Ozempic: Sugar Coated Success or the Best of Its Kind?

By Candis Morello and Parisa Karimian

In December 2017, Ozempic (semaglutide) received U.S. Food and Drug Administration (FDA) approval for the treatment of adults with type 2 diabetes (T2D).

Combined with eating healthy meals and regular activity, Ozempic may be used alone or with other diabetes medications. Ozempic is the 4th once-weekly glucagon like peptide-1 receptor agonist (GLP-1 RA) medication to enter the market after Bydureon (exenatide extended release), Trulicity (dulaglutide), and Tanzeum (albiglutide). Ozempic is expected to be launched in the U.S. by the spring, shortly before Tanzeum’s discontinuation from the market due to issues with sales. Ozempic sets itself apart from other once-weekly GLP-1 RAs by demonstrating the quickest and greatest effect in reducing blood glucose and body weight in studies. In addition, a pill version of Ozempic is now under evaluation in clinical trials.

How Does Ozempic Work?

Similar to the other once-weekly products, Ozempic is a GLP-1 RA. Even though it is synthetic, it acts similarly to the hormone GLP-1 naturally produced by the body that is deficient in people with T2D. It promotes the pancreas to release insulin (only when glucose values are elevated), makes people feel fuller faster so they tend to eat less, and reduces the amount of glucose made by the liver. Overall glucose concentrations are better controlled throughout the day and after meals, and most people lose some weight.

How is Ozempic Used?

Ozempic comes in easy-to-use prefilled disposable injector pens of either 0.5mg or 1 mg strengths. Since Ozempic has a long half-life (about seven days), it only needs to be given once per week. Select one day of the week (like Sunday, as an example) and make that your Ozempic day. To help you remember, you can mark your calendar or set a reminder alarm in your phone.

If you miss your day and remember within five days, administer it as soon as possible and set that day of the week as your NEW Ozempic day. If it is less than two days away from your next dose, wait the two days to administer.

Choose an administration site on your stomach (at least two inches away from your belly button), thigh, or upper arm. After uncapping the pen place the pen tip against your skin. Now, you are ready to press the injection button. Keep the button pressed down for 5-10 seconds to ensure complete dose delivery. Each week use a different injection site or rotate within that side. Each pen only contains four doses. Once empty, dispose the pen in a sharps container. New pens should be stored in a refrigerator, away from light in the original box.

 What Can You Expect?

Ozempic improves both fasting and post-prandial (after meal) blood glucose concentrations; however, based on its long-acting formulation, it has a stronger effect on fasting plasma glucose. You can expect your A1c to reduce by about 1.2- 1.8%, depending on the weekly dosage used. Ozempic, like other GLP-1 RAs, is associated with low risk of low blood glucose (hypoglycemia). One benefit of Ozempic is weight loss up to 13 lbs, which is considerably greater than reports from other GLP-1 RAs on the market.

Additionally, data from the clinical studies suggest that Ozempic reduces risk of cardiovascular problems including stroke and heart attack. Longer-term trials will confirm these benefits.

Like other GLP-1 RAs, a common side-effect of Ozempic is the slowing down of stomach emptying. In addition, mild to moderate stomach upset and nausea may occur. These symptoms usually go away within a few weeks from starting Ozempic. To reduce the indigestion symptoms, eat smaller food portions throughout the day.

Is Ozempic Right for You?

Before starting Ozempic, you and your provider will want to discuss your medical and family history. Specifically discuss if you have problems with your pancreas or kidneys, have a history of diabetic retinopathy, are pregnant or planning to become pregnant, have any history of severe gastrointestinal (GI) disease, thyroid cancer, or family history of thyroid cancer. Getting an annual dilated eye exam is also recommended. Also, be sure to inform your provider of all prescriptions, over-the-counter, and herbal medications that you are taking, to avoid any interactions.

The Bottom Line:

Compared with other GLP-1 RAs, Ozempic is a strong A1c reducer with the added benefits of moderate weight loss and possible cardiovascular protection. The results of future studies will provide clinicians with more insightful information of which once-weekly GLP-1 RA is best for each individual patient. Consult with your provider to see if adding Ozempic is the next beneficial step to reach your personal glucose goals.


About the Authors:

 Parisa Karimian, 4th Year Student Pharmacist at UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences.

Candis M. Morello, Pharm D, CDE, FCSHP, FASHP, Associate Dean for Student Affairs at UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences, Clinical Pharmacist Specialist at VASDHS.

  1. im interested with this cause im a type2 diabetic. And insulin dependent for 25 years . and i do shots twice a day

    • Glad it’s helpful info for you Yvette, and something to discuss with your doctor if you’re interested.

  2. started 3 weeks ago, the nausea isnt bad for me just like first couple days after injection I have lost so far 6 lbs! I do feel full and each hardly nothing during day… my levels though havent changed its anywhere from 140 to 188 most days I stopped my diabetic medication though it was causing weight gain and horrible edema in my feet/ankles that has since went away! I hope my sugar levels come down and a1c so far good drug! its expensive though you can get card from company to pay less or ask for samples from your doctor to try first

    • Hi Sabrina,
      We’re glad you are having positive results so far and hope it continues to benefit your diabetes management overall. Thank you for sharing – it helps others learn more about the effects of the medication as well!

  3. I am 5 weeks in on starting Ozempic. I do experience slight nausea a day or two after injecting. I don’t have much of an appetite the first few days after injecting. Those are the only side effects I’ve had. I am now on .5 mg after having 4 weeks of .25 mg. My blood sugars range from 130 to 150, versus 230’s before Ozempic. I’m loving this drug!!!

    • That’s great to hear, Linda! We’re glad it’s working for you, and thanks for sharing your experience.

  4. I have been taking Ozempic for several months but am still bothered by stomach pains much like when you know a bout of diarrhea is coming on. What can I do to lessen this? Otherwise, the results are favorable.

    • You should definitely ask your doctor, but he or she may suggest lowering the dose until it’s tolerable, and then slowly trying to go back up.

  5. I have been on Ozempic for 10 weeks. The first 4 weeks I was experiencing fatigue and diarhea and left my job.

    The next 4 weeks, on the .5 dose, I spent mostly in bed with nausea, poor appetite, dizziness, and severe diarrhea up to 4 times per day.

    I lost 12lbs in the first 8 weeks

    I am on week 11. Still have fatigue, nausea and loss of appetite. Some days I can get up and do things and some not. Diarrhea is subsiding. Dizziness and being lightheaded is subsiding as well.

    I have had 3 blood tests showing higher than normal calcium levels and we are monitoring closely due to the potential thyroid issues with this drug.

    My last A1C and fasting glucose levels were 8.1

    I was prescribed this drug because I am a commercial driver and would no longer be permitted to drive commercially if I were taking insulin.

    My GP and Endocronoligist think the dizziness my have been caused by dehydration due to the severe diarrhea.

    Hope this information is helpful to someone else.

    • Hello, just based on the info you provided their is a strong possibility your symptoms are likely not being caused by this drug. If your calcium levels are elevated then it is a high probability that you have what is called “primary Hyperparathyroidism”. Also known as Parathyroid disease. This is different from and unrelated to a more common thyroid disorder. You should have labs done for the following: Calcium, phosphate, creatinine, PTH, Vitamin D. They may also may want to do a 24 hour urinary calcium test but I would strongly advise against it as unless there are others in your family with high calcium levels the urine test only causes confusion to an otherwise easy diagnosis. Also if your Vitamin D comes back low, DO NOT, IF SUGGESTED, TAKE HIGH DOSE VITAMIN D!!! I cant stress this enough! This is a very common error. If the calcium is elevated, even just slightly, Low Vit. D CANNOT be the cause. Taking it if your calcium is high can be dangerous. Lastly, do not allow this to be taken lightly or take the watch and wait approach. Please contact me if you have questions at Patriots.81@outlook.com

    • Gail, please also go to http://www.parathyroid.com and review.
      Your symptoms could be and likely are due to the calcium rather than the drug. I would also suggest finding an experienced Endocrine Surgeon who specializes in Parathyroid Disease.

  6. I have been taking it for the last 3 weeks.
    I have lost my appetite completely, very tired and sleepy throughout the day. Experiencing cramps,shakiness,pulse rate extremely high . Ozempic has been more harmful than beneficial for me,I will not take another dose !

  7. I am on my 4th injection of Ozempic, I am on 0.5. On the lower dose I did much better, the 0.5 dose I have nausea almost every time I eat, even if I eat small amounts. The nausea sometimes ends in emesis and or dry heaves. Diarrhea is frequent but not as bother some as the nausea and vomiting. My appetite has decreased for sure because I don’t want to eat because I feel like I will be sick if I do. I want to do well on this medication, I am just getting tired of feeling sick all of the time. Will it ever go away? Is this why people lose weight on the drug because they are sick all the time? Any suggestions to improve symptoms? Anyone notice if any specific food makes it better or worse.

    • Hi Angie,
      You better have a talk with your doctor. If you go down to .25 and it still happens, it sounds like it may not be the best medication for you. Victoza is a once daily but you can titrate it from super small doses upwards to avoid nausea. A good conversation with your HCP is in order.

  8. I have been taking it for 4 weeks I started the .25 then went to the higher dosage like instructed. My levels still range 160-190.. When is this medication supposed to start lowering levels immediately or does it take time.

  9. I tried Ozempic as part of a drug study and my A1C dropped dramatically. After the study my Dr prescribed me the drug. My insurance does not cover it, and it will be over $700 a month. I am very disappointed.

  10. I had pancreatitis 12 yrs ago due to bile duct blockage. Had stone removed and duct flushed. I dont drink except a little wine at holidays. No further issues
    Would like to try as I am tired of pills.

  11. I have been on ozempic for 6 weeks. I have lost 17 pounds. I have way less discomfort or nausea than I experienced on Victoza. I find it helps if I eat low carb while taking ozempic.

    My blood sugars are stable, between 101 and 103 fasted and between 127 and 133 after a meal. I am not currently taking any other medications for my diabetes. I am going back to my doctor to re take my A1C the end of October. So far so good! Looking to lose more weight and manage my diabetes.

  12. Started Ozempic and within one week developed chest pain. Continued taking it thinking it may be some sort of indigestion from in for one month. Pain continued. Took off Ozempic and a month later pain and shortness of breath. Ended of having emergency heart cath with 98% blockage in LAD the widowmaker. No history at all of high BP or coronary disease.

  13. Disease = Money
    Especially Diabetes and Cancer. Then the prices are hiked because they know some insurance company’s will pay. Or if your part of ” The Haves” opposed to the “have not’s” I have T2D I am on A very good solution Metformen which is a old drug and helps more things than controlling Diabetes. I started Trulucity because Glipizide was causing weight gain. I am on an all raw veggie no carbs, some fruit like dark berries. I eat to fill the hole. Lol, but weight gain is something that must be managed to contribute to lower sugar.I’ve been fatigued a Lil nauseous. But the fatigued is something I’m not willing to deal with. Ive just rebuilt my life after major depression and chronic pain which I’ve stopped all poison opiates. I must stay busy to deal with this pain and not fall into depression. If it don’t pass, its not worth it.

  14. Just started this injection this week. The constant stomach pain is awful. Im tired, fog brained and after reading all of this and the packaging from the box Im starting to feel Im making a big mistake getting involved with this drug. My doctor is very pushy about me going on insulin with a combination of meds, or this injection with a combination of meds to lower my blood sugars. They have been averaging 230-269. Since I brought the hammer down a week ago they’ve dropped to below 170. My first injection was Wends and today my blood sugars are down to 141. I feel absolutely horrible though. My kids are running circles around me! Im not sure I can continue this

    • Hi Angie,
      Glad your numbers are down, but if the side affects do not become tolerable then a conversation with your healthcare provider is in order.

  15. Started Ozempic 3 months ago. A1C was 10.7. Recent A1C is 6.9. Doc wants it down to 6.5. I take Metformin 1000MG 2x a day and Atrovastatin 1x day. Glucose meter reads 104 in morning consistently. 135 in afternoons. However tonight after a low carb dinner it registered at 85. I have consistent nausea, burping, gas and I feel like I grind my teeth more so now. Sleep is hit or miss. Great results on Ozempic but unsure of long term effects. Blood and urine tests all come back in range.

  16. Curious, do you take your injections in morning or evening? Does it matter?

  17. Just started this week. I am very nauseous and have very bad mucle pain and stiffness all over my body. Is this normal and how long will it laat? I never get hungry except when I first wake up in the morning. I Would really prefer Ozempic because treseba causes alot of weight gain.

  18. I started Ozempic 5 weeks ago about to start 1mg bs considerably low very happy but only have one concern I started feeling neck pain then tense feeling on neck At first thought I had slept wrong but now going on two weeks. Throat feels swollen Should I be concerned?

  19. I went to my daughter to talk about weight loss and he prescribed this to me I am not diabetic what should I do?

    • Hi Maria,
      You may want to have a conversation with your doctor to find out why, and you may also want to seek out a second opinion.

  20. I’m on my 5th week and the nausea and vomiting are still bothering me. The last 2 days I can barely eat anything without getting sick. Does this get better the longer I’m on the medicine? I have called my doctor today. I just don’t know how much longer I can take this. Thanks. Beverly

  21. I am on the sixth day after first injection. Have been nauseated since day two, even now. I will take second injection tomorrow. I have already lost weight as food is no longer my passion. 4 pounds lost. Morning sugar levels are great already. Just need nausea cure. Could be a miracle drug if I can stay the course. By the way I am a borderline diabetic over 50 years old. Good luck to all.

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