Semaglutide

What Is Semaglutide?

Semaglutide is a medication that is similar to a hormone that our bodies naturally produce – incretin. It is a glucagon-like peptide-1 receptor agonist and mirrors the activity of incretin GLP-1. A receptor agonist binds to a cell’s receptor either inside or on the surface of the cell. Because of that binding ability, it can initiate the same process as the usual element that binds to the receptor. Semaglutide acetate is the form used to manufacture semaglutide products.

High blood sugar occurs after we eat, and incretin induces the release of insulin. Incretin also helps lower blood sugar by lowering the production of blood sugar in the liver. This improvement in blood glucose regulation has helped diabetic patients and patients grappling with chronic weight management.

What Is the Brand Name for Semaglutide?

The brand names for Semaglutide are Rybelsus, Wegovy, and Ozempic. At the present time, there are no other semaglutide containing products available in the U.S. for diabetes and/or weight management.

What Are the Differences Between Wegovy, Ozempic, and Rybelsus?

Wegovy is administered by subcutaneous injection and is used for weight loss. It is available in 0.25 mg, 0.5 mg, 1.7 mg, and 2.4 mg dose pens. There are specific parameters in which Wegovy is generally prescribed for weight management: a body mass index of at least 30 kg/m2 or a body mass index of at least 27 kg/m2 with weight-related comorbidities such as high blood pressure and type 2 diabetes. Diet and exercise are always recommended with Wegovy.

Ozempic is available as a subcutaneous injection in strengths of 0.25 mg, 0.5 mg, 1 mg, or 2 mg once weekly. Combined with diet and exercise, it helps control blood sugar levels in type 2 diabetic patients. In diabetics who already have cardiovascular disease and are at increased risk for a heart attack, Ozempic reduces risk.

Rybelsus is available in 3 mg, 7 mg, and 14 mg tablets. Together with diet and exercise, it is used for blood sugar regulation in type 2 diabetics.

Semaglutide Uses

Semaglutide is FDA approved for weight loss under the brand name Wegovy. If you are an adult with a BMI of 30 mg/kg² or higher, or have a BMI of 27 mg/kg² along with a weight-related health condition such as high cholesterol or high blood pressure, it may be a good choice for you.

Semaglutide is FDA approved to treat Type 2 Diabetes under the brand names Ozempic (injection) and Rybelsus (oral). It is not for the treatment of Type 1 Diabetes.

How Does Semaglutide Work?

Semaglutide works by mimicking incretin. This drug is part of a group of medications defined as incretin mimetics. Incretin hormones are produced in our gut; these gut peptides are released after we ingest nutrients. We require insulin to utilize nutrients and incretin activates insulin secretion. In medicine, a mimetic behaves in a similar fashion to another substance. So, your body will react to semaglutide in the same way that it reacts to incretin.

The liver acts as a glucose storage facility, and if functioning properly, it will control blood sugar levels at optimal levels. Glucagon stimulates the liver to convert glycogen (stored glucose) into its functional form and release it into your bloodstream. Glucagon also stimulates glucose production in the liver. Semaglutide restricts both glucagon release and hepatic (liver) gluconeogenesis (production of glucose within a biological system).

Semaglutide Molecule

How Does Semaglutide Control Blood Sugar?

Semaglutide controls blood sugar by mimicking incretin. Incretin activates the release of insulin. Once insulin is released, it goes to work. Circulating blood sugar must enter our cells for our bodies to produce energy. If too much remains in our bloodstreams, we have high blood sugar but low energy.

Our bodies crave balance to achieve proper functioning and controlling blood sugar is a way to achieve a balanced state. We want neither high blood sugar nor low blood sugar. Blood sugar control is necessary for effective weight management and weight loss is difficult to achieve without it. Unlike other drugs, semaglutide is not asking our body to do something that it does not want to do.

What Does Semaglutide Do to Your Body?

Semaglutide enhances the release of insulin. What’s even more important for many diabetic patients, semaglutide also promotes insulin sensitivity in all parts of the body. This helps remove the insulin from the bloodstream and transport it into the cells for energy production.

Semaglutide also impedes hunger by slowing gastric motility. When food spends more time in the stomach, we feel satiated for a longer period. Decreased appetite benefits people seeking rapid weight loss and sustained weight loss.

An exciting advantage to taking semaglutide is the effect it has on the brain. Semaglutide impacts the part of the brain called the hypothalamus that controls satiety and the food/reward system. Due to this change, people often make healthier food choices while taking this medication. For diabetic patients, patients with cardiovascular disease, and patients on a reduced calorie diet, making healthy food choices is imperative.

Many dieters believe that they can’t reduce body weight due to a slow metabolism. The truth is that many people can’t lose weight because they are not using fuel efficiently. Semaglutide assists the body in breaking down stored fat for energy.

Is Semaglutide Taken by Injection?

Semaglutide can be taken by once weekly injection. Ozempic and Wegovy are injectable semaglutide acetate preparations. Each dose comes in a prefilled pen, and you should inject semaglutide subcutaneously. Check the solution before use; it should be clear with no cloudiness or debris. You can use the same injection site, such as the upper arm, but it is advisable to rotate the injection site. If you inject in the same body area, don’t give the injections close together. A regular dosing schedule is necessary: the same day every week. Dose escalation should never be attempted unless prescribed by your doctor.

If a missed dose occurs and more than five days have passed, skip the missed dose and follow with your next scheduled dose. Never take two doses within 48 hours even if a missed dose has occurred.

Semaglutide Doses

Semaglutide Dose for Weight Loss

The dosing schedule for weight loss and weight management might be different for different patients. Your doctor might have to consider such things as baseline body weight, your level of physical activity, drug interactions, blood sugar levels, and medical history to determine your semaglutide injection dose. Delaying dose escalation might be necessary for people experiencing GI difficulties.

Ozempic

Begin with 0.25 mg and gradually increase to a 2.4 mg maintenance dose. These are administered by subcutaneous injection. If you have missed a dose and you are near your next scheduled dose, skip the missed dose and return to your regular schedule. Do not take two injections on the same day. Injections can be given in your upper arm, thighs, or stomach.

Wegovy

0.25 to 2.4 mg once weekly, with a similar increase schedule as Ozempic.

Rybelsus

One 3mg tablet daily for the first month, then one 7mg tablet daily for at least one month. After that, the dose can be increased to one 14 mg tablet daily. The manufacturer recommends Rybelsus be used in conjunction with a diet and exercise program.

Semaglutide Dose for Diabetes

Ozempic

0.25 mg subcutaneous injection once a week for four weeks. Dose escalation will be determined by your physician. The scheduled dose might increase to 2.4 mg once weekly.

Wegovy

0.25 mg subcutaneous injection once a week for four weeks. Dose escalation could increase to 2.4 mg once weekly.

Rybelsus

3 mg tablet to start. This can be increased to 14 mg. once daily. The scheduled dose would be determined by your physician.

Is Semaglutide Good for Weight Loss?

Yes, semaglutide is good for weight loss. Recent clinical trials have demonstrated its efficacy in helping patients achieve up to a 25% decrease in baseline body weight.

Semaglutide Clinical Trials for Weight Loss

In participants with overweight or obesity, 2.4 mg of semaglutide once weekly plus lifestyle intervention was associated with sustained, clinically relevant reduction in body weight.
– Wilding, John, et al. “Once-Weekly Semaglutide in Adults with Overweight or Obesity” The New England Journal of Medicine, March 18, 2021, https://www.nejm.org/doi/full/10.1056/NEJMoa2032183

In this randomized clinical trial of adults with overweight or obesity, 803 participants completed a 20-week run of weekly treatment with subcutaneous semaglutide, 2.4 mg, with a mean weight loss of 10.6%.
– Rubino, Domenica, Abrahamsson, Niclas, Davies, Melanie “Effect of Continued Weekly Subcutaneous Semaglutide vs Placebo on Weight Loss Maintenance in Adults with Overweight or Obesity” The Journal of the American Medical Association, March 23, 2021, https://jamanetwork.com/journals/jama/fullarticle/2777886

Treatment with once-weekly subcutaneous semaglutide in conjunction with behavioral intervention in adults with overweight (with at least one weight-related comorbidity) or obesity (without diabetes) was associated with clinically impactful and sustained weight loss of 15.2% at week 104, along with improvements in weight-related cardiometabolic risk factors.
– Garvey, W. Timothy, et al. “Two-year effects of semaglutide in adults with overweight or obesity: the STEP 5 trial” Nature Medicine, Oct. 10, 2022 https://www.nature.com/articles/s41591-022-02026-4

What Are the Benefits of Semaglutide?

Semaglutide will help lower blood sugar and decrease body weight. Since obesity and diabetes are two of the leading metabolic disorders in the United States, anything that offers relief from those conditions is a substantial breakthrough. The benefits of lower blood sugar are risk reduction for nerve damage, heart attack, stroke, eye problems, and kidney problems. The benefits of reducing body weight include lower blood pressure, reduced mortality rates, and decreased risk of stroke, cancer, type 2 diabetes, and COVID-19 mortality.

Studies have shown a reduction in major cardiovascular events with the use of semaglutide.

In patients with type 2 diabetes who were at high cardiovascular risk, the rate of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke was significantly lower among patients receiving semaglutide than among those receiving placebo, an outcome that confirmed the noninferiority of semaglutide.
– Marso, Steven, et al. “Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes” The New England Journal of Medicine, Nov. 10, 2016 https://www.nejm.org/doi/full/10.1056/nejmoa1607141

Is Semaglutide Insulin?

No, semaglutide is not insulin; semaglutide and insulin are two different substances. Insulin is a hormone produced in the beta cells in the pancreas. Insulin is released in response to food intake to promote the absorption of glucose into our cells. Semaglutide mimics a hormone called incretin that increases insulin secretion.

Is Metformin and Semaglutide the Same Thing?

No, Metformin and semaglutide are not the same thing. Semaglutide increases insulin secretion, slows digestion, and decreases the glucose released by the liver. Metformin decreases insulin resistance, decreases the amount of sugar that enters the bloodstream from the intestines, and, one function that it shares with semaglutide, lowers the amount of glucose produced in the liver.

Can I Buy Semaglutide Over the Counter?

No, you can’t buy semaglutide over the counter; you need a doctor’s prescription.

Can I Take Semaglutide If I Am Not Diabetic?

You can take semaglutide if you are not diabetic. Semaglutide has been used successfully for weight loss in non-diabetic adults.

What Are Semaglutide Side Effects?

As with all medications, side effects, such as allergic reactions, are subjective. Any of the following could constitute an allergic reaction: trouble breathing, blood pressure changes, rash or hives near or away from the injection site, and swelling of the throat or tongue. Contact a healthcare professional or call your doctor immediately if you experience any of these symptoms while taking Semaglutide.

Possible side effects include gastrointestinal disorders such as pain, nausea, diarrhea, and vomiting.

Hypoglycemia (low blood sugar) is not a side effect of semaglutide when used alone. Even though it does not cause lower blood sugar, taken with other drugs such as sulfonylureas or insulin, hypoglycemia might occur. Low blood sugar symptoms include, but are not confined to blurred vision, fatigue, difficulties with cognition, nervousness, anxiety, and headache. To temporarily ameliorate low blood sugar symptoms, ingest fruit juice or another sweet drink or glucose tablets.

Just as with hypoglycemia, diabetic ketoacidosis is not a direct result of the use of semaglutide. However, it has occurred when concomitant insulin was reduced too quickly.

In rodent studies, these medications have been shown to cause thyroid tumors. It is not known if Semaglutide will cause medullary thyroid carcinoma in people. Tell your doctor immediately if you notice a lump or swelling in your neck, trouble swallowing, shortness of breath, or hoarseness.

Who Should Not Take Semaglutide?

Type 1 diabetics should not take Semaglutide. Additionally, do not take Semaglutide if any of the following are true.

• You are allergic to it or any of the ingredients used in the injection suspension.
• If you have a personal or family history of multiple endocrine neoplasia syndrome type 2 (MEN 2), medullary thyroid carcinoma (MTC), or any form of thyroid cancer.
• You have diabetic retinopathy, acute kidney injury and other forms of kidney disease.
• You have a history of pancreatitis.
• You are pregnant. Discontinue use at least 2 months before becoming pregnant; it can take a minimum of 5 weeks for your body to completely clear the drug from your system.

Semaglutide Drug Interactions

Drug interactions are possible with 245 medications that interact with semaglutide. It is necessary to tell your doctor about all prescription drugs you are taking, including oral medications, injectable medications, dietary supplements, and herbal products. Though many people believe herbal products to be benign, even at a low dose there could be possible interactions. Because semaglutide delays gastric emptying, it might interfere with the absorption of other drugs.