Between 2019 and 2022, Ozempic®, also known as semaglutide, saw an astounding 40-fold increase in usage. This drug, primarily prescribed for managing type 2 diabetes mellitus (T2DM), has more recently gained attention as a promising option for weight loss.
Although not noted as a common side effect, some users report fatigue on Ozempic. This article reviews the potential causes of fatigue when using Ozempic and explores effective ways to manage it.
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What is Ozempic?
Ozempic belongs to a class of medications known as glucagon-like peptide-1 (GLP-1) receptor agonists. These drugs mimic the GLP-1 hormone, which is released in the gastrointestinal tract in response to caloric intake. GLP-1 stimulates the body to produce more insulin, thereby reducing blood glucose (sugar).
In addition, GLP-1 diminishes appetite and enhances feelings of fullness (satiety) by targeting areas of the brain that regulate hunger.
Ozempic is administered through subcutaneous injection. It is approved by the Food and Drug Administration (FDA) for:
- Lowering blood sugar in those with T2DM (as an adjunct to diet and exercise)
- Reducing the risk of heart attack and stroke in adults with T2DM with known cardiovascular disease (CVD)
Healthcare professionals are also prescribing Ozempic for weight management for off-label use (using a drug approved by the FDA for a different purpose). Semaglutide is also marketed under the brand names Wegovy® and Rybelsus®.
Common Side Effects
There are several potential side effects seen with Ozempic, the most common being gastrointestinal in nature:
- Nausea (occurring in up to 20% of people)
- Vomiting
- Abdominal pain
- Constipation or diarrhea
- Hypoglycemia (low blood sugar)
- Fatigue
- Headache
- Injection site discomfort
Although fewer than 1% of clinical trial participants reported fatigue, some studies have found that up to 13% of users may experience this adverse effect. Several factors may influence fatigue incidence while on the drug.
4 Potential Causes of Fatigue with Ozempic
Here are the top 4 most likely causes of fatigue while taking Ozempic:
1. Blood Sugar Fluctuations
Because Ozempic lowers blood glucose levels, there is a risk that sugar will become too low (hypoglycemia), especially when the medication is first started, the dose is increased, or it is used in combination with other blood sugar-lowering drugs like metformin, sulfonylureas, or insulin.
Glucose is the primary energy source for the body’s cells. Fluctuations in blood sugar lead to an inconsistent supply of glucose, resulting in reduced energy levels and feelings of fatigue.
2. Dehydration
Vomiting and diarrhea, two common Ozempic side effects, increase the risk of dehydration. While fatigue is directly related to dehydration, several other effects of fluid imbalance can further contribute to low energy levels, including:
- Low blood pressure (hypotension): Dehydration reduces blood volume, leading to decreased blood pressure and thus, weakness and fatigue.
- Loss of appetite: A reduced desire to eat results in lower energy intake.
- Constipation: Less water in the intestines makes it more difficult to pass stool, leading to discomfort and fatigue.
3. Nutrient Deficiencies
Ozempic impacts appetite through several mechanisms, including:
- Slowing gastric emptying (the passage of food from the stomach to the intestines)
- Reducing glucagon release (the hormone that increases blood sugar between meals, helping to maintain stable blood sugar levels throughout the day)
- Binding to GLP-1 receptors in the brain, reducing sensations of hunger
- Enhancing feelings of satiety
By reducing appetite, Ozempic can affect dietary intake, potentially leading to inadequate nutrition. The following nutrient deficiencies can have profound impacts on energy levels:
- Protein: Achieving adequate protein intake on Ozempic is essential for supporting energy levels and maintaining lean muscle mass.
- Vitamin B12 and zinc: Some evidence suggests that Ozempic may deplete B12 and zinc, which may be attributable to decreased animal protein intake, a key source of these nutrients.
- Other nutrient deficiencies that may result from poor dietary intake and contribute to fatigue include B complex vitamins, vitamin C, vitamin D, iron, and magnesium.
4. Adjustment Period
Healthcare professionals will typically start individuals on a dose of 0.25 mg injected once weekly for the first 4 weeks, followed by an increase to 0.5 mg per week thereafter. This is to give the body a chance to adapt to the medication, minimizing common potential side effects seen in the first few weeks, such as gastrointestinal upset and nausea.
Dealing with Fatigue While Using Ozempic
There are several considerations for managing fatigue while using Ozempic.
Regular Monitoring
Routine visits with your healthcare team can help monitor progress. For some individuals, frequent blood glucose checks throughout the day are necessary to maintain control and adjust diet or medications as needed. A hemoglobin A1c (HbA1c) level will typically be tested every 3-6 months to assess average glucose over the past 2-3 months.
Hydration
Drink plenty of fluids while taking Ozempic to avoid dehydration. Signs may include:
- Thirst
- Headaches
- Dry mouth or skin
- Dark colored urine
- Fatigue
If severe diarrhea, nausea, or vomiting occur, promptly contact your healthcare provider, as these side effects can lead to severe dehydration.
Hydration needs may vary based on numerous factors, including age, gender, pregnancy, body weight, activity level, or health conditions. However, it is generally recommended to drink 9-13 cups of fluids per day. Here are some tips for staying hydrated:
- Sip water throughout the day.
- Drink a full glass of water before each meal.
- Add fruit or herbs to your water, such as lemons, limes, berries, cucumber, or mint, to add flavor and make it more palatable.
- Invest in a water bottle and establish a daily goal for how many times you will refill it.
Diet and Nutrition
Maintaining a balanced diet while taking Ozempic is critical for managing associated fatigue and avoiding nutrient deficiencies. Key strategies include:
- Prioritizing protein, including lean meats, poultry, fish, eggs, low-fat dairy products, and legumes, supports lean muscle mass and metabolic function.
- Emphasizing fiber through adequate intake of vegetables, fruits, whole grains, and legumes, supporting blood sugar stability and digestive function.
- Incorporating healthy fats from sources like olive oil, avocado, nuts, seeds, and fatty fish.
If dietary changes are insufficient for correcting nutrient deficiencies, supplements may be necessary. Consult with a healthcare provider before implementing supplements to determine an appropriate protocol.
Gradual Dose Adjustment
Dosing is gradually increased to help manage blood sugar levels and minimize side effects. If additional glycemic control is needed, a maximum of 2 mg once weekly may be administered. Dose adjustments are individualized and done under the guidance of a healthcare professional.
Adequate Rest and Stress Management
Achieving adequate sleep and properly managing stress is imperative for fatigue management. The following tips may be helpful:
- Adhere to a regular sleep schedule, going to bed and waking at the same time each day.
- Optimize your sleep environment, ensuring a dark, quiet bedroom at a comfortable temperature.
- Avoid electronic devices (e.g., television, phones, computers) at least 1 hour before bedtime
- Practice calming activities before bed, such as meditation, breathing exercises, or gentle yoga.
- Engage in regular exercise to support sleep, reduce stress, and improve energy levels.
Lab Tests and Biomarkers to Monitor
Routine lab testing can be helpful for monitoring progress and ensuring balance while using Ozempic.
Blood Glucose
The following tests assess blood sugar control:
- Fasting glucose
- Postprandial glucose (after meals)
- Hemoglobin A1c (HbA1c), a measure of average glucose over the past 2-3 months
Electrolyte Balance
Monitoring electrolytes, often through a comprehensive metabolic panel (CMP), can help assess hydration and potential underlying factors in fatigue associated with using Ozempic and other antidiabetic drugs. These include:
- Sodium: Low levels (hyponatremia) are associated with fatigue, while high levels (hypernatremia) may indicate dehydration.
- Potassium: Low levels (hypokalemia) are associated with fatigue.
- Chloride: Both low (hypochloremia) and high (hyperchloremia) levels of chloride can indicate dehydration and fatigue.
- Imbalances in other electrolytes, including magnesium and calcium, can also impact energy levels.
Nutritional Status
Monitoring nutrient status is also important while on Ozempic, given its effects on appetite and dietary intake. The following markers may be assessed:
- Iron: Deficiencies can affect energy production, blood cell formation, oxygen delivery throughout the body, and muscle function.
- Vitamin B12: Low levels impair energy metabolism, blood cell formation, and cell growth.
- Folate: This nutrient teams up with vitamin B12 as an essential player in supporting important bodily functions.
- Zinc: Needed for energy production, muscle recovery, and repair.
- Vitamin D: Essential for healthy bones, muscle function, and optimal energy levels.
Kidney and Liver Function
The kidneys are responsible for filtering and eliminating waste. Chronic conditions like diabetes and some medications can impact kidney function, and thus renal testing helps monitor progression of disease and detect any signs of injury. Acute kidney injury is possible while on Ozempic, especially in patients who have experienced nausea, vomiting, diarrhea, or dehydration.
Evaluating liver function, particularly the activity of liver enzymes including AST and ALT, is essential for monitoring drug-induced liver injury. Although semaglutide significantly reduced ALT levels in clinical trials among individuals with obesity and T2DM, regularly monitoring these enzymes can track disease improvement but also identify any variations in patient response that may arise.
When to Seek Medical Advice
See a healthcare professional if you experience persistent or severe fatigue, which could indicate a more serious underlying condition. Timely evaluation is critical for appropriate management and medication adjustments may be warranted. Exploring alternative treatments with healthcare professionals can be beneficial in optimizing health and wellbeing.
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Key Takeaways
- Fatigue with Ozempic can result from several factors, including blood sugar fluctuations, dehydration, nutrient deficiencies, and medication adjustment periods.
- Effective management strategies include regular monitoring, dose adjustments as necessary, maintaining hydration and a balanced diet, and prioritizing a healthy lifestyle, including adequate rest, stress management, and exercise.
- Collaboration with healthcare providers is critical for personalized care while using Ozempic.
- Comprehensive management and a holistic approach are essential to achieving optimal results in diabetes and weight management and supporting overall health.
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