I love Ozempic!

Type 1 and LADA
21

Yeah, those yeast infections were the thing that put me off trying a SGLT-2. When I was very young and only taking one shot a day, I had them all the time. All the time! I was at the doctor all the time because of them and of course the sugar pouring out in my urine caused bladder infections and even a kidney infection.

So when we talked about trying a type 2 drug to help with some of my diabetes frustrations, I went with a GLP-1. When I first started with it, there wasn’t as many as there is now. I went Victoza which many don’t use due to injection is everyday vs some being weekly. After all those years of injections, it wasn’t a deal breaker for me. I have been on and off it for many years. My biggest frustration is that many clinical trials won’t let you use it. The 2 year stem cell study was very hard, but they finally about a 16 months in let me go back on it because the devices had all been removed. I hate the going on and going off because I have to slowly ramp up doses or stomach issues could be an issue. I go slowly so it has never been a problem.

Yeast infections for both men and women is a huge downside to a SGLT-2 but now the drugs to help are OTC so much easier to handle. So maybe that is why many are going with it.

For me the weight loss and appetite suppression was just what I needed to help with that stupid last 10 pounds. When I first started with Victoza, I lost around 40 pounds but did it over about 3 years. It was slow and steady, just the way I needed it. So now that I am on and off, I have that darn 10 pounds that just hangs on. And unfortunately I am starting another study after the first of the year and need to be off the drug for at least 6 weeks, so not really worth ramping up slowly and than stopping. So I just wait and hope the new study might help with some weight loss.

I will say the Farxiga helped with blood sugars but nothing on the weight side. And for me the increase in ketones was a problem. I never got higher then 1.0 on my meter but wow, I felt like crap. And again, the DKA experience at diagnosis has made me do everything I can to not be there. I don’t ever want to feel like that again, and this drug did make me feel like that. Even at .8, I was feeling dehydrated, labored breathing, lethargic. Just not a good place for me to be. But this is just me. I am a little more sensitive to some amounts.

But the cool thing about both these cases of drugs is that the do help some people. And if you can find a doctor to help you with the dosage and finding the right one for you, they can really help. And many of them help with cardiovascular issues! Double win!

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They have a warning of DKA for T1, while having normal BG readings

23

I read an article that I can’t find now, but it said that if you are taking 1 unit per hour by pump or injection, you won’t enter into DKA no matter what your sugars are.
I can’t find it now, but it would be useful to know if you are taking this drug.
I also don’t know if being on one of these drugs, would alter that 1 unit per hour threshold.

I take right around 1 unit per hour, but a lot of people take way less.

I’ve been in dKA a few times and it’s no picknick. Feels like the world is ending, or a feeling like I wish it would. And it takes 10x the insulin to bring it down.

I would immediately know if I was in dka because I know how it feels. But if my sugars were normal, maybe I wouldn’t notice.

There needs to be a lot more study on this.

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Euglycemic doesn’t mean “normal” BG readings. It means the DKA happens at less ELEVATED levels than typically associated with DKA. It includes BG readings all the way up to 250mg/dl.

You still have to have elevated sugars for a prolonged time for DKA to develop, and usually compounding factors such as illness, infection, or dehydration (from the FDA’s adverse event reporting). The SGLT2s lower the threshold for spilling glucose, but not well enough to achieve gluco-normal (less than 140) numbers on their own without any insulin.

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I’ve had the same result! It was my cardiologist who suggested Ozempic and gave me some samples, which I was so impressed with. My endo is not a fan, but did prescribe Trulicity, which is covered by my Medicare Part D.

That was horrible! My BG actually went up, I didn’t lose weight, and I was so constipated it took several sticks of dynamite to relieve the blockage.

My cardiologist helped me apply for the Novo Patient Assistance Program, and I was able to get back on the Ozempic. The results have been astounding — I’ve lost about 15 lbs since the first week in September, have reduced insulin by about 25 units per day, and generally feel better, if you want Ozempic but can’t afford it, I highly recommend the Patient Assistance Program.

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26

Yeah this was the problem for me. My basal rate is set at .3 for my work days, so when working the pump will be even lower than that set rate. And when using these type 2 drugs ,any have to lower insulin level, which is where I got into problems.
So the treatment plan was to snack every 2 hours and take insulin for those carbs. It worked but doesn’t help with the weight issue. When using these drugs there needs to be enough insulin floating around. So if you have low levels, DKA can be a problem.
I don’t think it will be a part of my toolbox moving forward due to my insulin levels, but there are many people using them very successfully! I do recommend having a ketone blood testing meter for anyone moving forward with these drugs. Actually I think most of us should have one. You never know and the strips are sealed.

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Type 1 diabetes has unknown cause(s) (last I looked). There’s a theory it might be induced by a viral infection, but many disagree. Does not seem to be much of a genetic component. For some reason, your pancreas takes early retirement, and the only answers are 1) insulin; and/or 2) transplants.

Type 2 diabetes has 3 well-known causes: 1) heredity; 2) age; and 3) weight. For reasons that escape me, most endocrinologists say it is impossible to be Type 1 and Type 2, but I (as have many others) got to be 60 years old and suddenly my insulin requirements greatly increased. Also, Humalog that used to work very quickly began to work very slowly. I thought of metformin, and finally asked my endocrinologist. She said there was nothing in the medical literature about someone with Type 1 developing Type 2, but scouring the literature, I found a very few articles about insulin resistance in elderly Type 1 diabetics with a family history of Type 2. She finally said, ‘Try metformin,’ and I’ve been on metformin for the last 5 years. Sounds like Ozempic might be better. The old Type 2 drugs from before metformin had problems: they did not extend life expectancy. The patients taking them did not die of renal failure and did not suffer gangrene, but they meant you died at about the same time as you would have died from Type 2 complications, but from different diseases (they also tended to cause weight gain). Then came metformin, by far the first choice for a newly diagnosed Type 2 (after telling the Type 2 to lose weight). And now there are other drugs for insulin resistance, and this discussion makes it sound like Ozempic might be better than metformin.

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It’s pretty well documented that type 1 diabetes is an auto immune disease.
Often a virus that the body fights off, but ramps up the immune system so much that it mistakenly attacks the beta cells.

My doctor diagnosed me with coxsackie B virus that I was still sick with and is a known trigger for type1. That was 34 years ago and it was known back then. But other viruses can trigger it too

Not all type 1 people have obvious infections, some don’t present any illness. But it is still and immune response that kills off the beta cells.

The genetic connection in type 1 is more of a risk or disposition than a innate disease like type2.
A person who is genetically type 2 will develop the disease no matter what other pathogens he or she is exposed to.

A person who is predisposed T1 will only develop the disease if the right immune trigger is introduced.

So they are both genetically driven, but the mechanism is different

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Last time I read the literature (a few years ago) it was suspected by some researchers that heredity and viruses might be involved in Type 1 diabetes, but it was not irrefutably proven, and different researchers reached different conclusions about the etiological significance of both.

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This is a pretty good explanation of type1 and the current understanding.

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They need better commercials

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There is a study in Charlottesville which is testing type 1 and Jardiance(sp?) at a lower dose. The goal is to safely increase time in range. The initial story is that it is extremely successful with little risk at the lower dose.

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@Jaybear, @Skye, @Drammar, @Robyn_H (and others) - I have been researching the glp-1 receptor agonists and am thinking about making the argument to my PCP (who oversees my type 1) to give one of the drugs a try. Wondering if you have thoughts on my questions:

  • any effect on dawn phenomenon? (I am hoping that the glucagon inhibition could be seen here!)
  • did you see any improvement in your time in range?
  • was it a hassle to get your insurance company to pay?
  • any recommendations on a specific drug to try to get started on?

Thank you so much! Jessica

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@Jessica —

I hope you are successful. It has made such a tremendous difference to me.

Control over the dawn phenomenon has been nothing less than amazing. My BG used to rise between 20-40 points in the morning, which was very disheartening. Since being on Ozempic my BG doesn’t rise until I’m actually up and moving — and then only about 5-10 points.

Yes, the time in range is much improved. I use the T-slim pump with the Dexcom G6 CGM, and between those, and the Ozempic I am rarely out of range.

My insurance will not pay for it. We have Medicare Part D pharma coverage. It will cover Trulicity, but not Ozempic. I was able to get help through the Nova Patient Assistance Program.

I find Ozempic works for me and Trulicity doesn’t. Can’t speak to any of the others.

AND — I continue to lose weight.

Hope this helps!
Drammar

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35

I use Tandem’s Control-IQ with sleep mode engaged nearly all the time, so I already had great time in range and it makes DP pretty much disappear… But with the GLP-1 RA, I’m able to do it with less insulin, which is the biggie for me. I’m intimately familiar with weight loss physiology, and I know my struggles are directly related to my insulin intake… Not food/exercise.

Our metabolisms are screwed up. We’re missing more than just insulin. There’s a communication breakdown in the system. I really feel like the GLP-1 RA is setting some of that straight.

It’s really easy for people who don’t struggle with weight to just say “eat less, do more exercise”, like it’s obvious. But the story isn’t that simple. I eat between 1,200 and 1,300 calories a day, without fail. I drink water like a fish. As a permaculture homesteader, I’m eating better food than most. I have a highly active lifestyle and make a point to exercise daily on top of it… and still struggle with weight! 2/3 of type 1s are overweight or worse. Yes, there’s an obesity pandemic in general, but 30-60 year old type 1s are heavier than our non-diabetic counterparts. It’s a growing problem that the medical community is highly focused on. As more of us are reaching treatment goals, the trend is that we’re blowing up like balloons. The skinny stereotype we’re known for was a product of poor control, and the truth of our problematic metabolism is becoming more evident.

I’ve noticed a big difference with the post-prandials. Did you know that while most people suppress glucagon while eating, we actually release MORE of it when we eat? Those after meal spikes aren’t just from the food we eat, but the additional glycogen the liver puts out (the stuff our basal insulin covers). So not only do the GLP-1s slow down your food absorption to better match your insulin, but it suppresses that glycogen spike. Win/win!

I’ve had zero problems with insurance coverage, but mine does require 3 months of Metformin before you’re allowed the more expensive stuff, though. Metformin was the first thing my doc prescribed anyway, though, when I mentioned wanting help with the weight loss. It did absolutely nothing, but it meant I had no problem upping to other type 2 meds.

I’ve only tried Trulicity, as far as the GLP-1s go, and I love it. This thread has me curious about Ozempic, though. Part of me wonders if it’s actually better, but the other part says “if it ain’t broke, don’t fix it.”

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36

I hear you re the yeast infections. Back when I was diagnosed – 1971 – within two years I had a yeast + vaginal strep infection + body-wide thrush infection that landed me in the hospital for ten days. I started out at my primary care doc complaining of the issues … he stood up from behind the desk and smelled my breath. He said to my mom, “Go to the hospital NOW.” As we walked in the entrance, a nurse standing there asked my name. She then proceeded to give me a large insulin injection in my deltoid. Yeah – good times!!!

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A month or so after measles (in spite of vaccine), I passed out after my usual 4 ounces of morning orange juice. My dad, his mom, all his brothers and sisters, all my older cousins were T2D, all tall and lean. My dad suspected blood glucose issue, immediately, took me to his endo. It was diabetes, but I was diagnosed T1D, like his father. One way or another my genes would have led to diabetes, but those needles! A friend who was an internist also suspected an autoimmune response to a disease process could help explain T1. A Lancet article in 2003 explored that and possible vaccination ties to autoimmune processes, but did not see connections to diabetes. Time will eventually tell. For now, all I know is Ozempic is a huge help.

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