My first 4 months using a GLP-1 receptor agonist (Ozempic)
I AM NOT A DOCTOR!
(or a nurse, or a PA, Dentist, Psychologist, Social Worker, Chiropractor, or anything of the type. I work on computer networks for a living.)
I think it's important that I begin here by repeating that I am not a medical professional, nothing in this post (really nothing I say anywhere) should be taken as any sort of medical advice. (Go talk to an actual doctor!)
Everyone's experience could/will be different than mine, but here's what my experience on a GLP-1 agonist (Ozempic) has been like for the last 4 months, so you can get an idea of what you (might) expect if you're considering it or are new to it.
Also, although I'm speaking specifically about Ozempic here, but I'd imagine that the experience on some of the other medications in this class (Trulicity, Mounjaro, etc) might be similar.
Introduction:
This is going to be a lengthy post. I'm going to try to be somewhat thorough with some of the things that I wish I had known ahead of time. I apologize if it feels a bit long-winded.
About 8 months ago I went in for a regularly scheduled diabetes checkup appointment, like I've been doing 3-4 times a year for the past 10+ years. Every one of those visits he'd tell me that my numbers were slightly higher than last time, because diabetes is a progressive disease. Occasionally he'd increase the dose of a medication, or add a a new medication into the mix, and for years that's worked pretty well, it's always been a challenge keeping my A1C under 7. Sometimes it was, sometimes slightly higher, but overall it was pretty well controlled.
This particular appointment it was considerably higher, so he added yet another medication (Pioglitazone) which he said he didn't really like using unless it was necessary because of some potential side effects. After reading about them, neither do I! So I was taking the maximum dose of Metformin, plus Jardiance, Glimepiride, and Pioglitazone.. It was starting to feel like insulin is going to be a thing for me soon..
Time for the next appointment 4 months later, and my A1C increased again to I think 8.8. So he asked "would you like to try one of the once weekly injections".
I'm possibly the world's biggest baby when it comes to needles. (Well...I was). When they take blood for my yearly bloodwork, they know to make sure I'm in the big padded chair, and to close the front arm/tray of the chair so I don't fall out, and the phlebotomist knows to keep me talking, asking about work, or my kids, or anything to distract me from the needle she's shoving into my arm to draw blood so I don't fall on her floor.
So you can imagine what my face probably looked like when he suggested that I do something like inject myself!?
After I got over the initial horror of that thought, I considered that where I'm probably heading is having to take insulin, which means a lot more than just one injection a week, so I agreed to give it a try. Which brings me to my first point that I've been working up to here.
Takeaway #1: If you don't like needles, you'll get over it really fast!
The needles on these injectors are very, very thin and short. A lancet on your finger for your normal glucometer test that we're all so familiar with sticking ourselves with at this point hurts a little, the needle on an Ozempic pen normally hurts even less. Usually I don't feel it at all, occasionally if I'm lucky enough to hit just the wrong spot I'll feel it maybe just a tiny, (really tiny) bit. (It seems to have a chance of hurting more in the arm than in the stomach), 16 injections later and honestly sticking myself with this pen doesn't bother me a bit, and if I ever get to the point that I need insulin, while it will certainly be a hassle to inject several times a day, I'm really no longer bothered by the thought of sticking myself with a needle. It will be interesting to see how the next blood draw goes.
My first injection(s) and first month:
They've done what they can to make dosing very easy here, and the process really isn't that bad, but the first time is intimidating if you've never done something like this yourself before.
Ozempic pens contain multiple doses, and as we all know, re-using needles (and lancets, and anything that's supposed to be sterile that you stick yourself with) is a bad idea. So the pens come with several single-use detachable needles (6 of them, the reason being your first 4 doses will probably be smaller, so there will be enough medication in your first pen for more than 4 injections).
They have pretty good directions in the box, and a video here (along with the high quality acting that you'd expect from a pharmaceutical company.) https://www.ozempic.com/how-to-take/ozempic-pen.html
If you're nervous about messing this up, and and one isn't enough, there's lots of other helpful videos on Youtube. So I'm not going to repeat here what others have already done better than I can anyway.
As mentioned above, in order to try to minimize unpleasant side effects, your doctor will likely instruct you to use a smaller dose for the first 4 weeks. In my case I'm on a .5 MG dose, so the first 4 weeks I only turned the dial to .25 mg.
The first 4 weeks:
There's varying reports of how people react to this. Anywhere from the extremes with people who don't notice anything (along with no results), to those who can't tolerate it at all and feel so bad that they decide it's not worth it. The list of potential side effects is long and scary just like every medication, but most commonly it's a week or two of nausea.
My first week at the half dose, I had some very mild nausea a couple of the days, nothing severe, or anything that I would have probably thought much about if I hadn't been waiting for it and thinking about it. After that the nausea was gone, and hasn't been back. (Well...unless you ignore my advice about not eating too much that I'll discuss further down.)
In my infinite wisdom, I started this medication the month that we went on a cruise...you know, the kind of vacation where food almost seems to be the point. The half-dose doesn't completely kill your appetite (In reality the full dose doesn't either, I'll explain below), but it certainly affects it. And in that kind of environment where the whole family is indulging, you notice (so do they). In the end it was fine though, I came home, didn't gain any weight on the cruise (I know!), and still no nausea or other major side effects.
Oh...and what about the whole point behind this endeavor, my glucose levels. They really didn't change much. By this time I had been on my first CGM for a while, so I was able to look back at the history, and there wasn't much difference. But the goal of weeks 1-4 is really just to get your body used to the medication and hopefully not be miserable for a month.
Takeaway #2: Follow the directions, don't jump in with a full dose right at first (unless directed to by your doctor of course), and hopefully you'll tolerate it as well as I have.
Month 2: Increasing the dose, and new super-fun side effects!
So now it was time to increase to the "normal" dosage. I didn't notice a drastic difference as far as any increased nausea, however (and I apologize for discussing here some things that are not typical polite conversation topics, but you'll want to know about these.)
I got the "Sulphur burps", and it was gross, for like a month. They eventually went away. Also it will delay your....uh...regularity down to maybe once every like 4-5 days it seems. And when it is time, constipation is an issue. One saving grace here is that Metformin to me might as well be labelled "Miralax", so the two seem to cancel each other out. I know some people have resorted to actually taking a real laxative with Ozempic just to help with that issue.
As you're probably aware, one of Ozempic's main things that it does is slow the rate your stomach empties, which slows the rate that you digest food. We're going to discuss managing meals further down, but for now: Because this means you're going to eat less calories per day, (which is why people use it for weight loss also), something I wasn't prepared for was how tired that would make me!
I helped to move my kids off to college during month two of this journey, and after carrying some beds, mattresses and boxes and whatever else we were moving, for like an hour...I felt like I had been working *hard* for a 12-hour day. This lasted for probably a good month, where just a small amount of any moderate exercise/work would completely drain me.
That's since subsided, as my body has gotten accustomed to running on less calories per day, but for that first month of taking the full dose it was a bit of a problem. Something to be aware could potentially happen.
Occasionally I would just gag, on sometimes nothing, or trying to swallow a pill, or brushing my teeth, because my stomach is just...full, and my body is I'm sure trying to tell me "don't you dare swallow anything else!".. That's also basically gone away now...but it was a thing for a while.
I can hear you asking... "What about your glucose levels??"
According to the sensor (a post all about my experience wearing a CGM is coming soon), it's great! It's telling me after a month of a full dose of Ozempic that my estimated A1c is going to be well under 7. We'll see how accurate that is when I go to the doctor in a couple months (in reality I'm already there as I type this, I went to the doctor yesterday--but you'll just have to keep reading. We're only in Month two in this paragraph.)
My doctor recommended continuing to take all of my medication at first, but monitoring my glucose very closely, especially for lows. Which became a thing. While taking all 4 of the oral medications along with Ozempic, I would quite often go low and have to eat some candy or drink juice to bring it back up. He told me which pills to eliminate first, and after about a month of my full dose, I had quit taking 2 of the 4. Only taking Metformin and Jardiance.
Takeaway #3: If you can (if your side effects are not absolutely debilitating and/or horrible), really give this thing a commitment and don't give up 2 months in. Basically all of my side effects have gone away at this point and I'm not dealing with any unpleasantness any more. And if you're taking other diabetes medication, pay attention that it doesn't drop you to dangerously low levels!
You're rambling Just tell me if it's helping or not!
As my CGM compiled more and more data, things kept looking better and better. The "GMI", (Glucose Management Indicator for those of you who are not familiar with CGMs), which is sort of an estimate of what it thinks your A1C would be, kept dropping, down as far as 6.0% where it's stayed for more than 2 months now. I hesitated to really believe it and get too excited, since it's just an app telling you what it "thinks" it is...but yesterday I went to the doctor, and my real, 3-month HbA1c level is... ready for this?
5.8% !!
Down from 8.8 just 4 months ago, and he told me yesterday to try dropping the Jardiance also and see what happens. Any time I can get away with taking less pills, I'm all in!
So I think it's safe to say it's doing it's job, and probably well worth the little bit of side effects and waiting for my body to get used to the medication.
Other thoughts and things to possibly expect:
A weight loss drug?
There's a reason that Ozempic has a reputation as a "weight loss" drug instead of the diabetes control that it was originally intended for. Because if you do what you're supposed to (eat well and exercise), it will make you lose weight even if that's not the primary goal. The "real" weight loss dose/branding from Novo Nordisk is called Wegovy..but it's the same ingredient.
When I started it, I was already at a "reasonably healthy" weight. I'm 6' tall, and when I was first diagnosed with Type 2 ten years ago, I was a bit overweight. Not really bad, but certainly not where I should be for my height. Just from changing my eating and increasing exercise over the last 10 years I dropped from 210 lbs. to bouncing between 175 and 180 pretty regularly. Weight loss was never my #1 goal here, just being generally "healthier". (Though I'm certainly not complaining!) I've probably been "stuck" at 175-180 for at least 5 years. Just at the top end of what is considered a reasonable weight for someone my height and not packed with muscle.
Since June, I've dropped from 175lbs to 160 lbs. Doctor wasn't too concerned yet about the rapid loss, and I've been levelling off for the last 2 weeks not losing much more at all, so hopefully that's tapering off, because this is working, and I don't want to have to cut my dose or quit taking something that's actually helping the problem.
Changing your relationship with food:
Ozempic does more than just curb your appetite. I'll argue that it really doesn't, it just keeps you full for longer. It doesn't make you feel full for longer, it actually keeps your stomach full for longer. (which I suppose depending on how you view it, could be considered "curbing your appetite")... anyway..semantics. I think a better way to describe it is that it changes your relationship with food. If I eat one large meal during the day, I'm done... no more for the rest of the day, which take some time to learn to manage. So many of our family dynamics, social situations, etc. tend to center around food. Think-- going to lunch with friends, having dinner with parents, the routine you get in of just feeding your family at a regular time. When you're on this medication you have to really consider and plan out when and what you're going to be eating, or you're going to be..unhappy. I'll explain in a minute.
If I eat breakfast, I usually have to skip lunch (unless it was a very small breakfast). and maybe plan on a small dinner. If I skip breakfast, and still want to have dinner, better make lunch a light one. It takes some time to break old habits of just eating the traditional 3 meals per day, especially when the "normal" people in the house still do. Many people say eating 5 very small meals throughout the day is better, but I'm not ready to try that yet.
Making sure what you do eat has enough protein can be another challenge. They (who are "they", anyway?) say to avoid muscle loss, you need to eat 1 gram of protein per day per kg of body weight. Doing the math, that's just over 70 grams of protein per day. that's not impossible, but it's a lot when you're not as hungry as you used to be. You really have to pay attention to *what* you're eating, even more so than I was before. I go through a lot of high-protein Greek yogurt, protein supplement shakes, eggs, lean meats, fish...that kind of thing.
What I learned not to do (sometimes the hard way):
Don't overeat!
This sounds like a ridiculous statement. This drug makes it so you don't eat as much right? I'll explain: A normal person can be full from a big lunch, and unexpectedly get invited to dinner with friends or whatever, and still go out, eat a big dinner, even if they're not particularly hungry, and be fine. You'd be full, but you can handle something like that on occasion.
If you try to pull something like that while taking one of these medications, eating a substantial dinner when your body is telling you that you're full, you are going to be miserable for the rest of the night. A couple times while trying to stick to what used to be a "normal" routine, cooking dinner for my family, or worse, going out to eat for a special occasion once, when I had already had a big (well, "big" by comparison) meal earlier in the day....it was bad. I'm talking about severe stomach pains pretty much all night. Be very careful if "surprise" meals come up, and don't overdo it! It's easy to do. And it really won't start to hurt until hours later, so you might think you're fine until you're trying to sleep.
One other thought here, people always talk about eating until you're something like 80% full to promote healthy eating habits. Consider that advice when on one of these medications, and consider making it 70% or less. It's a hard thing to make yourself do, but if you eat until you're completely full on Ozempic, in 30 minutes you'll be at 120%, and not be really happy.
Don't eat unhealthy foods!
Again something that seems silly to say. Of course you shouldn't eat unhealthy foods right? My point here is that if you eat fried foods, carb-heavy foods, etc. as the source of the limited daily calories that you're going to be capable of eating, that leaves no room for the fiber, protein and nutrition that you really need to keep yourself from shriveling up. Now I still eat the occasional slice of pizza, some days you'll have more of an appetite than others, and I'm not saying you should never, ever indulge in the foods you love. But the big majority of what you eat really does need to be healthy food, because since you're eating less total, what you do get needs to be good stuff. The good news is that this medication really helps with that goal. It just takes some time to re-train your brain and break some old habits.
Don't expect it to be a miracle drug.
Ozempic is a powerful and very helpful tool, but you still have to eat well, exercise, and in my case, still take at least one of my oral medications to keep your glucose in check. You unfortunately still can't just eat anything you want, anytime you want. Those days are gone, that ship has sailed, that particular horse has left the barn.
The "other" potential side effects and risks:
(And the argument of whether it's "worth it" or not).
Of course like any other medication, there's going to be risks with Ozempic and others in this class of meds.
Pancreatitis, allergic reactions, worsening of diabetic retinopathy, and some evidence of increased risk of thyroid cancer are also serious risks that you need to weigh into your decision.
If you spend any time on Facebook/other social media, and have ever searched Google for the word "Ozempic", you've probably seen the clickbait headlines like "Ozempic-style drugs cause hundreds of illnesses and deaths!!! ZOMG! WTF...BBQ!!!".... (they don't use the terms "GLP-1", or "Semaglutide", or "Tirzepatide"), if you use the "O-Word", that so many people have associated with just being a lazy way to lose some weight (which it is not), it just sounds scarier and people are more likely to take the bait.
I did a quick search, and apparently between 2018 and 2024, worldwide there were over 200 deaths linked to GLP-1 drugs, many of which lack verification, and just show a casual link to the medication. Estimates are that there are just over 19 million(!) people being treated with this class of drug.
Anyway, once I was done rolling my eyes, I thought.. ok, you know what else causes hundreds of deaths (not between 2018 and 2024)? but *per year*? T2 Diabetes. Along with possible complications like Neuropathy, Kidney Disease, Cardiovascular Disease, Foot ulcers/amputations, etc.
But wait, that's incorrect! Uncontrolled type-2 diabetes causes hundreds of thousands of deaths per year. Just about 400,000 per year just in the U.S. alone. Worldwide numbers are upwards of 1.5 Million some years. So I made the decision that the risks and temporary side effects are probably worth it in my case.
So is it worth it for you? Have a discussion with your doctor and decide for yourself. Me, I probably wouldn't choose to take it just for weight loss because of the risks, but I also don't have personal experience being severely overweight. Obesity carries serious health/death risks also, and for some people who have more than just a few pounds to lose this might be the only thing that really works. So again, decide with your doctor, and don't make a decision like this just based on reading some random blog post on the internet.
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