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Contact your GP or diabetes specialist nurse if you experience: Severe or worsening abdominal pain that is persistent, sharp, or different in character from typical bloating discomfort Persistent vomiting or inability to keep down food and fluids, which may indicate gastroparesis (severe delayed gastric emptying) or bowel obstruction Signs of dehydration including dark urine, dizziness, reduced urination, or extreme thirst Unintentional weight loss beyond your treatment goals, or inability to maintain adequate nutrition Blood in vomit or stools , which could indicate gastrointestinal bleeding Severe constipation lasting more than a few days despite usual remedies Symptoms that significantly impair your quality of life or prevent you from carrying out normal daily activities Sudden or persistent right upper abdominal pain (may radiate to the shoulder/back), fever, jaundice, pale stools, or dark urine, which could indicate gallbladder disease Seek urgent medical attention (A&E or call 999) if you develop: Sudden, severe abdominal pain with a rigid, board-like abdomen Persistent vomiting with inability to keep down any fluids Signs of pancreatitis: severe upper abdominal pain radiating to the back, often with nausea and vomiting Symptoms of bowel obstruction: absolute constipation (no passage of stool or gas), severe cramping, and progressive abdominal distension For urgent but non-life-threatening concerns, contact NHS 111 for advice

Eligible patients may discuss physician-supervised tirzepatide, semaglutide, nutrition planning, gradual dose adjustments, side-effect management, and regular follow-up care

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Treatment may include semaglutide or tirzepatide depending on what is appropriate for you