How Ozempic is changing the treatment of diabetes

For more than 20 years, Betsy Chadwell carried her insulin pens everywhere. Day after day, he carefully calibrated the doses needed to keep his type 2 diabetes under control. Every meal, every morning and every night controls your life, he said.

In late 2021, he started taking the diabetes drug Ozempic. After months, she was able to stop taking the short-acting insulin she usually takes before each meal and has substantially reduced the dose of long-acting insulin she uses daily. Cutting back on insulin has given her a sense of freedom, she said. He still uses a continuous glucose monitor to track his blood sugar, meticulously watching for dips and peaks, but even though he took less insulin, he said, Ozempic has helped keep his glucose levels more under control .

Millions of Americans depend on some form of insulin, a life-saving drug that has long been a mainstay of diabetes treatment. But it can also be a burden for patients like Chadwell, who have to juggle different formulations and doses, and often have to have insulin on hand at all times.

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I really feel for these patients, because you can never stop having that in the back of your mind, said Dr. Scott Hagan, an assistant professor of medicine at the University of Washington who studies obesity.

But in recent years, Ozempic and a similar drug, Mounjaro, both weekly injections that can lower blood sugar in part by mimicking a hormone that stimulates insulin production, have offered patients an attractive new option to try to manage your type 2 diabetes without being so dependent on your type 2 diabetes. insulin.

And drugmakers are examining other ways these drugs can work alongside insulin: Novo Nordisk, the company that makes Ozempic, is studying a new drug called IcoSema, a weekly injection that combines insulin icodec (a version of insulin ultra long-acting) and semaglutide, the compound in Ozempic.

Although it has yet to release full results, Novo Nordisk has said that promising but preliminary data from two trials suggest that IcoSema could lead to better glucose control than insulin or semaglutide alone. Previous trials have suggested that people who took semaglutide or tirzepatide, Mounjaro’s substance, along with insulin had better blood sugar control and lost more weight than those who took insulin alone.

Patients who are already using these drugs in tandem often do so in hopes of reducing the amount of insulin they take or weaning them off of it altogether. Hagan said patients are often eager to get off insulin, in part because it can be a logistical pain and in part because the medication can cause weight gain.

However, there is no standard guidance on how to dose Ozempic and insulin together, so doctors said they are learning in real time how to manage patients on both drugs. It’s kind of a moving target, Hagan said. Lower a person’s insulin dose too quickly and their blood sugar could spike out of control.

Don’t just reduce everyone’s insulin, or don’t just wait and see what happens for everyone, said Dr. Andrew Kraftson, clinical associate professor in the division of metabolism, endocrinology and diabetes at Michigan Medicine.

If the drugs lower your blood sugar too drastically, it could drop to dangerously low levels, known as hypoglycemia. Taking drugs like Ozempic along with insulin increases the risk of this happening, said Dr. Janice Jin Hwang, chief of the division of endocrinology and metabolism at the University of North Carolina School of Medicine.

When he explains this risk to patients, he said, he also explains the early signs of hypoglycemia: palpitations, tremors, sweating, dizziness and intense hunger. People with severe hypoglycaemia may have seizures, lose consciousness and struggle to walk, think or see clearly.

We do everything we can to prevent that from happening, he said.

Watch patients especially as they gradually increase their doses of Ozempic or Mounjaro. He sees them more often, makes sure they’re monitoring their blood sugar levels closely, and adjusts their insulin doses as needed.

Dr. Padmaja Akkireddy, an endocrinologist at Nebraska Medicine, said every time a patient increases their Ozempic dose, they check to see if they need to change their insulin dose as well. Those calculations can become even more difficult when patients taking Mounjaro or Ozempic struggle to get their next dose, either because there is a shortage, as there often is, or because their insurance coverage has lapsed.

With careful monitoring, however, Akkireddy said most of his patients have been able to reduce their insulin doses after starting Ozempic, and some have been able to go off insulin entirely. Not everyone will be able to get off the drug, experts said, and some will always need it to control their blood sugar.

But my hope, Hagan said, is that in 10 years we will have far fewer patients needing insulin.

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