How Ozempic is changing diabetes treatment

For over 20 years, Betsy Chadwell carried her insulin pens everywhere. Day after day, she carefully calibrated the doses needed to control her type 2 diabetes. “Every meal, every morning and every evening, it controls your life,” she said.

In late 2021, she started taking the diabetes medication Ozempic. Within a few months, she was able to completely stop taking the short-acting insulin she usually took before every meal, and she significantly reduced the dose of long-acting insulin she uses daily. Cutting back on insulin gave her a sense of freedom, she said. She still uses a continuous glucose monitor to track her blood sugar, meticulously monitoring dips and spikes — but even though she’s been taking less insulin, she said, Ozempic has helped control her blood sugar better.

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

“I really empathize with these patients, because you can never stop thinking about it,” 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 — two weekly injections that can lower blood sugar levels, in part by mimicking a hormone that stimulates insulin production — have given patients a tempting new option to try to manage their diabetes. type 2 without relying on them. heavily on insulin.

And drugmakers are studying other ways these drugs might 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 with ultra prolonged action of insulin) and semaglutide, the Ozempic complex.

Although it has not yet released full results, Novo Nordisk said promising but preliminary data from two trials suggest that IcoSema could lead to better blood sugar control than insulin or semaglutide alone. Previous trials have suggested that people taking semaglutide or tirzepatide, the substance in Mounjaro, in addition to insulin had better blood sugar control and lost more weight than those taking insulin alone.

Patients who already use these medications in tandem often do so in hopes of reducing the amount of insulin they take, or even getting rid of it altogether. Dr. Hagan said patients are often eager to stop taking insulin, partly because it can be logistically very taxing, and partly because the drug can cause weight gain.

There are no standard guidelines on how to dose Ozempic and insulin together, however, so doctors said they are learning in real time how to manage patients taking both drugs. “It’s kind of a moving target,” Dr. Hagan said. Reduce a person’s insulin dose too quickly and their blood sugar could spiral out of control.

“You don’t just lower insulin in everyone, or you 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 medications lower blood sugar too dramatically, it could drop to dangerously low levels, called hypoglycemia. Taking medications like Ozempic with insulin increases the risk of this happening, said Dr. Janice Jin Hwang, division chief of endocrinology and metabolism at the University of North Carolina School of Medicine.

When she talks to patients about this risk, she says, she also explains the early signs of hypoglycemia: palpitations, tremors, sweating, dizziness and intense hunger. People with severe hypoglycemia may have seizures, lose consciousness, and have trouble walking, thinking, or seeing clearly.

“We are doing everything we can to prevent this from happening,” she said.

She especially carefully monitors patients who gradually increase their doses of Ozempic or Mounjaro. She sees them more frequently, makes sure they monitor their blood sugar closely and adjusts insulin doses as needed.

Dr. Padmaja Akkireddy, an endocrinologist at Nebraska Medicine, said every time a patient increases their dose of Ozempic, she checks to see if their insulin dose needs to change as well. These calculations can become even more difficult when patients taking Mounjaro or Ozempic have trouble getting their next dose, whether because of a shortage – as is often the case – or because their insurance coverage is expired.

However, with careful monitoring, Dr. Akkireddy said most of his patients were able to reduce their insulin doses after starting Ozempic, and some were able to stop insulin altogether. Not everyone will be able to stop taking the drug, experts said — some will still need it to control their blood sugar.

But “my hope,” Dr. Hagan said, “is that in 10 years we will have a lot fewer patients who need to take insulin.”