Ozempic supply will continue to be limited until the end of 2025, according to the latest advice from Novo Nordisk, Ozempic’s supplier.

The Therapeutic Goods Administration (TGA) said Novo Nordisk has advised that it is continuing to increase manufacturing capacity, but it would take time to build supply levels to meet global and Australian demand.

The TGA said the semaglutide product is approved for the management of type 2 diabetes not adequately managed by other medications, in conjunction with diet and exercise. A separate semaglutide product, Wegovy, is approved to help with chronic weight management.

Diabetes Australia understands the significant concerns of Australians living with type 2 diabetes about the ongoing Ozempic shortage and will continue to advocate for prioritised access for people living with diabetes.

Diabetes Australia has advocated for the TGA to investigate the shortages of a number of diabetes-related medicines and products in recent years and redouble efforts to ensure Australians can be confident that supply chains are sufficient to meet their needs.

The TGA has asked health professionals to:

• consider the ongoing shortage when prescribing Ozempic, inform patients that supply is expected to be limited in 2025, and discuss alternative treatments when patients are unable to access the medicine.
• prescribe and supply both Ozempic and Wegovy according to their approved indications.

Information about the Ozempic shortage is available from the TGA website.

Novo Nordisk has advised that it will discontinue the Protaphane InnoLet human insulin (rys) 100 IU/mL injection multidose cartridge on February 1, 2025. The device is used particularly among the elderly because it’s easy to use and women with gestational diabetes mellitus.

Novo Nordisk is advising people to substitute Protaphane Penfill human insulin 100 IU/mL (ARTG 169635) or Humulin NPH biosynthetic human isophane insulin 100 IU/mL injection multidose cartridge (ARTG 39662).

Between now and February 1, the Therapeutic Goods Administration is advising pharmacists to use a Serious Scarcity Substitution Instrument (SSSI) to dispense the Protaphane Penfill human insulin (rys) 100 IU/mL injection multidose cartridge without the need for a new prescription. These penfills will need a new insulin delivery device and those using it will need to know how to insert cartridges and use the new pen safely and accurately.

People living with diabetes who will be affected by the discontinuation are advised to ask their health professionals about changing over to the suggested replacements as soon as possible.

Diabetes Australia has raised concerns about the discontinuation, including access to the replacement device.

While information for pharmacists and healthcare professionals has now been released about the replacement, not all prescribers and pharmacists will see this information in a timely manner. Concerns have also been raised about the cost of the extra time or appointments that people living with diabetes may need with their GPs, educators or endocrinologists to obtain new scripts or device instructions.

Diabetes Australia is seeking assurances that there will be enough replacement devices available when required; that there will be no cost to people living with diabetes; and that the substitute devices will be available across Australia including in regional, rural, and Aboriginal and Torres Strait Islander communities.

Diabetes Australia will continue its advocacy on behalf of the estimated 30,000 people using Innolet and update the community as information becomes available.

Further information is available from the Therapeutic Goods Administration website.

Diabetes Australia thanks the Albanese Government for its decision to expand the Pharmaceutical Benefits Scheme (PBS) listings for Forxiga® and Xigduo®, making vital medicines more affordable and accessible for Australians living with type 2 diabetes. 

This initiative is set to benefit more than 100,000 people annually, reducing financial barriers and improving health outcomes. 

Type 2 diabetes affects more than 1.3 million Australians, with significant complications, costs, and daily impacts.  

Heart disease, the leading cause of death among people with diabetes, is closely linked to type 2 diabetes. The expanded PBS listing announced this week enables earlier access to these medicines for individuals at high risk of heart disease or those already living with it. Patients no longer need to wait for their blood glucose levels to rise to 7 percent before accessing these life-changing treatments. 

Forxiga and Xigduo reduce the risks associated with cardiovascular complications in diabetes. Without PBS subsidies, patients could face costs exceeding $600 annually for these treatments. Now, eligible individuals will pay a maximum of $31.60 per prescription or $7.70 with a concession card. 

This decision will contribute to timely access to medications that can help manage diabetes and prevent severe complications such as heart attacks, strokes, and organ damage.  

With Australia in the midst of a diabetes epidemic, removing barriers to treatment is a vital step toward easing the burden on individuals and the healthcare system. 

The TGA has listed a potential for insulin leakage with the Accu-Chek Spirit 3.15 ml cartridge system due to a manufacturing problem.

The leakage can occur at the luer connection, where the cartridge connects to an infusion set and insulin leakage might not be immediately detectable when using the Accu-Chek Spirit 3.15 ml cartridge system.

This could lead to an under-delivery of insulin.

Affected product

Product Description	Product REF Number	Product Device Identifier (UDI / GTIN)	Product Date of Manufacture
Accu-Chek Spirit 3.15 ml cartridge system 25 pcs	05206073001	04015630882908	Manufactured between 2024-03-01 and 2024-10-31

What are the risks?

This problem, should it occur, could lead to an under-delivery of insulin. The potential consequences could range from no clinical impact to adverse health events, including severe hyperglycaemia or diabetic ketoacidosis (DKA).

What can you do?

Check your Accu-Chek Spirit 3.15 ml cartridge supply to see if it was manufactured during the affected manufacture date range.

If it is in this date range discontinue using Accu-Chek Spirit 3.15 ml cartridge systems and consult with your doctor or healthcare team as soon as possible to switch to an alternative therapy method, e.g. multiple daily injections (MDI), until Accu-Chek Spirit 3.15 ml cartridge systems are available again.

More information

You can visit the TGA website for more information for both people living with diabetes and health professionals. Consumers and health professionals are also encouraged to report problems with medical devices.

Recall: Accu-Chek Spirit 3.15 ml cartridge system – Therapeutic Goods Administration (TGA)

Diabetes is a condition that affects some 1.5 million Australians. One of the most important aspects of diabetes is keeping your glucose levels in your target range to keep your body healthy. Some people with type 2 diabetes or gestational diabetes can manage this through diet and exercise alone. However, many people need medications to help manage blood glucose levels, and people with type 1 diabetes need insulin because their bodies do not make any. This article explains the different types of medications available and why it is important to take them as prescribed. 

Types of medications 

There are several different types of diabetes medications, including tablets, insulin, and other injectable medications that are not insulin. 

Oral medications 

These are tablets commonly used for type 2 diabetes. They are grouped in different classes, listed below, according to how they work in your body. They work in different ways to lower glucose levels and have different benefits and side effects. 

Biguanides (for example, Metformin)

Lower your glucose by: 

• Blocking the release of glucose from the liver. 

• Slowing the release of glucose from carbohydrate foods from the gut. 

• Helping your insulin to work better. 

Sulphonylureas (for example, Diamicron)

Helps the pancreas to release more insulin. 

DPP-4 inhibitors (for example, Januvia)

Work by: 

• Stimulating the release of insulin from the pancreas. 

• Blocking the release of glucose from the liver. 

SGLT2 inhibitors (for example, Jardiance)

Allows more glucose to escape via the urine. 

Thiazolidinediones (for example, Actos)

Work by: 

• Decreasing glucose release from the liver.  

• Helping your insulin to work better. 

Insulin 

Insulin is a hormone that helps lower blood glucose. People with type 1 diabetes need insulin because their bodies do not make any insulin. Many people with type 2 diabetes also need insulin if other medications do not control their blood glucose. There are different types of insulin: 

Type of insulin	Starts to work	How long it works
Rapid acting	Less than 15 minutes	3-4 hours
Short acting	30-60 minutes	6-8 hours
Intermediate acting	2-4 hours	12-24 hours
Long acting	1-2 hours	24 hours or longer
Pre-mixed (mix of rapid and long acting)	Less than 15 minutes	24 hours or longer

Injectable medications that are not insulin 

GLP-1 agonists (for example, Ozempic)

Work by: 

• Blocking the release of glucose from the liver. 

• Slowing glucose release from the gut and helping you feel full. 

• Stimulating the release of insulin from your pancreas. 

GLP-1/GIP agonists (for example, Mounjaro)

Work by targeting two hormones in the gut, GLP-1 and GIP. 

• GLP-1 helps to lower blood glucose and helps you to feel full. 

• GIP stimulates the release of insulin from the pancreas. 

Each type of medication has its own benefits and side effects. Your doctor chooses them based on your health status and treatment goals. 

Take your medications as prescribed 

It is very important to take your diabetes medications as your doctor prescribes. Missing doses, not taking them regularly, or changing doses without telling your doctor can make your blood glucose harder to manage. This may lead to serious diabetes-related problems including heart disease, kidney damage, nerve damage, and vision problems. When you take your medications as prescribed you will get the best results and improve your quality of life in the short and long term.  

Diabetes can get harder to manage over time, so treatment plans may need to change. Keep having regular check-ups with your doctor to ensure your treatment is working well, and allow for changes if needed. 

As well as taking medications, it’s important to: 

• Eat a healthy diet 

• Exercise regularly 

• Check your blood glucose if required 

• Avoid smoking 

Further information 

If you would like some help with making lifestyle changes, ask your doctor to refer you to a diabetes educator, dietitian or exercise physiologist through a Chronic Disease Management Plan. These visits are subsidised, in part, by Medicare. 

The NDSS also offers the MedSmart and Living with Insulin programs that will help you further understand your medications. You can attend either a face to face session or online. To find these programs and more near you, visit events.ndss.com.au 

Should you have any questions about diabetes, call the NDSS Helpline on 1800 637 700, and ask to speak with a diabetes educator, dietitian or exercise physiologist. he NDSS Helpline on 1800 637 700, and ask to speak with a Diabetes Educator, Dietitian or Exercise Physiologist.

By Vania Khoury Credentialled Diabetes Educator and Registered Nurse

When you were diagnosed with type 2 diabetes, you possibly started not only glucose-lowering medication but blood pressure and cholesterol medication. These medications are necessary to reduce your risk of the impacts of diabetes. It is common for a person living with diabetes to be taking five or more medications.

Here are some tips to help you save some money.

Tip 1: Make every prescription count towards your safety net.

The Pharmaceutical Benefits Scheme (PBS) safety net scheme is similar to your Medicare safety net scheme. Most of the cost of your prescriptions can be added under the safety net in a calendar year to give you a discounted or free number of prescriptions until the end of the year if you have reached the threshold. The scheme financially protects people and families requiring many PBS prescription items. For the scheme, the family includes the person:

• their partner or de facto partner
• children under the age of 16 who are in the care and control of the person
• dependent full-time students under the age of 25.

The thresholds to receive discounted/free prescriptions at the time of this article are:

• $277.20 for anyone receiving a concessional amount. This equates to 36 prescriptions at $7.70 or 43 prescriptions if you are paying $6.70
• $1,647.90 for all other non-concessional clients. The highest price you will pay for a medication that PBS covers is $31.60. ⁽¹⁾

What you need to know is:

• Not all prescriptions will be charged at the highest amount; therefore, only the amount charged will be recorded. Your price may be slightly higher than what is recorded on your safety net.
• PBS prescriptions can be obtained from almost any pharmacy and hospital. There is no electronic link between pharmacies to collect your safety net records. You may regularly go to the same pharmacy; however, if you have a hospital stay or go on holiday, collect your safety net records when you collect your prescriptions and let your regular pharmacy know. External records can be included in your pharmacy’s tally, and you will get to your safety net sooner.
• Private prescriptions do not count towards this safety net.

Tip 2: Take the generic options

Generic doesn’t relate to the quality of the medication. Medications with the same ingredient at the same dose that release the active ingredient in the same manner as the original brand are called generic options. The companies that produce generic options must release safety and efficacy information to an Australian regulatory department, the Therapeutic Goods Administration (TGA). The TGA is responsible for ensuring the safety of food, medications and medical devices in Australia. You can save with generic options for over-the-counter medicines such as paracetamol, for example, Panadol vs Panamax. ⁽²⁾

The generic options are usually less expensive than the original brand. Here is an example:

• Diabex extended release 1000mg costs you $28.00 (concession $13.04). Diaformin XR 1000mg costs you $17.76 (concession $7.70). Alphapharm supplies both of these brands; they have the same action, strength of active ingredients and quantity of tablets. Both have the same amount recorded towards your safety net.

Note, you may not wish to take the generic option if:

• You are allergic or intolerant to any of the filler ingredients that are commonly found in medications
• You are taking a medication that must be tightly controlled – ask your doctor about this
• You get confused about active ingredients or generics
• You want to support the company that provided the research and development of your original medication brand.

Tip 3: 60-day dispensing

On 4 March 2024 the Australian Government announced it was adding an additional 94 medicines to the list of medicines available on 60-days supply for the cost of a single script. Among those were Forxiga and Metformin. Some blood pressure and cholesterol-lowering medications can also be prescribed as a 60-day supply. The savings are that you pay once every two months rather than every month for it to be supplied. Your GP can prescribe up to one year’s worth of medication.

As of 1 September 2024 the following medication to lower your blood glucose levels are available as a 60-day supply.

Medication	Actions
Acarbose	Slow the breakdown of carbohydrates in the gut.
Alogliptin, Linagliptin, Saxagliptin, Sitagliptin, Vildagliptin.	Increases the natural incretin hormone levels. This lowers blood glucose levels after food.
Dapagliflozin, Empagliflozin	Releases excess glucose into your urine.
Metformin	Helps your body’s insulin work efficiently
Gliclazide, Glimepiride, Glimepiride, Glipizide	Pushes more insulin out of your pancreas
Pioglitazone	Helps your body’s insulin to work efficiently

For example, one month’s supply of Empagliflozin 10mg will cost you $31.60, as will two months’ supply.

Yearly cost of Empagliflozin 10mg daily 12 x 30-day supply = $379.20. Concs $92.40

Yearly cost of Empagliflozin 10mg with 6 x 60-day supply = $189.60. Concs $46.20.

With a 60-day supply you will take longer to reach a safety net total. You often pay less now and more later in the year. Ensure you are still getting the same quantity of care if you choose 60-day dispensing.

Tip 4: Shop around

If your regular pharmacy is a lot more expensive, you could ask to match the price of other pharmacies, or meet in the middle with the cost. You are allowing your pharmacy to retain you as a loyal client.

If you are in a location where there are no competitive pharmacies, you could opt to have your medications posted to you. You will have to factor in postage costs; however, if your doctor allows you to receive multiple supplies and your medications are suitable, postal mail order is an option. Medications that cannot be supplied in this manner include any drugs of dependence and refrigerated items.

If you live rurally, think about getting your medications when you go to the nearest larger town to shop.

By Donna Itzstein, Pharmacist and Credentialled Diabetes Educator

References

1. Australian Government, Department of Health and Aged Care. About the PBS. The Pharmaceutical Benefits Scheme. [Online] July 1st, 2024. [Cited: September 12th 2024]
https://www.pbs.gov.au/info/healthpro/explanatory-notes/front/fee

2. OTC generic and originator brands. Therapeutic Goods Administration. [Online] August 31st, 2020. [Cited: February 12th 2024] https://www.tga.gov.au/news/news/generic-prescription-medicines-fact-sheet].

This article has been updated from the original which was first published in March 2024

Your respiratory tract is made up of an upper section (mouth, throat, nose, sinuses and vocal cords) and a lower respiratory tract (bronchi or breathing tubes and lungs). Viruses and bacteria may infect both. Upper respiratory tract infections (URTI) can cause a congested or runny nose, sore throat, sinus pain, headache and hoarseness. A lower respiratory tract infection is bronchitis (infection in the bronchi) or pneumonia (an inflammation of your lung tissue caused by an infection).

There is no objective evidence why we get more viral infections in winter, but speculation includes:

• Our internal body temperature falls after exposure to cold air, and so too does the immune system’s ability to resist viruses and bacteria.
• We spend more time indoors and in closer proximity to one another. Closer proximity promotes viral spread through shared air and frequently touched surfaces. You may have noticed that we had fewer respiratory infections during our past COVID-19 isolation times.

A rise in blood glucose levels

When you become infected, your immune system releases hormones such as cortisol which prevent your body’s insulin from working well. Insulin works to use and store glucose and when the insulin is not working well, glucose builds up in your body.

The first you know about an infection starting may be a rise in blood glucose levels. Living with diabetes means your body does not compensate for the build-up of glucose in your body. 

As your blood glucose levels rise, you may notice symptoms such as:

• Tiredness
• Frequent urination and thirst
• Blurred vision
• Dehydration.

Do you have a plan for those days when you don’t feel well? You may need to consider what medications and actions to take during sick days. If you are very unwell, one or more diabetes medications may need to be temporarily stopped. Your doctor and diabetes educator can make you an individualised plan for your sick days.

Read more on sick day planning

Medications for respiratory tract infections

Antibiotics

Getting better with respiratory tract infections is less likely to include antibiotic treatments. Antibiotics will act only on bacterial infections by killing or slowing bacterial growth, allowing your immune system to clean up and mend. If you have a respiratory tract infection, it is often viral and not able to be treated with antibiotics. For a viral infection, antibiotics will not help you get better faster, stop an illness from getting worse, or prevent spreading a virus. 

Using antibiotics when you don’t need them may lead to antibiotic resistance, so your doctor will not prescribe antibiotics at first. Antibiotic resistance may mean that if you have a severe infection in the future, such as bacterial pneumonia, antibiotics may not work as well for you. If you are prescribed antibiotics, follow your doctor’s directions on when, how, and how long to take them. Don’t be tempted to share antibiotics with someone else. Always return any leftover antibiotics to your pharmacy.

Pain and fever medications

• Paracetamol and ibuprofen are common ingredients in cold and flu medicines available without a prescription. If you are already taking pain medication, check you are not doubling up. 
• An important point is paracetamol slow release 665mg is often taken for osteoarthritis at the highest allowable dose. If this applies to you, do not add extra paracetamol in any other preparation. 
• Ibuprofen or aspirin may not be suitable if you have stomach issues, kidney damage, or if using a prescription anti-inflammatory or blood thinner. Check this with your pharmacist.

Decongestants

• Pseudoephedrine and phenylephrine will raise blood glucose levels and increase blood pressure. Our Australian medication supervisor, the Therapeutic Goods Administration (TGA), suggests caution for use in people living with diabetes.
• Nasal sprays work directly on the nasal cells with very little absorbed into your bloodstream – only a small amount of drug is required for a direct local effect. Nasal sprays will have little or no effect on your blood glucose levels. Nasal sprays may contain decongestants such as oxymetazoline and ipratropium, which can be used for three to five days. Ongoing use is not recommended due to rebound congestion. Hayfever symptoms may require steroid sprays for short or long periods. Saline sprays (salt water) are an option for congestion with or without other sprays or oral medications.
• Antihistamines may be helpful in tablet form or as nasal sprays. Some of the sedating antihistamines could be useful at night for their drying effect and hayfever symptoms. Non-sedating antihistamines may be an alternative to using phenylephedrine if you only have hayfever symtoms.

Cough preparations

• Cough syrups, tablets or lozenges may contain ingredients such as guaiphenesin, dextromethorphan, ivy leaf, senega and ammonia. These ingredients will not directly affect your blood glucose levels. Mixtures may contain sugar or honey, natural sugar sources. Consider how much sugar is in a dose, it is often minimal. If you use a sugary mixture or lozenge, please consider brushing your teeth more often. Prolonged exposure to sugar can increase dental carries and gum disease risk. Many of the currently available mixtures and lozenges are sugar-free.
• Herbal preparations in liquid or lozenge formulation may not directly affect your symptoms. They may assist in reducing the duration of illness; however, they often do not have reliable proof to recommend their use. Whether chemical or herbal, all ingredients must be considered drugs. All preparations can have serious interactions with your medications. Please check with your pharmacist that they are suitable for you before use. 

Old fashioned remedies

Old-fashioned remedies are often the best. Consider using chest rubs and inhalations or nasal rinses to clear congestion. Ask your pharmacist for recommendations on how to use these effectively. It would be best to rest and drink plenty of water and non-alcoholic fluids. Avoid smoking and exposure to cigarette smoke.

You can help soothe a sore throat by gargling with warm salty water or sucking on an ice cube or a non-medicated throat lozenge. Hot water with honey and lemon may also help.

Please check what is suitable for you before taking any non-prescription medications, especially if you are pregnant, taking blood thinners or sedating medications, have a heart condition, kidney damage or liver damage. Taking the wrong medication, even when it is from the supermarket aisle, can damage your overall health. 

By Donna Itzstein, Pharmacist and Credentialled Diabetes Educator

A new weight loss medicine, Wegovy, will be available in Australia from early August 2024.

Pharmaceutical company Novo Nordisk made the announcement on 1 August 2024.

Wegovy is not currently subsidised under the Pharmaceutical Benefits Scheme and is only available via private prescription. People may be able to receive a portion of the cost of a private prescription from their private health insurance.

According to the Therapeutic Goods Administration (TGA), Wegovy, which is a brand of semaglutide, is approved specifically for chronic weight management in adults and adolescents “as an adjunct to a reduced-energy diet and increased physical activity when specific criteria are met”.

Semaglutide is the same active ingredient found in Ozempic, a type 2 diabetes treatment.

The TGA has advised that while Wegovy and Ozempic contain the same active ingredient, the approved indications (circumstances for use) are different, as are the dosages.

Anyone interested in learning more about semaglutide products should speak with their health professional.

See the Wegovy Product Information for more information.

What is Wegovy?

Wegovy is a semaglutide injectable prescription medicine.

According to Novo Nordisk it is used with a reduced calorie diet and increased physical activity:

• to reduce the risk of major cardiovascular events in adults with known heart disease and with either obesity or overweight.
• that may help adults and children aged 12 years and older with obesity, or some adults with overweight who also have weight-related medical problems, to help them lose excess body weight and keep the weight off.

From this week, Government rules have been changed to ensure medicines like Ozempic and Trulicity are available for the people who need them most.

These medicines are called glucagon-like peptide 1 receptor agonists or GLP-1 RAs.

When the government began subsidising GLP-1 RAs they could only be available if you were being treated with other diabetes medicines  (like metformin, insulin, etc) and the other medicines weren’t working to reduce your blood glucose, or you had a reaction. However, data shows that people were being prescribed GLP-1 RAs outside of these rules.

In order to deal with this, the rules have been changed to:

• Increase access by only requiring one other medicine to have been tried (e.g. metformin), and
• Require doctors to get phone authorization before they can prescribe GLP-1 RAs to new users.

If you’re already on Ozempic or another GLP-1 RA and it is funded through the government, these new rules shouldn’t affect you. We know that GLP-1 RAs are in short supply, and we don’t think these rules will have an immediate effect on your ability to get access to these medicines.

More information is available from the PBS website.

Diabetes Australia welcomes the Federal Government’s decision to ban replicas of Ozempic and other weight loss medications following safety concerns.

Pharmacies compounding their own versions of these medications have been ordered to stop production from October 1, 2024.

The new regulations will remove glucagon-like peptide-1 receptor agonists (GLP-1RAs), many of which claim to be replicas of Ozempic or Mounjaro, from the pharmacy compounding exemption.

Diabetes Australia understands the significant concerns of Australians living with type 2 diabetes about the ongoing global shortage of Ozempic in particular, and will continue to advocate for prioritised access for people living with diabetes.

However, when it comes to compounded versions, the health and wellbeing of the community must be the most important consideration.

The compounded GLP-1RA products the government has banned have not been evaluated by the TGA for safety, quality and efficacy. When a medicine is compounded, it can have a different strength and different ingredients from similar medicines approved by the TGA.

Diabetes Australia has advocated for the Therapeutic Goods Administration (TGA) to investigate the shortages of a number of diabetes-related medicines and products in recent years and redouble efforts to ensure Australians can be confident that supply chains are sufficient to meet their needs.

More information about the safety of these products can be found on the TGA website.