Self-Injectable Weight Management Treatment

There is no quick weight management fix! This is a long term plan that will hopefully enable you to make sustainable lifestyle changes. It is important to be aware that weight loss will plateau, this is a normal part of the journey. It usually happens around week 40 of treatment. Don’t worry, the weight that you have lost can be maintained by continuing your medical treatment and lifestyle changes. 

Success is not just about the weight you lose but keeping it off, and the health benefits that you will gain.

Step 1 - Making A Decision: 

Make a decision to lose weight as part of a medical weight management programme. We will request that you complete an online medical assessment and upload a copy of your photo ID along with a verified BMI measurement taken by a healthcare professional (such as your pharmacist).

Step 2 - Education: 

Review the medical information and resources in this weight management programme and plan what changes you can make to your lifestyle.

Step 3 - Training: 

Complete training on how to use a self-injectable pen medication

Step 4 - Start Treatment 

Self-Injectable Weight management medications can  cause some unpleasant side effects such as nausea and vomiting. To minimise these, you start at a low dose and gradually build up your treatment dose.  

If you are still having side effects at the time of your next dose increase, do not increase your dose and let us know. It may be that you just need to increase the dose more slowly to let your body get used to this medication. We will give you specific advice about this depending on your individual situation.

Step 5 - Continue Treatment

You will continue to increase your treatment dose, as tolerated until you reach the target maintenance dose, this  may vary depending on how you tolerate the medication and the increases in dose. Just remember, this journey is a marathon, not a sprint! If it takes a few weeks longer to reach this dose, it will not have any significant impact on your weight loss. The most important thing is that you are doing this safely.

Step 6 - 16 Week Assessment: 

We will request that you complete an online assessment and upload another verified weight measurement taken by a healthcare professional. We will advise you if the treatment is suitable for you to continue.

Step 7 - Continue Treatment (if suitable): 

As part of long-term weight maintenance for health improvements, you continue this treatment. Please be aware that if you stop this treatment, then you will regain weight. It may be required long term.

This service is suitable for you if:

• You are over 18 years of age 
• Your initial (pre-treatment) BMI is 30 or more
• You can provide height and weight measurements verified by your healthcare professional
• You can provide a copy of your photo ID
• You are willing to engage with lifestyle changes in conjunction with medication

This service is not suitable for you if:

• You are more than 65 years of age
• You are pregnant or breastfeeding
• You are actively trying to conceive (including IVF)
• You have diabetes
• You have weight gain due to medication or an endocrine (hormonal) disorder
• You have been diagnosed with (or think you may have) an eating disorder
• You have severe liver, kidney or heart failure
• You have the following digestive conditions:
  • Inflammatory bowel disease
  • Gallbladder disease (including gallstones)
  • Pancreatitis
  • Gastroparesis
• You have a thyroid condition (e.g. an underactive or overactive thyroid or thyroid cancer.)

If you’re unsure of your BMI, you can check it with our BMI calculator.

The self-injectable weight management treatments we prescribe (when medically appropriate) are once-daily or once-weekly medications that can help with weight management.

They are prescribed as one part of a weight management plan that includes increased physical activity and a reduced calorie diet. 

The medications come in a pre-filled pen so that you can self-inject them at home. 

These medications belong to a group of medications called Glucagon Like-Peptide (GLP-1) agonists.

Your body produces a hormone called glucagon-like peptide (GLP-1), which is released from the gut in response to food. This plays an important role in regulating blood glucose levels, slowing the emptying of your stomach and suppressing your appetite.

These medications are synthetic versions of this hormone. They can be used in the management of diabetes, and to aid weight loss and maintenance.

Please note the dosing regimens and the licensed products available for each medical condition are different.

They act on the part of the brain that controls appetite, causing you to feel more satisfied after you eat and fuller for longer. Therefore, you eat less.

The effect of this medication is only apparent when you are using it. When you stop using it, appetite regulation returns to the pre-treatment pattern. Most people will start to eat more again and regain weight.

In some cases, patients will regain more weight than they lost (they will weigh more than before treatment started). For this reason, medication often needs to be continued life long, or until another suitable treatment is arranged.

It is very important to be aware of this before agreeing to commence this treatment as part of your weight management plan.

These medications are injected under the skin using a short needle, into the tissue just below the skin. This is called a subcutaneous injection. It is given daily or weekly depending on which medication you are prescribed.  

You self-administer the injections. We will provide training for this to ensure you are safe and comfortable with the self-injection technique. 

The best places to inject are:

• Your upper arms
• The front of your thighs
• Your abdomen (stomach)

You should inject a different place each day. 

This treatment comes in a pre-filled pen with a measurement gauge so you can set and check the dose to be administered. You will need to connect a new, clean needle each time you use it, and dispose of each needle into a sharps box after every injection. You should never reuse needles, and never share needles or medication with anyone.

It depends on which medication you have been prescribed.

If you are using it weekly, then you take it on the same day each week.       

It doesn’t matter if you take it with or without food. You should choose a time that suits you and works for your daily routine.

You start low and go slow! 

The dose of treatment will change over the first few weeks as you gradually build up the dose. This is to minimise any potential side effects, particularly nausea. 

If you do experience side effects, do not increase the dose as planned. This can be done more gradually to allow the side effects to settle. If you do increase the dose, the side effects are likely to become more troublesome and potentially very serious. We can provide you with advice on how to manage this if necessary.

When you reach the maximum dose, you will remain on this dose ongoing as maintenance treatment. 

It is important that you DO NOT use more than the maximum dose each day. This will increase the possibility of potentially serious side effects but will not have any effect on weight loss. 

Some people do not reach the max dose, as they have side effects, but you can still lose weight.  

We will provide detailed information on medication doses if your request is approved.

This will vary from person to person, and will depend on what dose of medication you are using. You can expect to lose 0.5-1kg per week when you reach the target treatment dose (week 5 ).

It is normal for your weight (and weight loss) to fluctuate from week to week.

You may not reach a ‘normal’ BMI (25 or less). That is OK! It is important to be aware of this and set a realistic mind-set. The focus of weight management should be health gain, and not the numbers on your scales.

Approximately 10- 20% of patients do not respond to this particular treatment, even if they make the required lifestyle changes. 

We will advise you when an assessment is required to see if you have responded. 

If you have not lost at least 5% of your initial body weight you will be advised to stop using this treatment as you have not responded. This is not a failure on your part, the treatment is just not effective for you. 

The timing of this will depend on the specific medication that you are using and how you tolerate this (how long the side effects take to settle with each dose change). 

This medication should not be used if you are actively trying to conceive. It should be stopped at least 1-2 months before trying to get pregnant, or starting IVF treatment, depending on the specific medication you are using.

Ideally, you should use a reliable form of contraception when using this medication. It is worth noting that fertility significantly improves with weight loss! If you do become pregnant when using this treatment, you should stop it immediately.

It should not be used if you are pregnant or breastfeeding. If you are not breastfeeding and you have recently had a baby, we advise that you wait at least 3 months before using this treatment.

If you would like more information on this, please contact our team (info@webdoctor.ie).

As with all medications, there is a possibility that you may experience some side effects (not everyone will experience these).

The most common side effects are related to gastric disturbance and include:

• Nausea
• Vomiting
• Diarrhoea
• Constipation
• Stomach pain/ cramps

These symptoms are the most problematic and approximately 65% of all patients report some (not all!) of these symptoms. They are usually mild and settle with time, hence the gradual increase in dose. Some people can take a little longer to settle on this medication than others. We can provide you with useful hints and tips on how to manage these and when to seek advice.

Other side effects include:

• Localised reaction at injection sites
  • Bruising, pain, redness, itch
• Difficulty sleeping (usually within the first 3 months of treatment)
• Altered sense of taste
• Dizziness
• Fatigue (tiredness)
• Headaches
• Increased heat rate (palpitations)
• Gallbladder problems such as gallstones
• Low blood sugar (hypoglycaemia)

If you are concerned that you are developing these side effects, we advise that you stop the medication and seek medical advice.

Potentially serious side effects are uncommon but include:

• Severe allergic reactions (anaphylaxis)
  • Seek URGENT medical advice if you experience lip/ tongue swelling, breathing problems, rapid heart rate.
• Pancreatitis (inflammation of the pancreas)
  • This is a serious, potentially life-threatening condition.
  • Seek URGENT medical advice if you develop nausea/ vomiting AND severe persistent pain in your upper tummy (this may move through to your back).

For full details of the potential side effects of this treatment, please ensure that you read the patient information leaflet that comes with your medication before you start to use it.

• Pre-filled injectable treatment pens:
• A sharps box
• Needles for the pre-filled pens

Please note: the price of this medication can vary between pharmacies. This should be checked directly with your chosen pharmacy.