Have been Type 1 or LADA? for 39 years with slowly increasing weight gain…worse since Covid and now have insulin resistance as a result? Both Type 1 and now, Type 2 as well. On insulin pump and endocrinologist recommending adding Ozempic. Have consulted second endocrinologist at University Center and told it would be safe for me to add Ozempic. I still am feeling really conflicted about the side effects and possible dangers as a Type 1. Also not told what to do with my pump settings if starting the Ozempic. Anyone with experience adding Ozempic to insulin therapy.
No personal experience with Ozempic. However, there have been several news comments that it seems to cause incontinence. You should look into this before trying it.
Welcome to the group.
This drug, Ozempic is aGLP-1agonist that gives one a feeling of fullness and increasing insulin secretion. Appetite suppressant can be helpful for you, but not will cause insulin secretion in a type 1.
I would think that Metformin would be the best first drug to try. It reduces glucose release from the liver, slows digestion and does increase cellular sensitivity to insulin. That’s if one can tolerate it, with their bodies adapting to the slower digestion and the cessation of gastric problems.
In my personal experience as a long time type 2, there are 2 key components in good glycemic management. 1. A low carb diet and 2. Regular, daily or nearly daily exercise. No type 2 pharmaceuticals work well without this 2 things.
A lower carbohydrate diet reduces the glucose entering the bloodstream and exercise increases cellular insulin sensitivity.
When your Beta cells bit the dust you lost 2 hormones, insulin and amylin. You can live without amylin, but no insulin. Pramlintide is an amylin analog that has been helpful for some people with type 1 and insulin using type 2. I believe the results are mixed. It requires preprandial injection, so there is that.
Actos (pioglitazone) is a once daily oral that actually works by increasing insulin sensitivity… I personally have avoided Actos because of the potential for bladder cancer which one of my grandfathers had.
To reiterate, lower dietary carbs and regular exercise are really important with insulin resistance, whether taking any drugs.
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Thank-you for the information and your thoughts. I now will discuss with my provider. I would not hesitate to try the metformin first. I didn’t mention that I have very restricted activity now due to late stage radiation heart disease…obviously complicated by DM. (I was diagnosed type 1/LADA on pre-op labs for a mastectomy at age 30 for breast cancer.) Interesting ride, but i am still hanging on. I walk as much as I am able with very easily provoked angina. Eager to start ‘river walking’ at our pool this week. I have off and on tried a lower carb diet as I know that makes the most sense in my situation. I am hoping the added metformin or Ozempic might help with the newly worse carb craving. Again I appreciate your reply and will discuss adding metformin as a first trial. My understanding is that Ozempic directly suppresses appetite…but also nausea/vomiting side effects contribute to weight loss. I do not tolerate nausea/vomiting at all due to it triggering ridiculous bradycardia…The worst ‘sense of doom’ imaginable! Metformin therefore seems a better option. Again, thank-you for your reply.
I feel for you about the radiation induced heart trouble. That’s a side effect of radiation therapy that’s new to me. I think sometimes how much insulin I would have to use if I couldn’t exercise. I hope the river walking becomes a fun and doable thing for you.
On the Metformin, It is best to start with a low dose, either regular or extended release to give your digestive system time to adjust. I have never had nausea with Metformin, more in the lower gut,
One other thing, sugar alcohols which are common in sugar free candies have a laxative effect. In combination with Metformin this can be embarrassing. I was blaming diarrhea on Metformin when it was actually caused by a sugar alcohol in Qwest bars (sweetened with Erythritol). I gave up Qwest and everything is copacetic 
I really liked those Qwest bars but not the side effects 
.
Hoping you find what works well for you.
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I just ran across this on GLP-1 agonists use by Type 1s. It suggests that this drug class does increase insulin sensitivity.
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The article you shared was VERY useful regarding other hormonal issues in T1D and the off-label use of the GLP-1 medications in addition to insulin. The website, T1D Exchange, will be helpful, too.
In regard to sugar alcohol sweeteners, I learned the hard way very early on, when friends were offering me ‘diabetic treats’. The resulting bowel gas along with diarrhea, quickly taught me to say ‘no’ to ‘diabetic foods’ containing any sugar alcohols. Another hidden source is breath freshener mints.
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I have been type1 for 35 years. When I started intensive insulin therapy with a pump, I also slowly began to gain weight. Partially because I was encouraged to eat anything I wanted, and I did for a while. But really almost no one ,diabetic or not, can eat like that.
I had an impossible time dropping weight even low carb wasn’t helping me because my blood sugar would drop and I would need to eat carbs anyway. I never felt like it was healthy for me as I was never a big meat lover. To go low carb meant eating a lot of it and I got tired of it after about a year.
So I tried Mastering Diabetes. Low fat and high carb, only not processed carb but carbs like potatoes and corn etc. the diet is vegan, but I still eat some lean meat once a week or every other week. Just for protein. I’ve gone all in and I found that I just didn’t feel great till I added back a small amount of meat.
That being said I was able to lose a small amount of weight. I started at 36 lbs overweight. At 6’3 I didn’t look that heavy but I realized my bmi was getting close to the obese range of 30. Where I was at 29 or so.
I decided to try intermittent fasting, along with the MD diet. Simply, I eat only one meal a day on weekends.
I never thought I could actually fast 24 hours and I was always warned against trying.
But as it turns out Fasting makes my blood sugar pretty close to perfect. Even with exercise. I don’t need any glucose or food and my sugar stays in range. Clearly I’m in Ketosis from this kind of fasting and exercising, but I eat a carb meal at the end of the day. And I don’t feel deprived. Of course I have a pump and thst helps I’m sure. But nothing like the constant chasing lows and highs I normally deal with when exercising.
In 3 months on this way of eating I’ve lost 21 Lbs and my sugars are in the high 90s for TIR. I’m getting close to my target weight of 200, which puts me into normal weight range, but I intend to go to 190.
I was never able to drop weight before and also I learned more about metabolism in 3 months than I ever knew was possible.
I really thought I knew how this all worked but I was wrong about a lot of things. I studied biology in college and I am a heavy reader about all things diabetes, but really I was in the dark for most of my life.
Mastering Diabetes really cracked the door open to a very different understanding about metabolism and insulin.
The number 1 thing I was taught early in was that mixing carb with fat is the way to keep sugar level. But really it’s a terrible idea. I mean I suggest one or the other. Both together is difficult at best, consider pizza or lasagna. It’s very difficult to dose and it also takes a ton of insulin to metabolize.
MD is not for everyone. Some people do really well with low carb and other diets too.
Others just don’t want to give up the daily ingestion of dairy and meat, but it has helped me get a better hold of my type1.
But mostly I like it, the only issue is the social issues of only eating one meal on weekends.
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I’ve been using Ozempic for a couple of years and have type 1. It is incredible. I have also used other variations of the med (Victoza, Trulicity, Symlin) in the past. No issues with nausea, vomiting, etc.
They really help with keeping me feel fuller longer. I used to be hungry and eat all the time - as type 1s we are missing hormones other than insulin, and this helps fill that gap. I’d recommend trying it. People who are worried about cancer and other side effects - that could go for any medicine. I figure this helps with keeping my blood sugars in a better range and keeps me at a lower weight (I do count calories but it’s easier to eat less!), which is better for my health overall.
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Glad to read your reply about Ozempic. I have mostly been worried about the nausea/vomiting which i don’t tolerate… I have heard of a few ‘horror stories’ about constant nausea, and am taking too many medications to add an anti-emetic drug like Zofran. My practitioners say they have not had the nausea issue with other patients? I know it would help the weight issue and insulin resistance…still weighing the best decision to make… Thanks for your response.
Check out Diabetes Connections - a podcast site. Their June 13 2023 edition has an interview with Dr Steve Edelman (Endo with T1D and founder of TCOYD) discussing this very issue - T2D Rx’s for T1D people.
Thank-you. What a wonderful Podcast. I learned so much and with questions answered, I am going to start the Ozempic.
@Allison1 , have you encountered any eye issues? I’m going to explore Ozempic as a T1 and am curious about the eye warnings.
Nope! I didn’t have any to begin with, not sure if that matters. I’ve been type 1 for 27 years.
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Good to know. I hadn’t had any either as 23 years T1, however, I recently had a vitreous detachment, which my ophthalmologist says is due to age. Idk, there’s no retina damage, but it scared me nonetheless. I guess that gives me a little pause. I will check with the ophthalmologist first, if my Endo thinks it’s a good option.
I’m not sure I have insulin resistance. I actually use less insulin than I did a few years ago. Though, I have fantasied taking the Ozempic, going back to MDI, taking a long acting insulin twice a day ad then small boluses before meals……is that feasible? I have a love/hate relationship with my pump. Lol
Like Allison1, I have also been using Trulicity for many years. I have not encountered nausea/vomiting during its use. My endo prescribed it to delay stomach emptying and help with insulin resistance. Trulicity has a “starter dose” that is half the usual dose that may help with preventing these symptoms. It may be the same for Ozempic. Trulicity is a once a week injection. I indicated no vomiting or nausea. But I do have occasional itching at the injection site that lasts a five or so minutes after injection.
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I am a type 1. I have not tried Ozempic. I react badly to drugs easily, so my reactions will not necessarily be yours. I was put on all sorts of drugs, one after another because I was misdiagnosed and my Bg level was still climbing. Part of my issues could have been I needed bolus insulin not drugs. I was just on a basal dose.
Actos caused major swelling in my legs. One of the common side effects is swelling. Mine was bad, made my legs ache like crazy before I realized what was going on. It can also cause weight gain, although they mention it might be from the increase in swelling it causes. But Actos also has a pretty stern heart risk warning, and you mentioned heart issues.
I had no side effects from metformin until they increased my dose. Once that happened, major nausea started and constipation. Usually people are prone to diarrhea. Going back down to a smaller dose didn’t work once it started. I started vomiting about 30-60 minutes after I took any dose. Unfortunate, because that is one of the safer drugs to use. It actually has some pluses to it. My husband takes it and he has no issues with it.
I really am of the belief Victoza almost killed me. Extreme nausea with the first dose. Once I took the second dose I was dry heaving, I was dry heaving only because I wasn’t eating because of the nausea. Within about 6-8 hours I had barely any energy and couldn’t even fathom getting out of bed. I remember thinking that maybe I should have my hubby call 911, but I didn’t want to even handle moving and the EMT’s making me get out of bed. My sugars were staying around 250, I ended up taking some sips of ginger ale with a small amount of basal insulin. I hadn’t taken any because I wasn’t eating. I rode it out and often wonder if it was DKA. I knew nothing about DKA and that it even existed.
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I want to know how so many T1s are getting GLP-1 RAs prescribed?
I used to take Trulicity, not Ozempic, and loved it. I felt like suddenly something just clicked on my metabolism and things just finally fell in line. I guess it restored some of the broken communication pathways. Post prandial spikes disappeared saved it cut my TDD nearly in half. (I’ve since Heather that I’m allergic to insulin, so this alone may have been responsible for a lot of my feelings.) But then United Healthcare gobbled up my little instance company last year, and they started denying the script. My plan didn’t change, just the people pushing the paper. I even tried to fight the decision, but they declared that it’s contraindicated for T1s and wouldn’t even consider it, even though previously my plan did.
So… If United Healthcare is the biggest medical insurer in the US, how are so many T1s getting around this obstacle?
I’ve heard it said that the GLP-1 RAs just went before the FDA at the wrong time for T1s. HbA1c was basically the only meaningful parameter measued, and there was not any significant difference there. FDA decided it wasn’t worth the increased risk of hypoglycemia for T1s without considering any of the other improvements. There haver been panels on “adjunctive therapies” for T1s (basically anything we can take in addition to insulin to fix the bigger metabolic problem) at the ADA Scientific Sessions, and it seems like the general consensus is that the FDA would have made a different decision if they had all the info THEN that we know NOW.
@Robyn_H , I don’t know how that works, except that I was prescribed Invokana years ago off label and my insurance covered it. I presumed no one checked into which type I had. I stopped that med after consulting with my Endo due to infections that I had never had before. I can’t prove it caused them, but……it was not for me. My Endo this time prescribed my Wegovy, small dosage, instead of Ozempic, since I’m t1. Maybe, insurance is more strict now on t1……? Anyway, since it’s on back order, I’m not sure when I’ll get it. I do qualify for Wegovy due to my weight and health condition.
I don’t know why you couldn’t do that - it’s called the “untethered” method - taking a long acting shot and boluses via pump. What is the issue with your pump? I have found that when my settings are dialed in right, it runs like a dream.