How to start dosing with semaglutide (Ozempic®)


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Semaglutide (Ozempic®) is an excellent medicine for Type 2 Diabetes. It's one of the best ones available right now, and many people have had great success with it.

When people with Type 2 Diabetes use Semaglutide for about three months, they often lose around 5% of their body weight and their A1c levels can drop by about 0.8%. This is good news because it means Semaglutide can help people get their blood sugar levels under control and lose some weight too.

Semaglutide can also be helpful for people who have obesity, even if they don't have diabetes.

If you don't like injections, there's also a tablet version called "Rybelsus" that you can take every day. However, dosing can be a little tricky as you are required to take this oral medication at the start of the day on an empty stomach with minimal water and then wait before consuming any other liquids or food.

BC Diabetes in Canada has posted the following information on dosing Ozempic:

Semaglutide’s only significant side-effect is nausea which is usually mild and settles with time, particularly if the dose is started low and increased slowly. The usual starting dose for Ozempic is 0.25 mg weekly (19 clicks on the pen, counting clicks is useful, see below). If after 4 weeks nausea is minimal the dose should be increased to 0.5 mg (38 clicks) and this dose continued for another 4 weeks. If target weight or sugar has not been achieved and nausea is absent or minimal, the dose is increased to 1.0 mg weekly (76 clicks), the usual maintenance dose. Ozempic is often prescribed off-label (not Health Canada approved) in doses higher than 1.0 mg per week. At BCDiabetes we do so by giving 1.0 mg more frequently than weekly. Common doses we use are 1 mg every 5 days and 1 mg every 3 days (equivalent to 2.4 mg per week, an obesity dose approved for use in the USA). Higher doses provide for more weight loss with a slightly higher rate of nausea.

If persistent nausea or vomiting occurs with Ozempic, the dose should be held until the nausea disappears and then reintroduced at no more than 50% of the previous dose. At BCDiabetes we employ in-between or micro doses of semaglutide measured in clicks, not milligrams. For instance, if we have a client who tolerates 0.25 mg per week (19 clicks) but not 0.5 mg per week (38 clicks) we might try 28 or 29 clicks weekly (0.125 mg). For those who do not tolerate 0.25 mg weekly (19 clicks, the usual starting dose) we may try them on 5 or 10 clicks weekly.

If Ozempic is stopped for more than two weeks and planned for reintroduction, your physician may recommend restarting at the usual starting dose of 0.25 mg weekly, not the previously tolerated dose.

Overall, semaglutide is an effective medicine for Type 2 Diabetes and obesity. If you have any questions, be sure to talk to your doctor to see if semaglutide is right for you.

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