Is Ozempic insulin?

How Ozempic works | Is Ozempic insulin? | Does Ozempic replace insulin? | Can you take Ozempic and insulin together? | Medications taken with Ozempic

Diabetes mellitus is a condition in which the body has trouble producing or managing insulin. Insulin is produced by the pancreas gland and helps the body use the sugar (glucose) from food. Insulin allows cells in the body, such as muscle cells, to absorb the glucose to use as a source of energy. If the pancreas doesn’t make enough insulin, or the body doesn’t use it properly, this can result in high blood glucose levels (hyperglycemia) which could lead to symptoms of pancreatitis.

The two types of diabetes are Type 1, in which the pancreas does not produce any insulin, and Type 2, in which the pancreas still produces insulin but it may not make enough or the body doesn’t use it properly. In people with Type 1 diabetes, since the pancreas no longer makes insulin, insulin injections are necessary. 

Those with Type 2 diabetes, on the other hand, have many more treatment options. The drugs commonly used to treat Type 2 diabetes either have a direct effect on improving insulin secretion or a direct effect on improving the use of the available insulin by the body’s cells.

This article will focus on Ozempic (semaglutide), a non-insulin medication for people with Type 2 diabetes mellitus, made by Novo Nordisk. Ozempic is an injectable drug in a class of medicines known as glucagon-like peptide-1 (GLP-1) receptor agonists. Other GLP-1 agonist drugs include Trulicity (dulaglutide), Victoza (liraglutide), Byetta (exenatide), and Bydureon (exenatide ER). An oral GLP-1 agonist, Rybelsus (semaglutide), is also available. 

RELATED: Is Trulicity insulin? | Ozempic alternatives

How Ozempic works

Ozempic is approved by the U.S. Food and Drug Administration (FDA) for adults with Type 2 diabetes to improve blood glucose levels (as an adjunct to diet and exercise). It works to lower blood glucose levels by stimulating insulin secretion from the pancreas, blocking glucagon, a hormone that causes the liver to release sugar, and slowing down food absorption in the stomach. Ozempic can also help lower hemoglobin A1c (HbA1c), a measurement that shows glucose control over a two- to three-month time frame.

Although Ozempic is not approved by the FDA for weight-loss, many people lose weight when initiating therapy because they feel less hungry and eat less. Semaglutide, under the brand name Wegovy, is approved as an adjunct for weight loss along with a reduced calorie diet and increased physical activity.

 Ozempic is not approved for use in Type 1 diabetes or for the treatment of diabetic ketoacidosis, a serious complication of diabetes that develops when the body doesn’t have enough insulin to allow blood sugar into the cells for use as energy.

RELATED: Who can take Ozempic for weight loss?

Is Ozempic insulin?

Although Ozempic is an injectable drug, as are most insulin products, it is not the same as insulin. Manufactured insulin products are either the exact same hormone as that produced by the beta cells in the pancreas (e.g., Humulin R or Novolin R) or variations similar to the actual insulin hormone (e.g., Humalog or Lantus). 

Ozempic vs. insulin

Unlike insulins, which are used to treat both Type 1 and Type 2 diabetes, GLP-1 agonists are a class of drugs only used to manage Type 2 diabetes. GLP-1 is a hormone produced in the intestine that helps with blood sugar control. GLP-1 agonists help enhance the effects of this naturally occurring hormone by: 

• Increasing insulin secretion by the pancreas
• Decreasing glucagon secretion from the pancreas
• Slowing gastric emptying

GLP-1 agonists’ main effect is to lower blood glucose levels immediately following a meal. Because Ozempic works only when a person eats it is less likely to cause low blood sugar levels (hypoglycemia) like may occur when using insulin, particularly intermediate (e.g., Novolin N) or long-lasting (e.g., Lantus) insulins. 

Dosages

Ozempic and insulin are dosed differently. Insulin must be injected at least once daily and, in some cases, up to three or four times daily. Ozempic is a long-acting diabetes medication and a dose of Ozempic is administered just once weekly. In the case of a missed dose, you can refer to the drug’s medication guide and reach out to your prescribing doctor if you have further questions as to when to take your next dose. 

Side effects

Ozempic and insulin share some of the same safety concerns. By nature of being injected in the subcutaneous tissue, i.e., just under the skin, people may experience injection site reactions such as pain, irritation, or redness from both the Ozempic pen and the insulin pen or syringe. Both Ozempic and insulin may result in low blood glucose levels, or hypoglycemia, characterized by the following symptoms:

• Fast heartbeat
• Lightheadedness or dizziness
• Confusion 
• Feeling nervous or anxious
• Sweating and chills
• Hunger
• Irritability

Because Ozempic and insulin work differently in the body to help provide glycemic control, they have very different safety profiles. The use of insulin may result in weight gain, whereas use of Ozempic typically results in weight loss. Other common side effects of Ozempic include the following:

• Nausea
• Vomiting
• Diarrhea
• Stomach pain
• Constipation

More serious side effects of Ozempic include the following:

• Allergic reactions 
• Thyroid cancer, including medullary thyroid carcinoma (MTC)
• Thyroid tumors
• Acute pancreatitis
• Diabetic retinopathy complications
• Acute kidney disease or worsening of kidney disease

All GLP-1 receptor agonists, including Ozempic, carry a “boxed warning,” also called a black box warning, regarding the risk of thyroid C-cell tumors. Ozempic is contraindicated in patients with a personal or family history of MTC or in patients with multiple endocrine neoplasia syndrome type 2 (MEN 2).

Does Ozempic replace insulin?

Ozempic and insulin are both injectable diabetes drugs however Ozempic does not replace insulin in those with diabetes whose pancreas does not produce insulin. Also, insulin may be used to treat either Type 1 or Type 2 diabetes, but Ozempic should only be used by persons with Type 2 diabetes. Ozempic is designed to respond after a meal when blood glucose levels rise, helping the body to release its own natural insulin. In this way, Ozempic works with the body’s ability to lower blood sugar and, as a result, can help lower a person’s A1c. 

 Neither Ozempic or insulin are necessarily better treatments compared to one another. The best treatment depends on the specific needs of the person with Type 2 diabetes. In head-to-head studies comparing the addition of either an insulin or a GLP-1 agonist to people with Type 2 diabetes already taking an oral diabetes drug, it was concluded that slightly better blood glucose control was seen with the addition of a GLP-1 agonist as compared to the addition of insulin treatment, with added benefits regarding weight loss, fewer hypoglycemia events, and improved blood pressure readings.

Can you take Ozempic and insulin together?

Ozempic and an insulin product may be used together if your healthcare provider determines that would be the best treatment regimen for your specific needs. Always seek medical advice from your healthcare provider to find out about possible drug interactions with prescription drugs and or supplements that you are taking. If prescribed together, the following are important considerations:

• Ozempic and insulin should not be mixed in the same syringe prior to injection.
• An injection of Ozempic and insulin may be made in the same body area (e.g., the upper arm or stomach area), but the injections should not be made right next to each other.
• When adding Ozempic treatment in people with Type 2 diabetes already using insulin, the dose of insulin may need to be decreased to reduce the risk of hypoglycemia.

In a review of clinical trials in which a GLP-1 agonist was combined with a basal, or long-acting, insulin, similar improvements were seen in the level of blood glucose control however the added benefit was greater loss in body weight.

Which medications are taken with Ozempic?

According to the American Diabetes Association Standards of Medical Care, metformin, an oral antidiabetic medicine, is considered first-line treatment for Type 2 diabetes. Because Type 2 diabetes is often a progressive disease, maintenance of good blood glucose control will often require combination therapy. In those patients with Type 2 diabetes who also have medical conditions such as cardiovascular disease, kidney problems, or heart disease, a GLP-1 agonist with demonstrated cardiovascular disease benefit, such as Ozempic, is recommended to be added to the metformin regimen. 

Besides basal insulin and metformin, other oral medications, such as sulfonylureas (e.g., Glucotrol or Glynase), may be prescribed along with Ozempic. Because the risk of hypoglycemia may be increased when adding a sulfonylurea, the Ozempic prescribing information recommends a reduction in the dose of the sulfonylurea when combining therapies. 

RELATED: How to save money on Ozempic

If costs are a concern when it comes to choosing which medications are right for you, using a SingleCare prescription discount card can create a savings of up to 80% off on Ozempic and many other prescription drugs at your local pharmacy.