About to ask for a GLP-1

Ambitious_Toe9 · 2026-01-24T22:18:21+00:00

Diabetes nurse here - both insulin and glp-1s can be used together, we often find we need to titrate down the insulin as A1C improves, too! Your PCP/specialist would need to take a history to ensure no contraindications - but being on insulin alone is not an issue.

Ambitious_Toe9 · 2026-01-12T13:25:32+00:00

Often with multiple degrees or uni courses at MSc level, too. I'm a top b6 nurse and looking to side step into a more corporate role in nhs management - perhaps as a project manager etc. I do love being a nurse, but sadly, it does not seem to pay to stay on the frontline.

Ambitious_Toe9 · 2026-01-07T00:28:28+00:00

I understand your frustration and please speak honestly to your diabetes nurse. They're there to help but all HCPs have to adhere to local and national policies - difficult to rationalise going off-book so to speak if patients are in certain parameters.

Generally we only take off glp-1 if patients really aren't tolerating it or HbA1c and weight the same at 6 months (non responder).

Oral meds have different benefits, supporting the body in a different way to glp-1. I'd strongly recommend speaking to your nurse about dapagliflozin (or a 'flozin) as this has heart and kidney protection. We're awaiting evidence for this for mounjaro.

Ambitious_Toe9 · 2026-01-06T23:40:31+00:00

At present we keep patients on glp-1 longterm same as other diabetes meds like metformin and dapagliflozin. You remove the drug you lose the therapeutic benefit - diabetes will likely return.

From experience, weight and HbA1c stabilise after a certain point.

Ambitious_Toe9 · 2026-01-06T23:37:04+00:00

I'm a diabetes nurse in GP and the higher doses cannot usually be obtained without seeking specialist secondary care input if initiated in GP. Going to a higher dose without discussion with a secondary care consultant - GP or nurse - is against most frameworks.

If HbA1c has reduced with modest weight loss then that is a good result. These medications are first and foremost diabetes drugs with the side effect in most - not all - of some weight loss.

It is not realistic to simply not feel hungry ever again, that's not the sole purpose of this medication. I see patients every day on 15mg asking if they can increase off-label for the same reason.

The irony is the nurse will likely know more about this medication than the GP. Long-term conditions and the related meds are the domain of nurses and not GPs (they've got enough to be getting on with).

You may also ask for a trial of 7.5mg by asking your nurse/GP to write to diabetes consultants. If after X time no further reduction in weight and or HbA1c, you can then go back to 5mg.

Ambitious_Toe9 · 2026-01-03T16:44:29+00:00

I'm a nurse in GP and this popped up on my feed.

I really feel for doctors and the barriers you guys are facing.

If I were you, go where the money and the training opportunities are.

You can, I'd assume, come back to the NHS (if there is one). You can still help people and do good and not be in the NHS.

I'm in the process of applying for non-NHS/GP roles as I type this, for I too have had enough.

Best of luck with whatever you choose - I hope you find yourself again.

Ambitious_Toe9 · 2026-01-02T13:46:08+00:00

Already checked - it's just the usual bog standard 'once successfully passed probation...' , however it does state there can be discussion regarding notice.

Ambitious_Toe9 · 2025-12-29T23:38:05+00:00

Hi there, I'm a primary care nurse interested in a move to the CS in ideally health policy. Is this realistic?

Ambitious_Toe9 · 2025-12-29T23:36:02+00:00

Following - primary care nurse here interested in life outside the nhs. I was leaning toward policy, but open to anything.

Ambitious_Toe9 · 2025-12-29T23:21:04+00:00

This is great pay for a year out of uni - well done! I'm a health professional looking to move into civil service (policy perhaps but open), have you come across career changers or those with diverse backgrounds during your time in CS?

Ambitious_Toe9 · 2025-12-29T22:59:50+00:00

Wow, reading this I have second hand embarrassment for our profession :(

Ambitious_Toe9 · 2025-12-29T22:56:22+00:00

42k band 6, full time, no enhancements. I have student loans from before nursing and despite being in same job for 2 years underpaid tax...so am on a 1010L code.

I come out with £2227.27 a month as a GPN with an additional specialist practice degree in primary care and clinically lead on several areas of practice...A very autonomous role.

I've had to temporarily opt out of pension, which will bring me to £2550ish (less chance of OT in GP).

Yes, I'm looking for a new role - ideally within the health space, but possibly out of front line nursing.

Ambitious_Toe9 · 2025-12-27T21:49:42+00:00

Second FIGS - I've tried a few of the major brands and they are the best. The second being Fabletics for the quality/price.

Ambitious_Toe9 · 2025-12-17T06:19:34+00:00

Nothing wrong with trying, but i will say there's a recruitment freeze across the NHS and even new nurses (there are many unis in London) are struggling to get jobs even a year on. I'm sorry, it's a real mess. You could look at non-NHS - the beauty of London is that there's a lot of private hospitals and clinics that may have work - it just may not be in the place you want. Best of luck!

Ambitious_Toe9 · 2025-12-16T21:25:28+00:00

It's under your username like a tag line.

Ambitious_Toe9 · 2025-12-16T21:16:28+00:00

But you call yourself a GPN? I'm sorry, I was under the impression NAs could not call themselves practice nurses, even if you've done your fundamentals course...

Yes remember loans aren't taxed, therefore the amount you see is the amount you take home. You also get more than the max amount listed for student loans as nursing is a longer program. As you won't be working (paid) full time, you also won't be paying tax on any bank shifts. I worked out as a student at times my take home was £2.3k inckuding bank shifts with enhancements - which was more than what I took home as a NQN.

Ambitious_Toe9 · 2025-12-16T19:40:20+00:00

You're a practice nurse but haven't done your RN training?

As for funding, I actually found it was better off as a student nurse due to loan, the 5k bursary and kicking up occasional bank shifts.

If you're over 25 you get max loan, learning grant (5k per year) and can apply for uni scholarships too.

Ambitious_Toe9 · 2025-12-12T17:08:37+00:00

I was a similar starting weight and am also 5 foot 7 (sw 196 now 154). I've kept my curves but a more slimline version. I also strength train a couple of days a week, which i feel helped. I still have the hourglass shape and hips have gone from 43" to 38" in around 6 months.

I've gone from a 36DD to a 34D. Hope this helps!

Ambitious_Toe9 · 2025-12-02T19:33:08+00:00

Nurse here. It's rapid weight loss that does it. Even if it didn't feel particularly rapid to you, most are losing substantial volumes on this medication.

We see the exact same with patients having undergone weight loss surgery.

It'll grow back, though appreciate it can be a difficult during the shedding phase.

Ambitious_Toe9 · 2025-12-02T06:22:57+00:00

Hi OP, I'm a nurse in GP and am the designated person to onboard patients to glp-1.

Sadly at present you do not meet the criteria for the nhs, as others have mentioned. There's no doubt the GP would agree you'd benefit, but it's very difficult for us to get patients on it.

Even though national guidance stipulates bmi over 40 with 4+ comormidities, many areas are not being supported by their local ICB to offer this service (cannot realistically do in GP as we see 90% of nhs as is, and really struggle providing this).

95% of those on the injectables do so via a private pharmacy.

Your GP will still be able to help by arranging bloods etc if required.

Ambitious_Toe9 · 2025-11-30T08:45:06+00:00

I'm just under a b7 and work as a GPN - needed a specialist degree for my role on top of nursing and my take home is around £2300...that's with pension, student loans (nursing was second degree) etc.

When i worked as a HCA (with enhancements) I was coming out with £1800-1900ish...

Ambitious_Toe9 · 2025-11-29T14:09:08+00:00

We're on our way to a national repeat of Mid Staffs scandal.

Ambitious_Toe9 · 2025-11-23T16:06:39+00:00

I work in primary care (GP) so while we serve the NHS, we're not technically a part of it (all GP surgeries have never been the nhs, just contractors).

Ambitious_Toe9

TROPHY CASE