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It may feel like it stops working, but this is usually a metabolic plateau caused by the body adapting to treatment

Diabetes Care 34 , 15171518 (2011)

Keep a low threshold for adjusting medication or adding psychiatric support

Clinical studies most often report mild side effects, including nausea, vomiting, diarrhea, heartburn, gas, headache, and general digestive discomfort.27 A 2021 safety review of high-dose NAC in chronic respiratory diseases found that oral doses between 600mg and 3,000mg daily were generally well tolerated, with gastrointestinal symptoms reported but not consistently more often than placebo.35 That doesnt mean NAC is risk-free

Link(Nature) Semaglutide and cardiovascular outcomes by baseline HbA1c