It is a synthetic GLP-1 (glucagon-like peptide receptor agonist) that goes by the brand name Ozempic. It has been studied extensively for the treatment of diabetes and weight loss. It is an FDA approved, once a week injectable medication for weight loss in patients with a BMI >30 or BMI >27 with comorbidities. The studied dose was 2.4mg/ week to lose 20% body weight. It is thought that this peptide is lower than normal in people with type 2 diabetes and obesity. GLP-1 receptor agonists belong to a class of medications that help the pancreas release ideal amounts of insulin to more effectively move sugar from the blood into the tissue where it can be used for energy.

Let’s unpack this just a bit.

What does Semaglutide Peptide do? 

  • It promotes fullness after eating
  • It suppresses the rise of hunger hormones
  • It reduces sugar production
  • It increases your cell’s ability to take up and use glucose efficiently
  • It helps with metabolic flexibility – the ability to burn carbs, proteins and fats efficiently to optimize weight
  • It slows the rate at which food leaves the stomach to control after meal blood sugar levels and appetite 

How does it work?

Semaglutide exerts its influence over many different areas of the body.

Brain

Lose desire to eat – it sends a signal to a specific region of the brain called the hypothalamus which is responsible for controlling appetite and thirst, reducing your desire to eat or drink. DehydrationDanger – Because it reduces the sensation of thirst, it’s vital to be sure to drink plenty of water and other fluids to stay hydrated.

Muscle

It stimulates gluconeogenesis—the synthesis of glucose in the body. More simply, the liver converts protein rather than carbohydrates to sugar for the body to use as fuel in the muscle. An increase in this process can help to lower blood sugars by stimulating glucose uptake by the cells and increasing how efficiently the body uses insulin. Gluconeogenesis is more likely to happen on a Low-carb Diet

Pancreas

When GLP-1 comes in contact with glucose, the pancreas secretes more insulin, thereby lowering the amount of glycogen in the blood after a meal. GLP-1 decreases the secretion of glucagon—a hormone that prevents blood sugar levels from dipping too low. Glucagon can cause blood glucose levels to become too high in people with diabetes.

 

Liver

GLP-1 lowers liver sugar production, which helps to lower blood sugars.

Stomach

GLP-1 decreases both the secretion of acid in the stomach and how quickly food is emptied from the stomach. This prolongs the sensation of fullness that in turn can limit how much a person eats..

Let’s get into the specifics and What’s the catch???

These medications are INJECTABLE. The patient self administers the shot into the fatty tissue just below the surface of the skin once a week.

There Are Side Effects

  • Nausea, vomiting, and diarrhea, which affect 10-40% of people who take it. They are more likely to occur with short-acting medications and tend to be less severe the longer a person takes the medication. I use long-acting versions of the medications that have less of this side effect.
  • Constipation, bloating, indigestion
  • Headache – usually related to the day of and day after the injection
  • Occasional redness, itching, or soreness of the skin at the injection site
  • Palpitations or higher than normal heart rate which may result in insomnia

There Are Serious Side Effects

Although rare, these side effects should be treated as an emergency.

  • Pancreatitis: Ongoing upper abdominal pain in the upper left or middle of the stomach that may spread to the back, with or without vomiting
  • A skin rash or hives
  • Diffuse body itching
  • Pounding heart
  • Dizziness or fainting
  • Allergic reactions such as: swelling of the eyes, face, mouth, tongue, throat, feet, ankles, or lower legs and trouble swallowing or breathing
  • Decreased urination
  • Very dry mouth or skin
  • Extreme thirst

Complications

  • In animal studies, other similar drugs (NOT Semaglutide) have been shown to promote thyroid cell tumors. Although these drugs haven’t been evaluated in humans for this potential complication, it is recommended that people with a history of or family history of medullary thyroid cancer or multiple endocrine neoplasia type 2 do not use GLP-1 receptor agonists.
  • As mentioned, there is a possible small increased risk of pancreatitis(inflammation of the pancreas) which may require hospitalization and support with intravenous hydration. It CAN be a very serious issue but fortunately is very unlikely to occur. 

Who Should Avoid Them?

This medication is not recommended for people who:

  • Have a history of pancreatitis
  • Have a history of gastroparesis (paralysis of the stomach)
  • Have medullary thyroid cancer or multiple endocrine neoplasia type 2 or a family history of these conditions
  • Are on dialysis (as the safety of using GLP-1 agonists in this situation hasn’t been proven)
  • History of suicidal and severe uncontrolled mood issues
  • People with impaired kidney function due to diabetes who have a GFR (glomerular filtration rate) of 30