Staying on track with GLP-1 medications requires more than simply administering your injections—it involves understanding how these medicines work, managing side effects effectively, and building sustainable lifestyle habits that support your treatment goals. GLP-1 receptor agonists such as semaglutide and liraglutide have transformed the management of type 2 diabetes and weight-related conditions, but long-term success depends on consistent adherence, regular monitoring, and close collaboration with your healthcare team. This guide provides practical strategies to help you navigate your GLP-1 journey, from starting treatment through to maintaining progress over time.

What Are GLP-1 Medications and How Do They Work?

Glucagon-like peptide-1 (GLP-1) receptor agonists are a class of medications primarily used to manage type 2 diabetes and, more recently, for weight management in specific patient groups. These medicines mimic the action of a naturally occurring hormone called GLP-1, which is released by the intestine in response to food intake.

The mechanism of action involves several complementary pathways. GLP-1 medications bind to GLP-1 receptors on pancreatic beta cells, stimulating insulin secretion in a glucose-dependent manner—meaning they only promote insulin release when blood glucose levels are elevated. This reduces the risk of hypoglycaemia compared to some other diabetes medications. Simultaneously, these agents suppress glucagon secretion from pancreatic alpha cells, further helping to regulate blood glucose levels. Additionally, GLP-1 receptor agonists slow gastric emptying, which prolongs the feeling of fullness after meals and reduces appetite through effects on the central nervous system.

Commonly prescribed GLP-1 medications in the UK include semaglutide (available as Ozempic for diabetes, Wegovy for weight management, and Rybelsus as an oral tablet for diabetes), liraglutide (Victoza for diabetes, Saxenda for weight management), and dulaglutide (Trulicity). These are typically administered via subcutaneous injection, with dosing frequencies ranging from once daily to once weekly depending on the specific formulation.

For type 2 diabetes, NICE guidance (NG28) recommends GLP-1 receptor agonists in specific circumstances, typically when other treatments have not achieved adequate glycaemic control and in people with a BMI ≥35 kg/m² (adjusted for ethnicity) or for whom weight loss would benefit other obesity-related comorbidities.

For weight management, semaglutide 2.4mg (Wegovy) is recommended by NICE (TA875) for adults with a BMI of at least 35 kg/m² (or 32.5 kg/m² for people from certain ethnic backgrounds) and at least one weight-related comorbidity, as part of a specialist weight management service. Liraglutide 3mg (Saxenda) has more restricted criteria under NICE TA664, specifically for those with non-diabetic hyperglycaemia and high cardiovascular risk.

Starting Your GLP-1 Treatment: What to Expect

Beginning GLP-1 therapy involves a gradual dose escalation to minimise gastrointestinal side effects and allow your body to adjust to the medication. Your healthcare team will typically start you on the lowest available dose, increasing it incrementally over several weeks or months until you reach the maintenance dose appropriate for your treatment goals.

Before starting treatment, your GP or specialist will conduct baseline assessments, which may include:

• Blood tests to check kidney function, liver enzymes, and HbA1c (for diabetes patients)

• Weight and BMI measurements

• Blood pressure monitoring

• Review of your medical history, particularly any history of pancreatitis, thyroid disease, or diabetic retinopathy

You will receive training on proper injection technique, typically from a practice nurse or diabetes specialist nurse. GLP-1 medications are administered subcutaneously, usually in the abdomen, thigh, or upper arm. The injection site should be rotated to prevent lipohypertrophy (lumps under the skin). Most modern GLP-1 pens are pre-filled and designed for ease of use, with fine needles that make injections relatively comfortable. Never share your pen with others, and dispose of used needles safely in a sharps bin.

During the first few weeks, it is normal to experience some gastrointestinal adjustment. Many patients report reduced appetite quite quickly, which is part of the medication's intended effect. However, this should not lead to inadequate nutrition. Your healthcare team will provide guidance on maintaining a balanced diet whilst adapting to these changes.

If you are taking insulin or sulfonylureas (such as gliclazide), your doctor may reduce these doses when starting GLP-1 treatment to reduce the risk of hypoglycaemia.

Importantly, GLP-1 medications are not recommended if you have severe gastrointestinal disease such as gastroparesis. They are also contraindicated during pregnancy and not recommended while breastfeeding. If you are of childbearing potential, effective contraception is advised during treatment, and you should discuss with your doctor if planning pregnancy, as a washout period may be needed.

It is important to attend all scheduled follow-up appointments during the initiation phase. These allow your healthcare team to monitor your response to treatment, adjust dosing appropriately, and address any concerns or side effects promptly. Keep a record of any symptoms, blood glucose readings (if you have diabetes), and weight changes to discuss at these appointments.

Managing Side Effects While Taking GLP-1 Medications

Gastrointestinal side effects are the most commonly reported adverse effects of GLP-1 medications, particularly during dose escalation. These typically include nausea, vomiting, diarrhoea, constipation, and abdominal discomfort. For most patients, these symptoms are mild to moderate and tend to improve over time as the body adjusts to the medication.

To minimise gastrointestinal symptoms, consider the following strategies:

• Eat smaller, more frequent meals rather than large portions

• Avoid high-fat, greasy, or heavily spiced foods, which can exacerbate nausea

• Stay well hydrated, particularly if experiencing vomiting or diarrhoea

• Eat slowly and stop when you feel comfortably satisfied

• Take the injection at a consistent time each day or week as prescribed

If nausea is particularly troublesome, your GP may consider anti-emetic medication or temporarily reducing the dose before attempting escalation again. Persistent vomiting that prevents adequate fluid intake requires medical attention to prevent dehydration and potential acute kidney injury.

Injection site reactions—such as redness, itching, or mild swelling—can occur but are usually minor. Rotating injection sites and ensuring the medication reaches room temperature before injecting can help reduce these reactions.

More serious but less common adverse effects include:

• Pancreatitis: Seek immediate medical attention if you experience severe, persistent abdominal pain that may radiate to the back, accompanied by nausea and vomiting

• Gallbladder problems: Rapid weight loss can increase the risk of gallstones; contact your GP if you develop right upper abdominal pain, particularly after eating

• Diabetic retinopathy complications: Patients with pre-existing diabetic eye disease should have regular ophthalmology follow-up, as rapid glucose improvement may temporarily worsen retinopathy, particularly with semaglutide

GLP-1 medications carry a warning regarding thyroid C-cell tumours based on animal studies. While this is not a contraindication in the UK, you should report any symptoms such as a lump in the neck, persistent hoarseness, or difficulty swallowing to your doctor.

To date, there is no established increased overall cancer risk in humans associated with GLP-1 medications, though ongoing monitoring continues as part of routine pharmacovigilance.

If you experience any suspected side effects, report them to the MHRA Yellow Card scheme (yellowcard.mhra.gov.uk or via the Yellow Card app).

Building Sustainable Habits to Support Your GLP-1 Treatment

Whilst GLP-1 medications are effective tools for managing diabetes and weight, long-term success depends on integrating sustainable lifestyle modifications alongside pharmacological treatment. These medications work best when combined with healthy eating patterns and regular physical activity.

Nutritional considerations are particularly important. The appetite suppression caused by GLP-1 medications can make it easier to reduce calorie intake, but it is essential to ensure you are still meeting your nutritional needs:

• Prioritise protein intake at each meal to preserve muscle mass during weight loss (many weight management programmes suggest 1.2–1.5g per kilogram of body weight daily, though this should be individualised, particularly if you have kidney disease)

• Include plenty of vegetables and fruits for essential vitamins, minerals, and fibre

• Choose whole grains over refined carbohydrates for sustained energy and better glycaemic control

• Stay adequately hydrated—aim for 6–8 glasses of fluid daily, primarily water

• Focus on nutrient-dense foods rather than supplements where possible; if considering a multivitamin, discuss with your healthcare provider to ensure it's appropriate for your needs

Some patients find it helpful to work with a registered dietitian who can provide personalised nutrition guidance tailored to their treatment goals and any other health conditions. This may be available through NHS specialist weight management services.

Physical activity remains a cornerstone of metabolic health. UK Chief Medical Officers' guidelines recommend at least 150 minutes of moderate-intensity aerobic activity per week, plus strength training exercises twice weekly. Start gradually if you are new to exercise, and build up slowly:

• Walking is an excellent starting point—aim to increase your daily step count progressively

• Resistance training helps maintain muscle mass and metabolic rate during weight loss

• Find activities you enjoy to improve adherence—this might include swimming, cycling, dancing, or group fitness classes

Behavioural strategies can help you stay on track:

• Set realistic, specific goals (e.g., "walk 30 minutes five days per week" rather than "exercise more")

• Keep a food and activity diary to identify patterns and triggers

• Build a support network—whether family, friends, or support groups

• Plan ahead for challenging situations such as social events or holidays

• Celebrate non-scale victories, such as improved energy levels, better sleep, or reduced medication requirements

Monitoring Progress and When to Contact Your Healthcare Team

Regular monitoring is essential to assess treatment effectiveness, adjust dosing, and identify any complications early. The frequency and type of monitoring will depend on whether you are using GLP-1 medication for diabetes management, weight loss, or both.

For patients with type 2 diabetes, monitoring typically includes:

• HbA1c measurements every 3–6 months to assess overall glycaemic control (NICE NG28 recommends individualised targets, commonly 48–53 mmol/mol depending on hypoglycaemia risk and comorbidities)

• Home blood glucose monitoring if you are at risk of hypoglycaemia or taking other diabetes medications

• Kidney function tests (eGFR and urine albumin-to-creatinine ratio) at least annually

• Annual diabetic eye screening and foot checks

• Cardiovascular risk assessment, including blood pressure and lipid profiles

For weight management patients, monitoring focuses on:

• Regular weight measurements—with product-specific review timeframes (for liraglutide 3mg [Saxenda], evaluate response at 12–16 weeks; for semaglutide 2.4mg [Wegovy], around 20 weeks)

• BMI and waist circumference tracking

• Blood pressure monitoring

• Assessment of weight-related comorbidities (e.g., sleep apnoea, joint pain, metabolic parameters)

If you're taking GLP-1 medications alongside insulin or sulfonylureas, your doses of these medications may need adjustment to prevent hypoglycaemia as your glucose control improves.

Contact your GP or healthcare team promptly if you experience:

• Severe or persistent abdominal pain, particularly if accompanied by vomiting (possible pancreatitis)

• Signs of dehydration from persistent vomiting or diarrhoea (dizziness, dark urine, reduced urination)

• Symptoms of hypoglycaemia if taking other diabetes medications (shakiness, sweating, confusion, rapid heartbeat)

• Visual changes or eye pain

• Unexplained lumps in the neck, hoarseness or difficulty swallowing

• Severe injection site reactions or signs of infection

• Mood changes or thoughts of self-harm

For urgent but non-emergency concerns, contact NHS 111 for advice.

Seek emergency medical attention (call 999 or attend A&E) if you develop severe abdominal pain, signs of severe dehydration, loss of consciousness, or severe allergic reactions (difficulty breathing, facial swelling).

Remember that GLP-1 treatment is typically a long-term commitment. Stopping the medication often results in weight regain and worsening glycaemic control. Discuss any concerns about continuing treatment with your healthcare team rather than stopping abruptly. They can help you weigh the benefits and risks and explore alternative strategies if needed. Staying engaged with your healthcare team and maintaining open communication are key factors in achieving and sustaining the health improvements that GLP-1 medications can facilitate.

Frequently Asked Questions