @JeremySE18 who has refused you your medication of choice? Your care is with the specialist. So are they not willing to prescribe it or is it just down to no availability of the drug (due to high demand for weight loss)?

As HSSS has stated - No one has refused it as yet. My concern as mentioned above is that the NHS England has written to all GPs asking them to not prescribe for new patients, because of shortages caused by private practices who charge a fortune for Gliptides purely for weight loss and not for T2s for their condition. People who can afford it will gladly pay for it. So to answer your question on availability - The latter

 

[JeremySE18]

So back from seeing the DN, she was very nice and I told her I was grateful to be able to get my side across.She even remarked that it looked like when I walked in that I was expecting a fight

Anyhow long story short, she will consult with my GP about possible prescribing a GLP-1, oral in the first instance or injectable if suited. Promised a call back on Wednesday

Hurry up and wait

 

[ViolaterUK]

TL;DR - What are my chances of getting Ozempic or similar prescribed?

I have arranged a diabetic review with the goal of getting my meds changed. I had one a week or so ago but although the HCA is a nice bloke and all, he was not in a prescribing post and took a note of my concerns and suggested I book an appointment with the prescribing diabetic nurse.

The reason I am not happy with my current meds? I'm on Dapafligozin (Forxiga) which replaced the Gliclazide I had previously been taking. The Doctor did this as the Glic was not helping me to lose weight. Admittedly, I did did lose a few pounds, however that came to crashing halt as I experienced more and more of the side effects of the new meds. I am now in constant pain in the my joints, legs, hips and shoulders. My exercise regime has come to the same crashing halt. I find it difficult to walk much or use (the pretty expensive) exercise bike I have. Suffice to say I have also suffered from the more common side effects of the meds.

I have written and printed a long screed describing various aspects of my now very poor quality of life, together with the increasing glucose levels over the last months (I fund my own CGM) in preparation for my appointment on Tuesday.

All of this has taken place while sticking to the same diet regime (LCHF) I have had since diagnoses 5 years ago.

Ok so here is the question - Is Ozempic or other Sepeglutides still in short supply, leading the NHS to write to all GP's telling them to not prescribe these meds to new patients? I have seen very recent postings from other T2's saying they had just been put on Ozempic etc.
If you read this far, thanks I could have typed a lot more, but I don't want to come across as a complainer

Just to note on the Ozempic, I have a lot going on in my life and I've asked for additional help. I was referred to Weight Management in the local hospital. They said I would benefit from Ozempic but due to demand and supply they were taking on any new patients, I was however put on oral semaglutide which is the table form.
Only just started it so I cannot tell you yet if it works, I am also on metformin.
Good luck, I hope they change your meds for you.

 

[JeremySE18]

**Sigh** Waiting on the phone call that never came