Three months on Ozempic and don´t understand what is happening!

I don´t have diabetes 2 (yet) but was diagnosed with insulin resistance back in June. I hope it´s OK to post here anyway!
My fasting insulin came back at 45 (ref 2.6-24.9) and should ideally be <5 according to doctor. Back then, I had terrible carb cravings. My doctor ordered the tests because I had been gaining a lot of weight which I attributed to increased appetite and difficulty controlling cravings.
I was put on Ozempic, started on 0.25 mg weekly, raised it to 0.5 mg weekly after four weeks and then to 1.0 mg weekly on August 7. My doctor said that, given my size (weight), I was likely to need at least 1 mg weekly.
I just got my latest lab results back and I do not understand what is happening: my fasting insulin has risen to 50(!). At the same time, my fasting blood glucose levels have decreased slightly (from 1.10 to 1.03; ref 0.74-1.09). I think they should be lower but still have improved somewhat. But can anyone help me explain what has happened to my insulin levels?! I know Ozempic helps the body produce more insulin to lower blood glucose levels, but is it normal for already high insulin levels to further increase on this drug? Chronic high insulin is said to have damaging effects on the body so I am anxious to sort this out. I am seeing my doctor on Sept 30 but would love to discuss this with others first.
I have felt great since starting Ozempic, the carb cravings are gone, I can now eat a healthy diet with a focus on good fats and protein and, as a result, I am slowly losing excess weight. I have not experienced any side effects.
Besides Ozempic, I have also been on berberine and chromium recommended by my doctor. But they don´t seem to do much for me, do they…?

I am not sure about this because I have never heard about testing insulin levels to see if your medication is working etc. Usually you’re looking at blood glucose levels not insulin levels. I would think if you normalize the blood glucose levels with whatever medication you’re using that would reduce the insulin levels as well but it doesn’t seem to have worked for your situation. But you’re on a medication that increases insulin production so maybe this is normal.

I’m not sure which measurement you’re using for Bg, could you translate that- like it is it 70- the fasting blood glucose?

Do you know what your a1 c is? That along with your fasting blood glucose will tell you if you are in diabetic range yet.

I hope someone comes along with some better advice.

It does make sense that Ozempic would raise your fasting insulin level. Increasing beta cell output is one of the things it does along with inhibiting the release of glucose by your liver and slowing stomach emptying.

In all the lab results I have received in my 30 years with Type2 diabetes I have never seen a fasting insulin test performed. The tests that have always been used to track my diabetes is an A1C test and fasting glucose test.

I am unfamiliar with what fasting insulin levels should be, but you indicate that, according to your doctor, your reading is high. While there are other possible causes for high insulin levels, insulin resistance is the most likely cause.

I am confused by your doctor’s approach, while Ozempic does increase insulin production, it does nothing to address your insulin resistance problem. As I see it more stress is being put on your pancreas.

Has your doctor discussed with the possibility of you taking an oral medicine to lower your insulin resistance, a couple of drugs come to mind, metformin and pioglitazone, with metformin being the drug prescribed most often.

1 Like

After that long winded explanation another possibility comes to mind, polycystic ovarian syndrome. One of the symptoms is insulin resistance which causes increased insulin production. The symptoms don’t stop there, please use this link to see more.

Polycystic ovary syndrome (PCOS) - Mayo Clinic

The GLP-1 RAs most definitely help with insulin-resistance. It’s generally believed that they’re most effective at this by suppressing inflammatory cytokinases, but there are others means of doing so, too.

Though, I’m guessing you already knew this, as a simple Google search shows this along with the unlinkable (direct pdf download) PCOS article that likely lead to your next recommendation. Your didn’t modify your previous judgement about GLP-1 RAs not being able to do so, though, and I have a hard time leaving misinformation hanging there.

Sorry, @Anna69 , I don’t have a better answer to your question. I agree with @Stemwinder_Gary that it seems like you’re looking for the wrong result/information with this combo. Higher levels of insulin production are just par for the course with T2. It’s like running a diagnostic test for a disease you already have a diagnosis for. Were you fasting for those blood tests and had them done in nearly identical circumstances (time of day and similar daily routine)? Because insulin production varies so much through the day, it would be incredibly difficult to make a worthwhile comparison. It’s not an average value, like HbA1c. Your insulin production can spike drastically in some circumstances and plummet in others.

In theory, the only way to make less insulin is to need less insulin, which you get to by losing weight, decreasing insulin-resistance, and modifying good choices (edit: food choices). Your Ozempic can help with the first 2, but it’s a slow pathway. The studies are usually looking at these results 18+ months down the road. And I’ve never once read a GLP-1 RA study that used reduced insulin production as a measure of success. So we can only draw a theoretical correlation between the two.

Also, this conclusion that increased insulin production leads to complications is subject to the age old debate of causation vs correlation. Yes, we know that people with elevated insulin production are more prone to a myriad of health complications. It just so happens that Type 2 diabetics are the ones most commonly making extra insulin, because of their insulin-resistance. Type 2 diabetics are prone to those complications already. We can’t say for sure that it is the increased insulin that CAUSES the complications, as they could be a result of of other factors associated with Type 2, such as increased inflammation, reduced ability to heal, and the damage elevated sugars cause to blood vessels. All we can say is that there is correlation between the two. It might not be worth stressing over how much insulin you make, so long as you still have the ability to make it!

I suspect a typo in @Robyn_H’s comment, “modifying good choices” was intended as modifying food choices.

For those who need a reminder, like me, GLP-1 RA, means glucose like peptide 1 receptor agonist.

1 Like

@Anna69 welcome to the forum. I don’t know what country you call home. The USA and a few other nations measures blood glucose levels in mg/dl, it appears your BG is in grams/Liter, so 1.03g/L = 103mg/dl. Most other nations use mmol/L. 1.03g/L= 5.7mmol/L.

I ran across the use of grams per liter on another site.

I have to agree with @Stemwinder_Gary that this drug stimulates higher insulin secretion. The best way I know to increase insulin sensitivity is regular exercise. There are a couple of drugs, such as Actos that do increase insulin sensitivity.

1 Like

Yep. I type on my phone. Together with autoINcorrect, we’re truly skilled at making typos

3 Likes

Perhaps my simple Google search was too simple. I did not see or at least I did not pick up on this fact. I would never wish to mislead anyone, and I apologize if I did.

In what I read, Ozempic was said to increase insulin production, reduce liver glucose dumps and slow carb absorption by slowing stomach emptying. Never was reduction of insulin resistance mentioned.

It horrifies me to think I may have mis-lead. @Robyn_H can you please help me see what I have missed on this subject, any links you have read on this subject would be of great help to me.

My apologies. I knew GLP-1 RAs worked for insulin resistance because it’s one of the big selling points amongst the proponents of it for use in T1 diabetics, since we generally have insulin resistance, too. (Even those who think they’re sensitive, it’s mostly just in comparison to other diabetics. The subcutaneous delivery alone makes us resistant.) But since I wouldn’t expect my own opinion to be enough, I did a Google search for references. This was the very first item I was shown:

I can’t share the link for that particular article because it’s a direct download link for the pdf file, which TuDiabetes doesn’t permit. Upon clicking it, though, the title of the paper is “The Role of Glp-1 Receptor Agonists in Insulin Resistance with Concomitant Obesity Treatment in Polycystic Ovary Syndrome.” I wrongly assumed you did the same exact Google search and read the same result, given your follow response about PCOS.

From the abstract:

Glucagon-like peptide-1 receptor agonists (GLP1-RAs) not only act by reducing body weight but also can affect the mechanisms involved in insulin resistance, like an increasing expression of glucose transporters in insulin-dependent tissues, decreasing inflammation, reducing oxidative stress, and modulating lipid metabolism.

Some other links if you wish to pursue it further:

Liraglutide [GLP-1 RA, brand name Victoza] restored body weight as well as HOMA-IR (Insulin resistance index) via up-regulation of hepatic adenylate cyclase 3 level (66). It has been shown that liraglutide induces its beneficial effects on metabolism by driving white adipose tissue phenotype to brown phenotype via soluble guanylate cyclase- mediated pathway

Both treatments gave a similar improvement of glycemic control, without any differences between the two groups. Only exenatide [GLP-1 RA, brand names Bydureon/Byetta] gave a decrease of BMI, insulin resistance parameters such as fasting plasma insulin, HOMA-IR, and adiponectin and a decrease of inflammatory parameters such as tumor necrosis factor-α, and high sensitivity-C reactive protein. Furthermore, the values obtained with exenatide [the GLP-1 RA] were significantly better than the values recorded with glimepiride. We can conclude that exenatide [the GLP-1 RA] was better than glimepiride [a Sulfonylurea] in improving insulin resistance and inflammatory state.

Asd

They didn’t do my insulin levels but I’ve had a few c peptides run. Mine went down when I was on Ozempic by about 2 points. I had to come off because of side effect and have been on Jardiance for a few months. It’s back up to where it was before the Ozempic. It’s a little elevated. Perhaps you should ask your doctor why she is monitoring your insulin levels and her interpretation of the results. We could only speculate here.

1 Like

Thank you @Robyn_H. I can understand why I missed these. I have no medical, laboratory, or chemical training. I tend to stay away from articles in medical journals
because they tend to use terminology that is unknown to me and beyond my grasp.

I posted the second time about PCOS because it is a subject discussed many times here on Tudiabetes. It was only after my first post that I realized that @Anna69s symptoms seemed to fit with what have I read in numerous posts made about it.

2 Likes