Paula, a 68-year-old retiree, was diagnosed with type 2 diabetes 10 years ago. She was initially managed with metformin but required the addition of insulin six years ago. She has a history of asthma, anxiety, gastro-oesophageal reflux disease, laparoscopic fundoplication and dyslipidaemia. She has no known micro- or macrovascular complications of diabetes and attends regular follow-up as recommended. Paula lives at home with her husband, and they share the household chores.

Her current diabetes management includes insulin isophane/insulin neutral 30/70 40 units mane and 28 units nocte and semaglutide 0.5mg via subcutaneous injection weekly.  

Since commencing semaglutide six months ago, Paula has noticed a significant improvement in glycaemic control. Her current fasting blood glucose levels range between 5.4mmol/L and 13.7mmol/L, and her HbA1c has decreased from 8.3% to 6.5%. Her total cholesterol and triglyceride levels have also improved, dropping from 7.4mmol/L to 6.8mmol/L and 3.8mmol/L to 1.7mmol/L respectively.

However, her appetite has been significantly impacted, and she is struggling to eat. She is referred to a dietitian for nutrition assessment.