Ozempic (Semaglutide), a GLP-1 receptor agonist, has revolutionized type 2 diabetes management over the past 20+ years with its impressive success in regard to weight loss and blood sugar lowering. But what about those of us living with type 1 diabetes (T1D)?
For people living with T1D, the daily challenges of managing blood sugar levels never stop. There is a constant need for insulin adjustments, carbohydrate counting, and the ever-present threat of high and low blood sugars. This brings up an interesting question – can people with type 1 diabetes take Ozempic?
While Ozempic is not FDA-approved for type 1 diabetes, there’s growing interest in its potential use as a supplementary therapy. Currently, using Ozempic in T1D is “off-label” use, meaning it’s being prescribed for a condition it wasn’t originally intended for. This requires careful consideration and close medical supervision.
So, how might Ozempic, a medication primarily designed for type 2 diabetes, potentially benefit those with type 1 diabetes? Continue reading to learn about all of the benefits as well as the risks, considerations, and my own personal experience with this medication.
The information provided is for educational purposes only and should not be considered a substitute for professional medical advice from a qualified healthcare provider; always consult your doctor before making any health-related decisions based on this information.
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The Challenges of Living with Type 1 Diabetes
Despite advancements in insulin therapies and blood sugar monitoring technology, achieving consistent blood sugar control remains a big challenge for those of us living with T1D. Factors like diet, exercise, stress, hormonal fluctuations, and dozens of other factors can significantly impact glucose levels, leading to unpredictable swings.
The constant decision-making and vigilance required to manage these blood sugar fluctuations place a significant emotional and physical burden on people living with T1D.
Potential Benefits of Ozempic in Type 1 Diabetes
Emerging research suggests that Ozempic, when used as an adjunct to insulin, may offer several potential benefits for people with type 1 diabetes. While Ozempic will never replace insulin for those with T1D, it can enhance its effectiveness and improve overall blood sugar control.
Ozempic works by mimicking the naturally occurring GLP-1 hormone. As a GLP-1 receptor agonist, there are several ways it could be beneficial in the context of type 1 diabetes:
- Slowing Gastric Emptying: By slowing the rate at which food empties from the stomach, Ozempic can help smooth out post-meal blood sugar spikes.
- Potential Reduction in Glucagon Secretion: While the effect is more pronounced in type 2 diabetes, Ozempic may also help minimize inappropriate glucagon secretion, which contributes to elevated blood sugars.
- Improved Time in Range and Reduced Glucose Variability: These combined effects could lead to more stable blood glucose levels, potentially increasing the time spent within the target glucose range and reducing blood sugar swings.
- Weight Management: For individuals with type 1 diabetes who also struggle with weight, Ozempic’s weight loss effects could indirectly improve insulin sensitivity and overall metabolic health.
- Improved Insulin Resistance and Reduced Insulin Needs: The improvement in insulin resistance may result in needing less insulin overall. Taking less insulin can help prevent severe hypoglycemia.
- Reduction in Food Noise: The reduced food noise can help people with type 1 diabetes stick to a consistent meal plan, reducing grazing and overeating and helping to promote stable blood sugars.
- Other Potential Benefits: The latest research has proven the benefits of GLP-1s for cardiovascular and kidney protection, as well as the potential for reduced dementia risk and even improvements in sleep apnea.
Managing Risks and Potential Side Effects of Ozempic
While Ozempic offers potential benefits for some individuals with type 1 diabetes, it’s also important to acknowledge the potential risks and side effects.
Risk of DKA
One significant concern is the risk of diabetic ketoacidosis (DKA). If insulin is reduced too drastically, the risk of DKA increases. Therefore, any changes to insulin doses should be made under medical supervision. Ketone test strips should be kept on hand at all times for monitoring as needed.
GI Side Effects
Gastrointestinal side effects, such as nausea, vomiting, and diarrhea, are common with GLP-1s. These side effects are often mitigated by starting with a low dose and gradually titrating up to the target dose as needed, as prescribed by your doctor. Dietary adjustments, such as eating smaller, more frequent meals and avoiding fatty or spicy foods, can also help minimize these symptoms.
Hypoglycemia Risk
Hypoglycemia is another potential risk. The combination of slowed gastric emptying and potential improvements in insulin sensitivity can increase the likelihood of low blood sugar. To prevent hypoglycemia, meticulous blood sugar monitoring is crucial, particularly before and after meals, during exercise, and overnight; the use of a CGM is recommended. It is also important to always be prepared with proper snacks to treat low blood sugars.
Muscle Loss
Lastly, the risk of muscle loss is a concern for anyone on a GLP-1 medication, including those with T1D. Since these medications can cause rapid weight loss, muscle loss is sometimes inevitable. The key is ensuring you are eating enough calories and protein to help slow down the rate of weight loss while also adding regular strength training or resistance training to your exercise regimen.
If you cannot keep up with your calorie and protein goals, you may need to consider a lower dose of the medication.
Everyone’s response to GLP-1 medications will vary, so it is important to communicate regularly with your healthcare team to help develop a personalized plan.
Expert Perspectives and Ongoing Research
The use of GLP-1s in type 1 diabetes is an evolving area of research. Ongoing clinical trials are exploring the safety and efficacy of these medications as adjunct therapies, aiming to provide more concrete data on their potential benefits and risks. These studies are crucial for establishing evidence-based guidelines for off-label use with the hopes of eventually making these medications more widely available for type 1s.
Many endocrinologists understand the challenges of managing T1D and are open to considering Ozempic as an option to help improve glycemic control and quality of life. Others are not quite there yet, but hopefully with more and more research, will be more willing to consider this option.
The medical community is continuing to learn more about the best ways to utilize this type of medication, and the importance of staying up to date with the latest research is key.
Practical Guidance for Those Considering Ozempic
If you’re considering Ozempic for your type 1 diabetes, the first step is to talk with your endocrinologist. This decision is not to be made lightly, and it’s ideal to have a healthcare provider you trust on board. They will help you determine if Ozempic is appropriate for your individual situation.
For those who do move forward with Ozempic, consistent blood sugar monitoring is crucial. You’ll need to monitor before and after meals, during exercise, and overnight, so a CGM is highly recommended.
Your endocrinologist will guide you on adjusting your insulin doses based on your blood sugar. These adjustments must be made carefully and gradually to minimize the risk of hypoglycemia and DKA. Keeping detailed records of your blood sugar levels, food intake, exercise, and medication dosages is essential for tracking your progress and identifying any potential issues. This data will help your healthcare team fine-tune your treatment plan and optimize your outcomes.
My Personal Experience with Ozempic
As a dietitian and someone living with type 1 diabetes, I am always interested in trying out new therapies and technology and experiencing firsthand what my own clients are experiencing. This is why, in Mid-2024, I decided I wanted to try out Ozempic for myself.
After weighing the pros and cons, doing a ton of research, and listening to every podcast I could find on T1D and GLP-1s, I got up the nerve to have a conversation with my endocrinologist about his willingness to prescribe a low dose of Ozempic for me. He swiftly turned this down stating my BMI was not high enough, it was not FDA approved for type 1, and there were too many possible side effects.
From my research, I knew that many endos were still not on board with this treatment for type 1s. However, there are many that are, so I set out to find a provider who would be willing to let me try out a GLP-1. I found a virtual provider who lives with T1D himself and is a proponent of type 1s taking these medications.
I was able to set up a virtual appointment with him. We discussed all the options in detail, and he was able to prescribe Ozempic and, by some act of God, get it covered by my insurance.
Ozempic Benefits I Have Personally Experienced
Since starting Ozempic in October 2024, I have realized that I only need a tiny dose to get the benefits (I still only take ½ of the smallest therapeutic dose). Ozempic has helped me manage my diabetes in many ways.
First, I no longer have the food noise I used to have constantly. I always thought about the next meal or snack, eating food off my kid’s plates and grazing throughout the day. I didn’t realize how much that impacted my blood sugar levels. Now I eat when I am hungry. I don’t find myself constantly thinking about food. I don’t feel hangry the minute it’s “time to eat,” which has allowed me to be much more flexible and spontaneous and has even helped me be a more patient mom and wife.
While Ozempic was never about massive weight loss for me, I did lose about 5 pounds in the first couple of months and have been easily able to maintain this weight without stressing about calorie counting, macro tracking, or worrying about missing a workout. That being said, I am very cognizant of making sure I am eating enough calories, protein, and fiber and drinking plenty of water daily to prevent muscle loss or too much weight loss and to stay regular.
Most importantly, while there hasn’t been a drastic change in my overall blood sugar management, my blood sugar has been smoother and easier to manage. I almost always wake up below 130, rarely have low blood sugars, use about 25-30% less insulin than I was using before, and have less swings after eating. I find myself thinking less about my diabetes which is incredibly refreshing.
In order to continue reaping the benefits of Ozempic, I know I will need to continue taking a small dose indefinitely, which for now, I feel okay with.
Conclusion
In conclusion, Ozempic is not a replacement for insulin therapy in type 1 diabetes. Rather, it offers the potential to serve as a valuable adjunct therapy potentially improving both blood sugar control and quality of life. However, close medical supervision is important. The off-label nature of this treatment requires a thorough understanding of the potential benefits and risks, as well as meticulous blood sugar monitoring and personalized and timely adjustments to insulin therapy.
Those of us with type 1 diabetes need to advocate for ourselves and actively engage in discussions with our endocrinologists about all available treatment options. By staying informed about the latest research and working closely with our healthcare teams, we can make informed choices that best support our health and well-being.
While Ozempic is not a magic potion, it is a tool that has made my life and the lives of many others with T1D much more manageable. If you are a woman with T1D who is either taking a GLP-1 or wants to learn more, make sure to join my private Facebook group ONLY for women with T1D! And don’t forget to grab my FREE guide for managing GLP-1s with T1D.
Lastly, as a Registered Dietitian and Certified Diabetes Care and Education Specialist, I would love to help you manage your GLP-1 journey. Reach out to me anytime at Lindsay@mama-betes.com!