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However, if systemic estrogen deficiency remains unaddressed, insulin resistance may continue to be hormonally driven

Each comes with its own level of evidence, safety concerns, and practicality

Contact your GP or diabetes specialist nurse if you experience: Severe or worsening fatigue that significantly impacts your daily activities or quality of life Persistent tiredness that does not improve after several weeks despite self-management strategies Symptoms suggesting hypoglycaemia , including shakiness, sweating, confusion, palpitations, or hunger alongside tiredness Signs of dehydration , such as dark urine, dizziness, dry mouth, or reduced urine output, particularly if accompanied by vomiting or diarrhoea Unexplained weight loss beyond what would be expected from improved diabetes control New or worsening symptoms such as shortness of breath, chest pain, or palpitations Visual changes or deterioration , as rapid improvement in blood glucose can sometimes worsen diabetic retinopathy [10] Right upper abdominal pain, fever, yellowing of skin/eyes or pale stools , which could indicate gallbladder disease (a known risk with GLP-1 receptor agonists) [8] [9] Seek urgent medical attention (call 999 or attend A&E) if you develop: Severe abdominal pain that does not resolve, particularly if radiating to the back (potential pancreatitis) Signs of severe dehydration with inability to keep fluids down Altered consciousness or severe confusion Symptoms of diabetic ketoacidosis (though rare in type 2 diabetes), including excessive thirst, frequent urination, fruity breath odour, and rapid breathing For urgent but non-life-threatening concerns, contact NHS 111 for advice

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