Oral GLP-1 Semaglutide
My name is Dr. William Conway, a Nashville physician devoted to restoring the human side of medicine.
Concierge care, to me, is a relationship built on trust. It means you have a doctor who listens before speaking, who knows your story, and who answers when you call.
Through Suboxone+Primary Care™ and Nashville Concierge Medicine, I bring together internal medicine and addiction care — attentive, discreet, and grounded in years of experience.
I study medicine with devotion, and I practice it with compassion. My goal is simple: to help you heal, grow, and stay well — for years to come.
Semaglutide is highly studied and effective, though it can be costly. Previously administered by injection alone, Semaglutide is now available orally, as a daily pill, offering my patients a simpler option.
In my experience, many of my Nashville patients are curious, but hesitant when new treatments appear. They have questions. Does it work? How expensive is it? Should I begin? This article reviews what I tell my own patients when we consider Rybelsus, the oral form of semaglutide.
Why Rybelsus
Oral Semaglutide is convenient
Semaglutide is an extremely popular treatment for diabetes and weight management. It is commonly given by injection on a weekly basis. It can be taken daily by pill. Rybelsus is the brand name.
Convenience does matter for my patients in Nashville at my private medicine practice at Nashville Concierge Medicines. Many of my patients have not taken insulin because of their fear of needles. This fear of needles can extend to semaglutide. Having a daily pill provides these patients with a method of taking semaglutide orally.
Convenience does matter. Fear does matter. Patients lead busy complicated lives. Getting into a routine within all the daily demands can be challenging. Rybelsus is a convenient addition to your daily medication regimen. I spend much time everyday coaching patients on how to take their pills. I explore their habits. Do they use moisturizer on the skin in the morning or night? Could they add the daily medication to their moisturizer? In diabetes, taking your daily medication when you feel well is everything. I, Dr Conway, focus upon detailed discussions to make the daily taking of your medication as a habit
Oral Semaglutide enhances the control of blood sugar.
Oral semaglutide helps with the control of blood sugar. It has an effectiveness in lowering average blood sugar which is comparable to most of the oral agents. ’ Rybelsus could be a substitute for one of your other oral agents used to glycemic (blood sugar) control. Insulin is the standard of care once blood sugar levels reach a certain threshold. Please note that no oral agent is as effective in lowering blood sugar as insulin. When your HgAIC reaches a certain level, insulin remains my choice for patients with diabetes in my practice of internal medicine, Nashville Concierge Medicines.
The treatment of diabetes has become very complicated, with multiple choices. Each choice has its benefits and disadvantages. Each choice has its cost in terms of time and money. The actual disease is extremely variable in an individual. Some patients go an entire lifetime with no complications. Other patients rapidly move to blindness, amputations, or foot pain from neuropathy. Moreover, each patient has a story. Each patient has preferences. I spent significant time deciding what your reasonable choices are, explaining those choices, and understanding your preferences.
Semaglutide is a pharmacological substitute for natural diabetes hormone. This hormone makes the stomach work better: reduces appetite: smooths out insulin secretion. It is not surprising that semaglutide contributes to control of blood sugar. It is not surprising that semaglutide reduces appetite. What is surprising is the reduction of risk of heart attacks, and the reduction of progression of kidney disease. Research supports a reduction in major cardiovascular events in adults with type 2 diabetes. These effect make semaglutide, either oral or injected, a very valuable medicine for my patients.
Oral semaglutide produces weight loss
A recent article in the New England Journal of Medicine confirmed that oral semaglutide produces weight loss. The extent of weight gain is highly variable, as I have discussed in prior blogs on GlP1-1 agonists. However, the average weight loss of almost 14 percent is significant. Oral semaglutide works well for weight loss.
Patients who begin Rybelsus for diabetes usually experience a reduction in their appetite soon, day by day. My patients eat less. Their cravings for food are reduced. They feel better. I , Dr Conway, have my patients improve with semaglutide.
Oral Semaglutide protects the heart
A recent article in the New England Journal confirms that oral semaglutide has been shown in clinical studies to reduce the risk of major cardiovascular events , reducing the frequency of serious adverse cardiovascular events in patients with type 2 diabetes.[i]
Most patients do not realize that diabetes is a disease of small and large blood vessels. Large vessel complications of diabetes include strokes, heart attacks, and leg disease. Small blood vessel disease of diabetes includes eye, kidney, and nerves of the feet. Progression of small blood vessel disease can lead to blindness, kidney failure, or neuropathy of the feet.
The benefits of semaglutide on protection of the heart are significant. It is a major benefit which is not found in all medications designed for blood sugar control.
Because diabetes is heart disease, protection of the heart is important. In the past, patients with diabetes often died of a heart attack. Reducing the occurrence of a heart attack maintains vitality. A heart attack may produce a decline in energy and function. Rybelsus is important for its reduction of the risk of heart attack.
Nausea from Oral Semaglutide
Nausea, vomiting, and GI distress are also a side effect of oral semaglutide. I advise my patients on methods to reduce the discomfort for oral semaglutide.
These side effects usually occur early. Over time, they usually disappear, but not always. To avoid nausea, I start the patient at the lowest dose and advance the dose very slowly. This is a marathon, not a sprint. We are not in a “biggest looser” contest. Our objective is first to avoid further weight gain, and next to gradually lose weight.
Other possible side effects may include diarrhea and abdominal pain. Uncommon but serious side effects can include pancreatitis or gallbladder disease.
Conclusion
It is exciting to have additional choices for this wonderful drug, semaglutide. In my practice at Nashville Concierge Medicines, I will offer Rybelsus to patients with diabetes as an option to injectable semaglutide. Telemedicine is available to Tennessee residents when clinically appropriate.
Rybelsus is worthy of your consideration.
Call for an appointment for Dr. Conway at Nashville Concierge Medicines.
If what you’ve read here resonates with you — if you’re ready for care that feels personal, private, and enduring — I, Dr. Conway would be honored to be your physician.
At Nashville Concierge Medicines, every visit is unhurried, and every patient is remembered. I listen carefully, respond thoughtfully, and stay available between visits — whether in the office or by secure telemedicine.
You deserve care that is intelligent, kind, and consistent.
Let’s begin.
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[i] Oral Semaglutide and Cardiovascular Outcomes in High-Risk Type 2 Diabetes
D.K. McGuire and OthersN Engl J Med 2025;392:2001-2012
advice. This blog is for education alone.
