Ask the person taking Ozempic

Miscellaneous and Personal Stuff I Must Share
161

Meanwhile, my step up to the 2mg dose has gone well. I was prepped for the potential for constipation after my experiences going up to the 1mg dose last summer, so made a point of keeping fiber and water high and didn’t have that issue this time. I am back to losing weight again - albeit very slowly. I’m knocking on the door of 260, which is putting me close to 40 lbs in a year. Not as fast as some, but definitely faster than I’ve ever managed to lose weight.

I’ll have bloodwork at my physical in August and I’m interested to see what my A1c is doing then. Hopefully it’s solidly down in the normal range for the first time in a good long time.

162

I’d bet there;s a VERY strong correlation between the appetite / food preferences and the weight loss, and of course it won’t work for everyone. Your A1c may well be lower due to a combination of the meds AND the dietary changes (congrats on that! Right now especially, I could NOT go low-carb).

Hah - for me, that’s a feature. I have a chronic diarrhea problem; I actually take a cholesterol-lowering medication which was specifically prescribed because its side effect profile includes constipation. The Ozempic has made it possible for me to take slightly less of that.

163

In an effort to bump up my protein intake, since so many foods do not taste good any more, I ate a can of tuna last night. Just a little mayonnaise to moisten it. And it tasted pretty decent.

But guess what I’m burping up this morning? :angry:

I went to the grocery store this morning and picked up some yogurt and a couple of kefir bottles; those have decent protein. Not gonna try one until the tuna-burps subside though. Strawberry/tuna burps. Mmmmmmmm.

164

I saw the doc today because of the increasing dizziness. Based on home readings, and ones
they got there, I’m now officially off the BP meds.

Doc did note that I looked pale (compared with 9 days ago when I last saw her), and orded a bunch of blood work. Hopefully they’ll have the results tomorrow… as this doc is moving to a different practice after this week! She said she wanted to do an EKG but that seems to have been forgotten in the rush.

I asked about a temporary handicapped tag, and she thought it was a dandy idea, so I have paperwork for that. Just need to stop by the DMV this week or next (before we go on our trip). I’d been concerned over some destinations requiring long walks potentially complicated by long waits standing up, or some such; obviously I hope to NOT need the tag. But it will be nice to have it, to remove some worry.

I strongly suspect my blood work will turn up as anemic. Given that recent readings have always had one that was just below the normal range (one time it’ll be hematocrit, another time it’ll be iron, or whatever), that it’s difficult to take an iron supplement due to timing concerns with other meds and food, and given that I’m barely eating ANYTHING, I’d be more shocked if I did NOT show as anemic.

I even “sprung a leak” from the blood draw site as I was starting to head out - glanced down and saw a spot of blood under the tape that had not been there a minute before. Then a second later, MORE blood. So I clamped the other hand over it, and elevated the arm, and waited for the receptionist to get off the phone to buzz me back to the lap, and got re-bandaged.

165

Glad to hear you will have a temporary parking tag~they can make a lot of difference when being able to park close to your destination saves your limited energy for whatever activity you are going in for.

166

Cholestyramine, I bet.

Cholesterol problems are common in diabetics, so you’re less likely to have to worry about that in the meantime.

167

Colesevelam (Welchol), actually. Pills (albeit, ones that would choke a horse). Much easier to manage than cholestyramine.

Weirdly, my triglyceride level has not dropped at all - bouncing around the same level for several years. My other cholesterol readings (total and HDL come to mind) are improving.

I just booked an appointment with the cardiologist to discuss the possible POTS scenario. I managed to book it on the same day I have two other doctor’s appointments. I think I’ll just take the whole day off work.

168

When I was a newly minted pharmacist, they briefly marketed cholestyramine tablets. That didn’t last very long, because people had to take 4 at a time, and they were big old horse pills that needed to be taken with a full glass of water, which too many people didn’t do, and they ended up getting stuck in the esophagus.

169

Some good news for me: my A1C was 5.4 this week. Lower than it has ever been. Between the Ozempic, and eating so little…

And yesterday, I did not feel queasy at all. Had meatloaf, some peas and some mashed sweet potato for dinner and it tasted good. I commented that this was likely more food than I had eaten in a day all week.

If this continues, I may be able to stay on this dosage. The weight loss HAS to slow down some.

170

5.4 is excellent news!

171

5.4! Great!

172

So I’m finding that there are “easy days” and there are “queasy days”.

Queasy days are generally, but not always, the ones starting a day or so after my weekly dose. Easy days are generally, but not always, the last day or so, and dosing days. Sometimes, eating something will settle the stomach.

Yesterday (dose day) was an easy one. I likely got a thousand calories or more, topping it off with a really yummy bowl of chili.

This morning was clearly a queasy day. I thought I’d try a small portion of that chili. Bad idea.

Within 20 minutes I felt things were not going well.

I will digress to note that my parents never appreciated that the TWO TIMES I got car sick as a kid, I recognized that unfamiliar sensation, and got my head out the window in time. I literally NEVER barfed any other time (except once on a carnival ride, and even then I knew… just could not get off the ride in time). How did I recognize what was about to happen?

And the two times I’ve hurled as an adult. Same thing: recognized it, and made it to the bathroom in time. I guess everyone has their own superpower.

Anyway, today was no exception. I realized that chili had been an error, and returned it to the plumbing system via a more direct route than planned. Ugh.

I will see a new primary care doc in a month or so (mine is moving, to a place an hour away). I am considering pushing to go back to the lower dose.

I haven’t weighed myself in a week or so, so I don’t know whether I’ve lost any more. Hard to imagine that I haven’t, however.

173

I didn’t know, but i have the same super power. My mother had several miscarriages after i was born, and was pregnant more often than not for the first few years of my life. And she had bad morning sickness. And i watched her go to the toilet to vomit regularly.

She tells me that the very first time i had a stomach bug, i ran to the toilet and threw up in the toilet, just like I’d seen her do it.

(And i, too, have only thrown up in inconvenient places when it was physically impossible to get to a better place in time.)

I sometimes wonder how i knew what was going on that first time, though.

174

I’m having some luck with a Relief Band. I bought my first one for motion sickness and found it works pretty well for me. However, that model has a band that moves around too much on my wrist, so I just bought this one, which has a larger diameter and can be tightened more precisely. (The first one has a somewhat finicky USB charger; the second uses batteries.) This product can reduce my queasiness enough to let me be in a room where hamburgers are being fried (otherwise, I can’t go to a lot of restaurants), or simply eat food that otherwise triggers my nausea on Ozempic. I’m trying A. to eat! and B. to decrease the chances that I’ll develop longstanding food aversions due to nausea being such a great physiological reinforcer.

ETA: This is an electronic stimulation device that’s FDA-cleared, not a pressure point wristlet.

175

Thanks!! I’m a little put off by the “contains copper and gold” bit, as that’s just pandering to the woo crowd, but I’ll do some more research on the electronic part of it! It’s sold out at the moment, so I have time, LOL.

176

So, can anyone here explain to a math-impaired layperson about the recent study that came out suggesting a possible higher rate of nonarteritic anterior ischemic optic neuropathy (NAION) in patients taking semaglutide?

I understand the study indicates a correlation but does not prove that semaglutide caused the NAION, but I guess I just don’t understand how worried I should be about this. I never even heard of this condition before and am now concerned I will wake up blind in one eye (I’ve been taking semaglutide for I guess about a year now).

Not being well-versed in understanding studies, I don’t know how to assess the limitations.

177

I’m not a statistician or a mathematician, but I did look into this when I saw it last week.

First, the typical rate of occurrence in for this is about 10/100,000 people. The increase seen with these meds would put that at about 70/100,000. So the risk is still pretty low.

Second, comorbidities with obesity and diabetes increase the risk for this condition already, so without knowing full medical histories on these patients, you’re right - this is correlation, not causation, that’s demonstrated in this study. Fwiw 25% of diabetics have diabetes-related retinopathy, which is the leading cause is blindness in the country. Around 5% of those people have vision loss associated with it.(Study Finds Significantly More Adults Living with Diabetic Retinopathy in the United States than Previously Estimated - Prevent Blindness ) High blood pressure is also a risk factor for this, and a common comorbidity with obesity.

Finally, this is not a study of the general population. These patients presented at this clinic with the condition and were then found to be taking a GLP1. Larger studies in the future, looking beyond the patients presenting with this, would be helpful in more understanding of the risk.

My personal takeaway is that taking a GLP1 is not enough of an increased risk for this without stronger evidence. But the risks of obesity and hypertension across the board are worth it for me to continue using ozempic (as long as my insurance covers, that is) because those have risks for me far beyond vision.

Now, I do think that perhaps this will give some of those looking at these drugs for relatively small losses (say 20-25 lbs) a second thought, because these drugs aren’t good choices for that in most cases IMO - I am not a doctor, so I can’t say there aren’t times when GLP1s are a reasonable choice.

178

Well. I think given the focus’s narrowing-down of correlation for Type 2 diabetics and the obese, I’d at least give it some additional thought if I fit into either (or both) categories, which I do. From the summary:

Type 2 diabetics:

The Kaplan-Meier survival analysis at 36 months showed a cumulative incidence of NAION of 8.9% (95% CI, 4.5%-13.1%) for the semaglutide cohort vs 1.8% (95% CI, 0%-3.5%) for the nonsemaglutide cohort.

Obese patients:

The Kaplan-Meier survival analysis at 36 months showed a cumulative incidence of NAION of 6.7% (95% CI, 3.6%-9.7%) for the semaglutide cohort vs 0.8% (95% CI, 0%-1.8%) for the nonsemaglutide cohort.

179

A fascinating look into the Ozempic effect, in particular the “quieting of food noise”.

180

Interesting. I see my opthalmologist tomorrow, and will ask about this.

Though, once you’ve been on the stuff for a while, your bloodwork will no longer show you as T2DM (though I understand that “once diabetic, always diabetic” even if it’s under good control with meds / diet / exercise), and you may well no longer show as obese. Studies DO show a paradoxical increase in diabetic retinopathy with semaglutide use, which is of course of concern - they’ve never detected that in me.

We just got back from 2 weeks “on the road”. I weighed myself once on the trip, and had not lost any weight; I re-weighed after we got back and maybe a pound or so. This may be spurious, as driving tends to make me accumulate fluid, which resolves in a week or so. I definitely was NOT eating enough calories most days.

As an example, one “queasy” day, I forced myself to eat a packet of Belvita crackers (230 calories), and nothing until dinner which was virtually all of a slice of Chicago deep-dish pizza. at about 600 calories. On our drive home this weekend, I ate a half a beignet, 3 Popeye’s chicken strips, and half a hamburger. I had to force myself to eat each of these.

I sorta barfed one more day on the trip: my gag reflex is so much more sensitive, and one morning (before eating anything) I managed to accidentally gag myself. Goodbye, slight remnants of last night’s hamburger.