Weekly type 2 diabetes injections offer a convenient, effective treatment option for patients whose blood glucose remains poorly controlled despite oral medicines. These once-weekly shots, primarily glucagon-like peptide-1 receptor agonists (GLP-1 RAs), work by enhancing insulin secretion, suppressing glucagon release, and slowing gastric emptying. Unlike daily tablets or multiple injections, they require just one subcutaneous injection per week. Licensed options in the UK include semaglutide (Ozempic), dulaglutide (Trulicity), and exenatide prolonged-release (Bydureon). NICE guidance determines eligibility based on HbA1c levels, BMI, and previous treatment response. These medicines also support weight loss and, in some cases, reduce cardiovascular risk—important benefits for many people living with type 2 diabetes.
Summary: The best weekly type 2 diabetes shots in the UK are GLP-1 receptor agonists—semaglutide (Ozempic), dulaglutide (Trulicity), and exenatide prolonged-release (Bydureon)—prescribed when oral medicines have not achieved adequate blood glucose control.
- GLP-1 receptor agonists stimulate insulin secretion in a glucose-dependent manner, suppress glucagon, and slow gastric emptying.
- Semaglutide typically reduces HbA1c by 1.0–1.8% and supports weight loss of 4–6 kg on average.
- Common side effects include nausea, vomiting, and diarrhoea, usually improving within 4–8 weeks.
- NICE eligibility requires HbA1c ≥58 mmol/mol despite oral treatment and BMI ≥35 kg/m² (or <35 kg/m² with specific criteria).
- National supply constraints may currently affect access; local formulary policies guide prescribing decisions.
- Treatment is reviewed at six months and continued only if HbA1c falls by ≥11 mmol/mol and weight loss ≥3% is achieved.
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What Are Weekly Type 2 Diabetes Injections?
Weekly type 2 diabetes injections represent a significant advancement in diabetes management, offering patients a convenient alternative to daily medication regimens. These injectable treatments belong primarily to a class of medicines called glucagon-like peptide-1 receptor agonists (GLP-1 RAs), which work by mimicking the action of naturally occurring hormones that regulate blood glucose levels. It is important to note that GLP-1 receptor agonists are not insulin and are not indicated for type 1 diabetes or diabetic ketoacidosis.
The mechanism of action involves several complementary pathways. GLP-1 receptor agonists stimulate insulin secretion from pancreatic beta cells in a glucose-dependent manner, meaning they only promote insulin release when blood glucose levels are elevated. Simultaneously, they suppress the release of glucagon, a hormone that raises blood sugar, and slow gastric emptying, which helps moderate the post-meal glucose spike. These medicines also act on appetite centres in the brain, often resulting in reduced food intake and weight loss—a particularly beneficial effect for many people with type 2 diabetes who are overweight.
The once-weekly formulation offers practical advantages over older diabetes treatments. Patients need only remember one injection per week rather than daily tablets or multiple daily injections. The subcutaneous injections are administered using pre-filled pens with fine needles, typically into the abdomen, thigh, or upper arm. Most patients find the injection process straightforward after initial training from their diabetes specialist nurse.
These treatments are generally prescribed when lifestyle modifications and oral medicines such as metformin have not achieved adequate glycaemic control. The Medicines and Healthcare products Regulatory Agency (MHRA) has licensed several weekly GLP-1 receptor agonists for use in the UK, and NICE provides guidance on their appropriate use within the NHS. Patients should be aware that national supply constraints may currently affect access to some GLP-1 receptor agonists, and local formulary policies will guide prescribing decisions.
Comparing Weekly GLP-1 Injections Available in the UK
Several once-weekly GLP-1 receptor agonists are currently licensed and available through the NHS, each with distinct characteristics that may influence prescribing decisions. Understanding the differences between these options helps patients and clinicians select the most appropriate treatment.
Dulaglutide (Trulicity) is administered as a fixed-dose injection available in 0.75 mg, 1.5 mg, 3 mg, and 4.5 mg strengths. Treatment is typically initiated at 0.75 mg or 1.5 mg once weekly, with dose escalation as needed. It features a single-use pen that requires no manual needle attachment, making it particularly user-friendly. Clinical trials have demonstrated HbA1c reductions of 0.8–1.6% depending on the dose, with associated weight loss averaging 2–3 kg. No dose adjustment is required in renal impairment, though caution is advised in severe renal disease.
Semaglutide (Ozempic) is available in 0.25 mg, 0.5 mg, 1 mg, and 2 mg doses. Treatment is initiated at 0.25 mg once weekly for four weeks (not a therapeutic dose), then increased to 0.5 mg. Further dose escalation to 1 mg or 2 mg may be considered based on glycaemic response. Semaglutide has shown HbA1c reductions of 1.0–1.8% and weight loss averaging 4–6 kg in clinical trials. The SUSTAIN clinical trial programme demonstrated cardiovascular benefits, including reduced risk of major adverse cardiovascular events in patients with established cardiovascular disease. No dose adjustment is required in renal impairment. Patients with diabetic retinopathy should be monitored, as rapid improvement in glycaemic control has been associated with temporary worsening of diabetic retinopathy; patients should seek prompt review if they experience new or worsening visual symptoms.
Exenatide prolonged-release (Bydureon) was one of the first weekly GLP-1 receptor agonists available. Administered as a 2 mg weekly injection, it provides HbA1c reductions of approximately 1.0–1.5%. Some patients experience injection site nodules due to its microsphere formulation. Exenatide prolonged-release is not recommended in patients with estimated glomerular filtration rate (eGFR) below 30 mL/min/1.73 m².
All three medicines have demonstrated cardiovascular safety in dedicated outcome trials (REWIND, SUSTAIN-6, EXSCEL), with semaglutide and dulaglutide showing additional cardiovascular protective effects in high-risk populations. The choice between agents depends on individual patient factors, tolerability, renal function, local formulary restrictions, and cost-effectiveness considerations as outlined in NICE technology appraisals. Your diabetes specialist will consider your specific clinical circumstances, including baseline HbA1c, body weight, cardiovascular risk profile, presence of diabetic retinopathy, and personal preferences when recommending a particular weekly injection. National supply constraints may currently affect availability of some GLP-1 receptor agonists, and local policies will guide prescribing.
Benefits and Side Effects of Weekly Diabetes Treatments
Weekly GLP-1 receptor agonist injections offer multiple clinical benefits beyond glucose control, making them an attractive option for many patients with type 2 diabetes. The primary advantage is improved glycaemic control, with most patients experiencing HbA1c reductions of 1.0–1.8%, which can reduce the long-term risk of diabetes-related complications such as retinopathy, nephropathy, and neuropathy.
Weight loss represents another substantial benefit, particularly valuable given that approximately 90% of people with type 2 diabetes are overweight or obese. Unlike some diabetes medicines that cause weight gain, GLP-1 receptor agonists typically result in weight reduction of 2–6 kg, which can improve insulin sensitivity and overall metabolic health. Additionally, cardiovascular outcome trials have demonstrated that certain weekly GLP-1 RAs reduce the risk of heart attack, stroke, and cardiovascular death in patients with established cardiovascular disease—a critical consideration given that cardiovascular disease remains the leading cause of mortality in diabetes.
The low risk of hypoglycaemia when used as monotherapy or with metformin is another important advantage, as the glucose-dependent mechanism of insulin secretion means these medicines do not typically cause dangerously low blood sugar levels. However, when GLP-1 receptor agonists are used in combination with insulin or sulphonylureas, the risk of hypoglycaemia increases, and your prescriber may need to reduce the dose of those medicines when starting a GLP-1 RA.
However, these medicines are not without side effects. Gastrointestinal symptoms are the most common adverse effects, particularly during treatment initiation or dose escalation. These include:
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Nausea (most common, usually temporary)
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Vomiting
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Diarrhoea
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Constipation
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Abdominal discomfort
These symptoms typically improve over 4–8 weeks as the body adjusts. Starting with a lower dose and gradually increasing (dose titration) can help minimise gastrointestinal side effects. It is important to maintain adequate hydration, particularly if experiencing vomiting or diarrhoea, as dehydration can lead to acute kidney injury, especially in patients with existing renal impairment or those taking other medicines that affect the kidneys.
Injection site reactions—including redness, itching, or bruising—occur occasionally but are generally mild. Rare but serious adverse effects include pancreatitis (inflammation of the pancreas) and gallbladder disease. Preclinical studies in rodents showed thyroid C-cell tumours at very high doses of GLP-1 receptor agonists; the relevance of this finding to humans is unknown, and routine clinical vigilance is advised. Patients should contact their GP immediately if they experience severe, persistent abdominal pain, as this may indicate pancreatitis requiring urgent assessment.
Patients taking semaglutide who have pre-existing diabetic retinopathy should be monitored, and all patients should seek prompt review if they notice new or worsening visual symptoms. If you experience any side effects, including those not listed here, you can report them via the MHRA Yellow Card Scheme at yellowcard.mhra.gov.uk or through the Yellow Card app.
Who Is Suitable for Once-Weekly Type 2 Diabetes Injections?
NICE guidance provides clear criteria for initiating GLP-1 receptor agonist therapy in type 2 diabetes, ensuring these medicines are prescribed to patients most likely to benefit. Understanding eligibility criteria helps patients have informed discussions with their healthcare team about treatment options.
Primary eligibility criteria according to NICE NG28 include:
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HbA1c remaining above target (typically ≥58 mmol/mol or 7.5%) despite treatment with metformin and at least one other oral diabetes medicine
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Body mass index (BMI) ≥35 kg/m² with specific psychological or medical problems associated with obesity, OR
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BMI <35 kg/m² when insulin therapy would have significant occupational implications or weight loss would benefit other significant obesity-related comorbidities
NICE advises using lower BMI thresholds for people from some minority ethnic groups when assessing eligibility. Weekly GLP-1 receptor agonists are particularly suitable for patients who struggle with medication adherence, as the once-weekly regimen is simpler than multiple daily tablets. They represent an option for individuals wishing to avoid or delay insulin therapy, and for those with established cardiovascular disease who may derive additional protective benefits according to NICE criteria and local formulary considerations.
Contraindications and cautions must be carefully considered. These medicines are contraindicated in:
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Type 1 diabetes (they do not replace insulin)
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Diabetic ketoacidosis
Caution is advised or use is not recommended in patients with severe gastrointestinal disease, including gastroparesis, as these medicines slow gastric emptying. Preclinical studies in rodents showed thyroid C-cell tumours at very high doses; the relevance to humans is unknown, and routine clinical vigilance is advised.
Regarding renal impairment, most GLP-1 receptor agonists (semaglutide and dulaglutide) require no dose adjustment, though caution is advised in severe renal disease. Exenatide prolonged-release is not recommended in patients with eGFR below 30 mL/min/1.73 m². Patients with renal impairment should maintain adequate hydration to reduce the risk of acute kidney injury, particularly if experiencing gastrointestinal side effects.
Pregnant women or those planning pregnancy should not use these medicines, as safety data in pregnancy are limited. Women of childbearing potential should use effective contraception. For semaglutide, treatment should be discontinued at least two months before a planned pregnancy; for other GLP-1 receptor agonists, consult the product's Summary of Product Characteristics or the BNF for specific guidance. GLP-1 receptor agonists are not recommended during breastfeeding.
Older adults can safely use weekly injections, though careful monitoring for side effects, particularly dehydration from gastrointestinal symptoms, is important. Patients taking semaglutide with pre-existing diabetic retinopathy should be monitored, and all patients should seek prompt review for new or worsening visual symptoms. Your diabetes specialist will conduct a comprehensive assessment of your medical history, current medicines, kidney function, and individual circumstances before recommending a weekly injection. Treatment continuation is typically reviewed after six months, with NICE recommending discontinuation if HbA1c has not fallen by at least 11 mmol/mol (1.0%) and weight loss of at least 3% of initial body weight has not been achieved.
Getting Weekly Diabetes Shots Through the NHS
Accessing weekly GLP-1 receptor agonist injections through the NHS involves a structured pathway, typically coordinated through your GP practice and local diabetes services. Understanding this process can help you navigate the system effectively and set realistic expectations. Please note that national supply constraints may currently restrict new initiations or switches between GLP-1 receptor agonists, and patients should follow local advice.
Initial assessment and referral: If your diabetes control remains suboptimal despite oral medicines, your GP will review your treatment regimen and may refer you to the local diabetes specialist team. This referral triggers a comprehensive assessment including recent HbA1c results, BMI calculation, review of current medicines, kidney function tests, and evaluation of cardiovascular risk factors. Some areas operate shared-care protocols where GPs can initiate GLP-1 receptor agonists following local guidelines, whilst others require specialist initiation.
Specialist consultation: The diabetes specialist nurse or consultant will discuss treatment options, explain how weekly injections work, review potential benefits and side effects, and ensure you meet NICE eligibility criteria. If weekly injections are deemed appropriate, you will receive detailed training on injection technique, pen device operation, injection site rotation, and proper storage (these medicines require refrigeration before first use). Most diabetes centres provide written information and may offer group education sessions for patients starting injectable therapies.
Prescription and supply: Once initiated, prescriptions are typically issued monthly or quarterly. The medicine is usually dispensed through community pharmacies; in some areas, homecare delivery services may be available, though this varies locally. Costs: Prescriptions are free for everyone in Scotland, Wales, and Northern Ireland. In England, people with diabetes who are treated with medicine can apply for a medical exemption certificate, which provides free prescriptions. Without an exemption, the standard NHS prescription charge applies per item. If you require multiple regular prescriptions, a prescription prepayment certificate (PPC) may offer savings. For more information, visit the NHS Business Services Authority website.
Ongoing monitoring: Regular follow-up appointments are essential to monitor treatment response, adjust doses, assess for side effects, and provide ongoing support. NICE recommends formal review at six months to determine whether treatment should continue based on HbA1c reduction and weight loss achieved. Subsequent reviews typically occur every 6–12 months, with HbA1c monitoring every 3–6 months.
When to contact your healthcare team: Seek advice if you experience severe or persistent nausea and vomiting leading to dehydration, severe abdominal pain that does not resolve, signs of pancreatitis, new or worsening visual symptoms, unexplained weight loss with other symptoms, or difficulty managing your injection regimen. Your diabetes specialist nurse is usually your first point of contact for medicine-related queries, with telephone advice lines available in most diabetes centres. For urgent concerns outside normal hours, contact NHS 111. In an emergency—such as chest pain, suspected stroke, or other life-threatening symptoms—dial 999 or attend your local A&E department.
Frequently Asked Questions
Which weekly diabetes injection is most effective for lowering blood sugar?
Semaglutide (Ozempic) typically achieves the greatest HbA1c reductions, lowering levels by 1.0–1.8% in clinical trials, though individual response varies. Dulaglutide and exenatide prolonged-release also provide significant glucose control, with HbA1c reductions of 0.8–1.6% and 1.0–1.5% respectively, and your diabetes specialist will recommend the most suitable option based on your clinical profile and local formulary.
Can I use a weekly type 2 diabetes shot instead of metformin?
Weekly GLP-1 injections are not typically used as first-line treatment in place of metformin. NICE guidance recommends them when HbA1c remains above target despite metformin and at least one other oral medicine, meaning they are usually added to existing treatment rather than replacing it entirely.
How do I get a prescription for weekly diabetes injections on the NHS?
Your GP will refer you to the local diabetes specialist team if your blood glucose control remains inadequate despite oral medicines and you meet NICE eligibility criteria (HbA1c ≥58 mmol/mol and BMI ≥35 kg/m² or specific lower BMI criteria). The specialist will assess your suitability, provide injection training, and initiate treatment, though national supply constraints may currently affect access.
What's the difference between semaglutide and dulaglutide for type 2 diabetes?
Both are weekly GLP-1 receptor agonists, but semaglutide generally produces greater HbA1c reductions (1.0–1.8%) and weight loss (4–6 kg) compared to dulaglutide (0.8–1.6% HbA1c reduction, 2–3 kg weight loss). Semaglutide requires a four-week initiation period at 0.25 mg, whilst dulaglutide can start at a therapeutic dose, and both have demonstrated cardiovascular benefits in high-risk patients.
Will weekly diabetes shots help me lose weight as well as control my blood sugar?
Yes, weekly GLP-1 injections typically result in weight loss of 2–6 kg by acting on appetite centres in the brain and slowing gastric emptying. This dual benefit of improved glucose control and weight reduction makes them particularly suitable for people with type 2 diabetes who are overweight, though individual results vary.
What should I do if I experience severe nausea after starting a weekly diabetes injection?
Contact your diabetes specialist nurse or GP if nausea is severe or persistent, as they may adjust your dose or recommend anti-nausea strategies. Maintain adequate hydration, eat smaller meals, and avoid fatty foods; most gastrointestinal side effects improve within 4–8 weeks as your body adjusts to the medicine.
The health-related content published on this site is based on credible scientific sources and is periodically reviewed to ensure accuracy and relevance. Although we aim to reflect the most current medical knowledge, the material is meant for general education and awareness only.
The information on this site is not a substitute for professional medical advice. For any health concerns, please speak with a qualified medical professional. By using this information, you acknowledge responsibility for any decisions made and understand we are not liable for any consequences that may result.
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