This content originally appeared on diaTribe. Republished with permission.
By Christine Fallabel
The world’s hottest new miracle drug for type 2 diabetes, Ozempic (semaglutide), has surged in popularity among people with and without diabetes looking to lose weight, including celebrities and influencers, causing a global shortage. So, what are people with diabetes supposed to do?
The world’s hottest new miracle drug, Ozempic (semaglutide, a GLP-1 agonist), has surged in popularity among people with type 2 diabetes, as well as with people with and without diabetes, including celebrities and influencers, looking to lose weight.
However, this diabetes medication, an injectable drug developed by Novo Nordisk that was approved for use by the Food and Drug Administration (FDA) in 2017, is now increasingly challenging to find for people with diabetes, who need it to help manage their blood sugar.
So, what are people with diabetes supposed to do? We talked with patients and providers to see how they are dealing with the shortage.
What can people with diabetes do during the shortage?
People with diabetes have reported rationing their Ozempic doses to deal with the global shortage. For instance, if they usually take 2 mg per week, they’ve reduced their dose to notched that down to 1 mg per week, and if they were taking 1 mg per week, they’ve rationed their dose down to 0.5 mg. While this isn’t ideal, it can still deliver some benefits of the medication and make it last longer until their prescription can be refilled.
“The shortage of Ozempic has been frustrating for our patients and for us health care providers,” said Nicole Schneider, a diabetes nurse practitioner in Madison, Wisconsin. “Some patients have been on Ozempic for many years, and it’s proven to work extremely well for them. It is upsetting that many patients who don’t even have diabetes are getting Ozempic prescriptions for weight loss.”
In response to the shortage, providers have been prescribing other GLP-1 agonists to their patients, such as the following:
Dulaglutide (Trulicity), injected weekly
Tirzepatide (Mounjaro), injected once weekly
Liraglutide (Victoza, Saxenda), injected daily
Exenatide (Byetta), injected twice daily
Semaglutide (Rybelsus), taken orally once daily
Lixisenatide (Adlyxin), injected daily
Always check your health insurance to see if alternatives would be covered, as coverage can depend on the brand and how your health insurance company covers different products. If you do switch to a different medication, be aware that some are taken weekly, daily, and some twice daily.
To help with blood sugar management, Schneider said many patients with type 2 diabetes have opted to start insulin treatment, which, she said, “may contribute to weight gain and poor glycemic control, which could lead to microvascular and macrovascular complications.”
Kirsten Nowak, of Cleveland, Ohio, has had type 2 diabetes for 10 years and uses a combination of Ozempic, diet, and exercise to manage her blood insulin resistance. She says that she’s increased her daily amount of exercise and has tried to cut carbohydrates because she has not been able to fill her prescription recently.
“Even though I am exercising more and eating very low carb, my blood sugars are spiking, and I am anxious to fill my Ozempic,” she said. “No one knows when this shortage will end. I’ve started taking basal insulin again, and that seems to be helping a little bit with my high blood sugars.”
Increasing your amount of physical activity and changing your diet may help improve insulin sensitivity and glucose levels for those unable to fill their Ozempic prescription. Always talk with your doctor, and if you’re unsure of where to begin, ask to see a registered dietitian for meal planning ideas.
How does Ozempic work?
Ozempic increases insulin sensitivity while inhibiting the liver from releasing glucagon to help lower blood sugar levels. It also suppresses appetite and slows digestion, causing many people to lose weight.
Due to its long duration of action, it is only taken once per week, which makes it convenient.
Although not approved for type 1 diabetes, doctors may prescribe Ozempic and other GLP-1 agonists “off-label” for type 1 diabetes. This may help them better manage blood sugar levels and help to reduce insulin resistance.
Does Ozempic really cause weight loss?
It’s important to note that Ozempic (semaglutide) is specifically approved by the FDA for diabetes and not weight loss. The same medication under a different name, Wegovy (semaglutide), is approved for weight loss and maintenance; however, it is difficult to get Wegovy covered by insurance. Taking Ozempic in higher doses has the same weight loss effects as Wegovy, and often comes with much-needed insurance coverage.
Studies prove Ozempic causes weight loss. One such study showed that participants in a trial lost between 10-15% of their body weight over a little more than a year with weekly Ozempic injections when used in combination with healthy eating and exercise. In the placebo group, only 2% of people lost weight, but in the Ozempic group, about 75% of people lost 5% or more of their body weight.
Another study showed similar results, with participants on semaglutide losing an average of 16.7% of their total body weight versus 0.6% with a placebo. The semaglutide group were also much more likely to lose at least 5% of their body weight, with 84% of semaglutide study participants losing at least that much weight.
Finally, a study called SURE Denmark/Sweden showed significant weight loss among patients using semaglutide, with improved blood sugar and A1C levels as well.
All of this weight loss has caught the public’s attention in a nation that is struggling more than ever with the obesity epidemic. According to the Centers for Disease Control and Prevention, more than a third of Americans have obesity, and another third are overweight.
When people are strapped for time, taking a once-a-week injectable diabetes drug, even if one doesn’t have diabetes, can seem like a quick fix for weight loss.
However, celebrities like Kim Kardashian, entrepreneurs like Elon Musk, and TikTok influencers are touting its weight loss benefits, causing a shortage of the drug in the United States, and many people with diabetes haven’t been able to fill their prescriptions for months. Doctors are equally to blame, who are often giving out Ozempic prescriptions to help people without diabetes lose weight.
Dave Carlson, of Seattle, Washington, lives with type 1 diabetes and hasn’t been able to fill his Ozempic prescription at all this year. “I’m having a really hard time getting it,” he said.
Shannon Moreau, from Stratford, Connecticut, has type 1 diabetes, and she was prescribed Ozempic “off-label” to help manage insulin resistance. “I received my prescription in November and was only able to fill it once,” she said. “I haven’t been able to get my Ozempic since then.”
When people with diabetes who are prescribed Ozempic as a medical necessity are unable to get it, insulin resistance can skyrocket, and insulin needs and blood sugars can fluctuate.
“I’ve stopped taking it completely,” said Kathryn Kirk, who has type 2 diabetes and lives in upstate New York. “It’s really frustrating because my blood sugars had improved immensely over the past year while taking Ozempic, but now my blood sugars are worse, and I’ve gained weight.”
When will the shortage end?
Novo Nordisk is planning to ramp up the development of the drug. Novo Nordisk told diaTribe that its 0.25 and 0.5 pens were having the most supply disruptions, “due to the combination of incredible demand coupled with overall global supply constraints.” The company said in a statement that anyone concerned about their continuity of treatment and care should contact their doctors for advice.
“While we recognize that some healthcare providers may be prescribing Ozempic for patients whose goal is to lose weight, Novo Nordisk does not promote, suggest, or encourage off-label use of our medicines and is committed to fully complying with all applicable US laws and regulations,” Novo Nordisk said in a statement to diaTribe. “We trust that healthcare providers are evaluating a patient’s individual needs and determining which medicine is right for that particular patient.”
For Schneider, the nurse in Madison, Wisconsin, and many other providers we spoke to who see people with diabetes struggling every day to fill their prescriptions, the shortage can’t end soon enough. “I just want what’s best for my patients,” Schneider said, “and the ability to fill their prescriptions is part of that.”