From the Guidelines
Insulin doses should be adjusted in patients on Ozempic (semaglutide) based on fasting finger-stick glucose test results, with a goal of 90–150 mg/dL (5.0–8.3 mmol/L), and adjustments made accordingly to prevent hypoglycemia and optimize glucose control. When adjusting insulin in patients on Ozempic, consider the following key points:
- If 50% of the fasting finger-stick glucose values are over the goal, increase the dose by 2 units 1
- If >2 fasting finger-stick values/week are <80 mg/dL (<4.4 mmol/L), decrease the dose by 2 units 1
- Consider changing the timing of basal insulin from bedtime to morning, and titrate the dose based on fasting glucose results 1
- For patients on premixed insulin, consider discontinuing prandial insulin and adding noninsulin agents, or decreasing the dose by 50% and adding noninsulin agents 1
- Regular blood glucose monitoring and follow-up every 2-4 weeks during dose titration are crucial to make appropriate insulin adjustments based on glucose patterns 1
- Patient education on recognizing hypoglycemia symptoms and treating low blood glucose immediately with 15g of fast-acting carbohydrates is essential 1
- The mechanism of Ozempic as a GLP-1 receptor agonist, which enhances glucose-dependent insulin secretion, suppresses glucagon, and delays gastric emptying, can potentiate insulin's effects and requires careful insulin dose adjustments 1
From the Research
Adjusting Insulin in Patients on Ozempic (Semaglutide)
Overview of Treatment Intensification
- When patients with type 2 diabetes are on basal insulin and require treatment intensification, options include adding prandial insulin or a GLP-1 receptor agonist like semaglutide 2, 3.
- The choice of intensification strategy depends on various factors, including the patient's glycemic control, weight, and risk of hypoglycemia.
Role of Semaglutide in Treatment Intensification
- Semaglutide, a GLP-1 receptor agonist, has been shown to be effective in improving glycemic control and reducing weight in patients with type 2 diabetes on basal insulin 4, 5.
- Studies have demonstrated that semaglutide can be used as an add-on to basal insulin, with significant improvements in HbA1c levels and weight loss compared to basal-bolus insulin regimens 5.
- Once-weekly semaglutide has been compared to fully optimized basal-bolus insulin in patients with type 2 diabetes, with results showing that semaglutide is associated with better glycemic control, weight loss, and reduced hypoglycemia 5.
Considerations for Adjusting Insulin
- When adjusting insulin in patients on Ozempic (semaglutide), clinicians should consider the patient's individual needs and response to treatment 3, 6.
- The dosage of semaglutide and basal insulin may need to be adjusted to achieve optimal glycemic control while minimizing the risk of hypoglycemia and weight gain.
- Regular monitoring of HbA1c levels, weight, and hypoglycemic events is essential to guide treatment decisions and adjust the insulin regimen as needed 2, 4.
Key Findings and Recommendations
- Studies have shown that semaglutide is a viable option for treatment intensification in patients with type 2 diabetes on basal insulin, offering improved glycemic control and weight loss with a lower risk of hypoglycemia 5, 6.
- Clinicians should consider semaglutide as a potential add-on to basal insulin in patients who require treatment intensification, taking into account individual patient factors and response to treatment 3, 6.