I'm in Wales, I was on liraglutide (Saxenda) for diabetes for about 12 years, right up until September 2023 when the local chemists could no longer get hold of it for the NHS.
Before liraglutide I was on exenatide (Byetta) the first generation of these drugs, which had been wonderful because it meant I could stop counting carbs and calculating insulin units before every meal. I read back then that exanatide was developed from a substance found in the poisonous spit of the Gila monster lizard.
I have been morbidly obese since the 1990s, and lost 10kg without effort when I first started taking liraglutide. After that initial loss the main benefit was that it kept my glucose levels steady without causing hypos and my weight stabilised at 160 kgs rather than increasing each year as it had been doing while I was on insulin.
In February 2022 I listened to a Zoe food science podcast where the guest scientist said test subjects had reduced the inflammation markers in their blood by 20% after adding small portions of kimchi, sauerkraut, kombucha and kefir to their daily food intake. I was crippled with rheumatoid arthritis and the prospect of a 20% improvement caught my attention. I went online and subscribed to a fermented vegetable delivery, added kombucha and kefir to my grocery orders and continued to eat as usual, but adding kimchi and kefir to breakfast and saurkraut and kefir to dinner.
An unexpected side effect was that the weight started falling off me. I remained on the same dose of liraglutide that I had been on for more than 10 years, and was eating between 3000 and 4000 calories/day.
I stopped taking ibuprofen (after finding out that it is as bad as antibiotics for killing beneficial gut bacteria) and each time I listened to a new Zoe food science podcast I tweaked what I ate, adding 15g of nuts and a square of black chocolate to my lunch, then including more and more plants, a sprinkling of inulin on the kefir and berries, I even started eating oily fish after being vegetarian/vegan since 1982.
I lost 30 kg that first year, without restricting my calorie intake. I added a load of things to my diet instead of cutting stuff out.
By September 2023 I had lost a further 27 kg and had gradually whittled my daily calorie intake down from 4000 to around 2200/day and started fasting overnight, first for 14 hours, then 16 before finally settling into 18 hours fasting and 6 hours scoffing.
I was losing between 2 and 3kg each month without any effort. I was also sleeping better than I had since my teens, my blood pressure dropped so low that I had to stop taking the blood pressure tablets I'd been on for years, and my glucose control became excellent (100% time in range, no hypos).
Then in September my next month's medicines arrived without the liraglutide, I phoned to ask where it was and the chemist said they'd tried all their suppliers and couldn't fill the prescription, they were sorry and advised me to phone the diabetes clinic. The diabetes clinic explained that there was a world wide shortage, all the liraglutide and semaglutide was being made by a single company in Denmark who kept expanding their production lines but were unable to keep up with the constantly increasing demand now that the drugs were being used for weight loss. The available supply was being bought up by private weight loss clinics, who were willing and able to pay a lot more than the NHS.
The diabetes consultant promised that a new American drug (Mounjaro) was in the final stages of being approved, and would become available sometime in 2024. Once the American production facilities were running ample supplies would be guaranteed. So all liraglutide patients were going to be moved onto Mounjaro as soon as it was available, but until then the only medication they could offer was insulin.
That was horrible, insulin stimulates the body to store glucose as fat, so it's an uphill struggle to avoid gaining weight when you have insulin resistance and need to inject extra insulin to keep your blood glucose from getting dangerously high.
Around Christmas 2023 someone on a mumsnet thread mentioned that they were buying liraglutide/Saxenda from an online pharmacy. I looked into it and discovered that if I was willing to pay £210 for the three pens that the NHS had been giving me for free it would be possible to buy a month's supply online. l was so sick of being starving hungry all the time, and having to count carbs and inject multiple times a day that I turned down the thermostat, cancelled all my subscriptions (except for the fermented vegetables), cut back on all frivolities and filled out the application form on the website. At the end of the form it told me I was eligible and gave me the option of choosing between Saxenda/liraglutide, Wegovy/semaglutide or the less effective tablet version of semaglutide/Rybelsus.
Wegovy is an improvement on Saxenda, and since it only needs to be injected once a week a £140 pen lasts a month, so works out cheaper than Saxenda. It was bliss to be able to stop counting carbs, calculating insulin units and injecting every time I wanted to eat anything containing carbohydrates. Swapping all that for just one injection a month was worth all the other sacrifices.
Last June I upgraded to Mounjaro as soon as I noticed my provider was offering it. Then last September the diabetes centre was finally able to offer me a Mounjaro prescription, but they aren't allowed to prescribe more than 5mg for diabetes so I've continued to buy a pen from Voy and take two injections at the same time to reach 12.5mg. I will probably increase to the highest dose by ordering a 10mg pen from Voy when I get closer to the normal BMI range and need to decrease my calorie intake again.
I think these medicines are miraculous. I have not had any side effects, not from any of the four generations of drugs that I have been prescribed. Each one has been an improvement on the earlier version. Having taken all of them my advice is to move onto Mounjaro, because it is a lot more effective than Wegovy, and Wegovy in turn is more effective than Saxenda. But if Saxenda is all that is available it is still a lot better than nothing.
I'm very fortunate never to have experienced side effects, but on the other hand I have never had the levels of suppression that some other people experience. Not even on 12.5 mg of Mounjaro. Never felt unable to clear my plate, I could easily eat twice as much at every meal. Over the past 3 years I have lost 81kgs (That's 12.75 stones in old money according to Google) but I don't really consider the weight I lost while on liraglutide to have been due to the medication, since I had already been on it for 10 years at a steady weight before adding the fermented stuff to my diet and being more protective of my gut microbes, who reciprocated by boosting my metabolism.
It was really hard in September, October, November and December 2023 when I was back to injecting insulin, the half a kilo a month I managed to lose then was a real slog and stretched my willpower to the limits. By comparison it has been almost effortless to resist temptations on Wegovy and then Mounjaro.
I think if I was still on liraglutide my weight loss would have stabilised by now, and I'd have been delighted to no longer be obese and to be able to squeeze into a size 16 after wearing size 36 for 30 years.
However, the little bit of extra edge I get from the higher doses of Mounjaro might make it possible to continue losing weight until I get down to within the normal BMI range.