WASHINGTON - For more than a month, Mr Shane Anthony, a 57-year-old car mechanic, has not been able to get his diabetes medication.

Ozempic, an injection that keeps blood sugar levels in check for patients with type 2 diabetes, has been in short supply for about four months, according to the database maintained by the US Food and Drug Administration.

Without the Novo Nordisk-made prescription drug, Mr Anthony has suffered recurring dizzy spells while repairing cars. Alternative medications are either out of stock or not covered by his insurance.

While increased demand and supply chain delays have left multiple medicines from the antibiotic amoxicillin to Adderall, which is used to treat attention deficit hyperactivity disorder, in short supply, the reason for a lack of certain diabetes drugs is unusual: Doctors are prescribing them to non-diabetics who want to use them for weight loss.

“All these famous people, stars who don’t need to lose weight, are going and getting it,” Mr Anthony said. “I need it to stay healthy and not die.”

For the more than 35 million people who live with type 2 diabetes, the shortages have added yet another layer to managing an already complicated and costly chronic illness.

They have also exposed weaknesses in America’s use of off-label prescribing, which allows doctors to hand out drugs to treat a different condition than the one for which they were officially approved.

When those medications are hard to find because of celebrity and social-media hype, patients with diabetes suffer.

Ozempic, known generically as semaglutide, is one of a class of diabetes drugs known as GLP-1 receptor agonists which have been around for nearly two decades. It was first approved in the United States in 2017 for use in those with type 2 diabetes.

Ozempic mimics a hormone involved in appetite and eating, helping to stimulate insulin production and lower patients’ blood glucose levels. It also often leads to them shedding pounds.

Dr Francisco Prieto, a family doctor in Sacramento, California, sees at least one person with diabetes per week who is having trouble filling their prescription for Ozempic. Patients will call multiple pharmacies and drive around town to see if it is in stock, but some still have not been able to get it, said Dr Prieto, who also does advocacy work for the American Diabetes Association.

Recently, one of his patients experienced a three week-long delay filling a prescription for Trulicity, a similar type 2 diabetes drug that is also seeing increased demand for weight-loss use.

Without their medication, patients with diabetes could be at higher risk for things such as heart disease, heart attacks, infections like Covid-19, disability and even death, Dr Prieto said. And while getting a different prescription can be an option, it can come with new hurdles, including insurance coverage and closer monitoring in case the alternative does not work as well.

A representative for Ozempic manufacturer Novo Nordisk said the issues are expected to continue through January. The company cited “incredible demand” and short-term capacity limitations at some factories, and said that it is investing to grow manufacturing.

Though off-label prescribing is common and legal in the US, it has long created issues. In the early months of the Covid-19 pandemic, for example, people took an unproven medication called hydroxychloroquine, which they believed helped with the virus. That created shortages for patients who take it for lupus and arthritis.

Ozempic is a good candidate for off-label use for obesity, which is also considered a disease and can put people at higher risk for other conditions – official ads for the drug say patients lose on average up to 5kg when taking it. It is just not clear that everyone using the drug has a medical need for it.

On TikTok, some videos featuring the hashtag Ozempic have been viewed more than a million times. Medical spas offer the prescription alongside shots of Botox and laser hair removal. Sponsored ads on Google promise weight loss with no exercise or dieting. A plastic surgeon brags on Facebook about using the drug to lose 4.5kg she gained during Covid-19, and says to call her office to get started.

The FDA does not regulate this kind of prescribing. That means many decisions about what to do are up to individuals.

“Which disease is most acute and most severe? Which has alternatives? How adequate are those alternatives?” said Dr Holly Fernandez Lynch, an assistant professor of medical ethics and law at the University of Pennsylvania. “These are the kinds of questions that would help you figure out which patients should have priority access.”

She said a judgment would depend on the individual case, but those who just want to lose a few pounds should not take a scarce resource that someone else needs. BLOOMBERG