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You should contact your GP or diabetes care team if: No improvement in blood glucose control after six months at the target maintenance dose, particularly if HbA1c reduction is less than 11 mmol/mol (1%) and weight loss is less than 3% where applicable (NICE NG28 continuation criteria for type 2 diabetes) Persistent or severe gastrointestinal side effects (nausea, vomiting, diarrhoea, or abdominal pain) that do not improve with time or dose adjustment, as these may indicate intolerance requiring treatment modification Persistent vomiting or inability to keep fluids down , which can lead to dehydration and acute kidney injury requiring urgent assessment Unexplained weight loss plateau or weight regain after initial success, which might suggest the need for dose optimisation, lifestyle review, or investigation of other contributing factors Signs of hypoglycaemia (shakiness, sweating, confusion, rapid heartbeat), especially if you are taking GLP-1 medication alongside insulin or sulfonylureas Symptoms of pancreatitis , including severe, persistent abdominal pain radiating to the back, often accompanied by nausea and vomitingstop the medication immediately and seek urgent medical assessment (call 999 or go to A&E if symptoms are severe) Persistent right upper quadrant pain, fever or jaundice , which could indicate gallbladder problems Changes in vision or symptoms of diabetic retinopathy, as rapid improvements in glucose control can occasionally worsen existing eye disease [17] [18] Difficulty with injection technique or concerns about proper medication storage and handling Planning pregnancy or breastfeeding , as GLP-1 receptor agonists are not recommended during pregnancy or lactation and should be discontinued in advance of conception [4] [5] Your healthcare provider can assess multiple factors that might be affecting treatment response, including adherence patterns, injection technique, concurrent medications, and lifestyle factors

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Typically, this involves starting with a dose of 0.25 mg once weekly for the first four weeks, allowing your body to acclimate to the medication while minimizing potential gastrointestinal side effects