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These drug supply issues are a great opportunity to have patient management reviews, emphasise principles around healthy lifestyle, and review therapies including prescribing options or even de-prescribing if possible. Alternative treatment options suggested by the RACGP include: Liraglutide, which is administered once daily and has evidence of cardiovascular benefit, but is not subsidised by PBS SGLT-2 inhibitors, especially in those who also have cardiovascular disease, multiple cardiovascular risk factors and/or kidney disease DPP-4 inhibitors, which may be useful in those who do not have cardiovascular disease, multiple cardiovascular risk factors or kidney disease, and are unable to achieve optimal blood glucose levels Sulphonylureas or insulin (initiation or titrated doses), but these may lead to risks for hypoglycaemia and weight gain The twice daily exenatide (Byetta) is not recommended as a potential substitute, as it is being discontinued and will no longer be available once existing stock runs out, which is predicted to occur next month

Normal urine acidic-to-alkaline levels range from 4.5 to 8 pH

Efficacy and safety of once-weekly semaglutide 1.0 mg vs once-daily liraglutide 1.2 mg as add-on to 1-3 oral antidiabetic drugs in subjects with type 2 diabetes (SUSTAIN 10)

Doses greatly exceeding the nutritional requirements (for example, hundreds of milligrams daily) have not been studied in randomized trials for safety, so one should avoid mega doses in pregnancy unless treating a specific condition (such as pyridoxine-responsive seizures) under careful supervision

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