Can Insulin and Ozempic (Semaglutide) be used together?

From the Guidelines

Using insulin and Ozempic (semaglutide) together is a medically appropriate combination for some patients with diabetes, particularly those with type 2 diabetes who need additional glucose control. This combination works well because the medications function through different mechanisms - insulin directly lowers blood glucose by facilitating glucose uptake into cells, while Ozempic, a GLP-1 receptor agonist, improves insulin secretion, reduces glucagon release, slows gastric emptying, and promotes satiety 1.

Key Considerations

• When starting this combination, patients typically continue their prescribed insulin regimen while adding Ozempic at 0.25 mg once weekly for the first four weeks, then increasing to 0.5 mg weekly if needed.
• Blood glucose monitoring becomes especially important when using these medications together, as the combination may increase the risk of hypoglycemia.
• Patients should watch for signs of low blood sugar such as shakiness, sweating, confusion, or dizziness.
• Dose adjustments of insulin are often necessary after adding Ozempic, as many patients require less insulin over time, as noted in the 2024 standards of care in diabetes 1.

Benefits and Risks

• This combination offers benefits beyond glucose control, including potential weight loss and cardiovascular benefits from the Ozempic component, making it particularly valuable for overweight or obese patients with type 2 diabetes.
• The combination of basal insulin and GLP-1 RA has potent glucose-lowering actions and less weight gain and hypoglycemia compared with intensified insulin regimens, as demonstrated in recent studies 1.

Clinical Decision Making

• Insulin dosing should be reassessed upon addition or dose escalation of a GLP-1 RA or dual GIP and GLP-1 RA, as recommended in the 2024 standards of care in diabetes 1.
• The decision to use insulin and Ozempic together should be based on individual patient needs and medical history, with careful consideration of the potential benefits and risks.

From the FDA Drug Label

OZEMPIC may be taken with or without food Do not mix insulin and OZEMPIC together in the same injection. You may give an injection of OZEMPIC and insulin in the same body area (such as your stomach area), but not right next to each other. When using OZEMPIC with insulin, instruct patients to administer as separate injections and to never mix the products. It is acceptable to inject OZEMPIC and insulin in the same body region, but the injections should not be adjacent to each other.

Yes, Insulin and Ozempic (Semaglutide) can be used together, but they should be administered as separate injections and not mixed together in the same injection. It is also acceptable to inject them in the same body region, but not adjacent to each other 2 2.

From the Research

Combination Therapy with Insulin and Semaglutide

• The use of semaglutide in combination with basal insulin has been studied in several clinical trials, with results indicating significant improvements in glycemic control and reduction in body weight 3, 4.
• A randomized, controlled trial (SUSTAIN 5) demonstrated that semaglutide added to basal insulin significantly reduced HbA1c and body weight in patients with uncontrolled type 2 diabetes compared to placebo 3.
• Another study found that the combination of semaglutide and basal insulin resulted in significant reductions in HbA1c, body weight, and fasting blood glucose levels, without an increased risk of hypoglycemia 4.

Efficacy and Safety of Combination Therapy

• The efficacy and safety of semaglutide in combination with basal insulin have been extensively investigated in clinical trials, with results indicating that the combination is effective and safe for the treatment of type 2 diabetes 3, 5, 6, 4.
• The combination therapy has been shown to provide significant reductions in HbA1c, body weight, and fasting blood glucose levels, as well as a low risk of hypoglycemia 3, 6, 4.
• Gastrointestinal side effects, such as nausea and vomiting, are common with semaglutide treatment, but are often transient and tend to occur during dose escalation 5, 6, 4.

Clinical Recommendations

• The use of semaglutide in combination with basal insulin is recommended for patients with type 2 diabetes who require treatment intensification, particularly those with cardiovascular disease or at high risk of cardiovascular events 7, 5.
• The combination therapy may be considered as an alternative to other injectable therapies, such as GLP-1 receptor agonists or insulin, for patients who require treatment intensification 6.
• Healthcare providers should carefully evaluate the benefits and risks of the combination therapy and monitor patients closely for adverse events, particularly gastrointestinal side effects 3, 5, 6, 4.