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Foods That Help Prevent Hypoglycemia on Ozempic (Semaglutide 0.5 to 2 mg)

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At a glance

  • Low glucose on Ozempic alone / 1.6% on 0.5 mg and 3.8% on 1 mg, versus 0% on placebo, at or below 70 mg/dL [1]
  • With basal insulin / 16.7% on 0.5 mg and 29.8% on 1 mg versus 15.2% on placebo [1]
  • Severe low glucose with basal insulin / 0% on placebo, 0% on 0.5 mg, 1.5% on 1 mg [1]
  • Insulin or sulfonylurea warning / label says risk of hypoglycemia, including severe hypoglycemia, is increased [1]
  • Label action when starting / consider lowering the sulfonylurea or insulin dose [1]
  • Usually low glycemic index / dairy, legumes, pasta, fruit, 55 or less [2]
  • Usually high glycemic index / most potato varieties [2]
  • Dosing / once weekly, any time of day, with or without meals [1]

Does Ozempic alone push glucose too low?

The label says Ozempic stimulates insulin release when blood glucose is elevated [1]. In the label's 30-week monotherapy trial (127 to 130 people per arm), no severe hypoglycemia occurred in any arm. Documented symptomatic events at or below 70 mg/dL were 0% on placebo, 1.6% on 0.5 mg and 3.8% on 1 mg. Severe or blood-glucose-confirmed symptomatic events at or below 56 mg/dL were 1.6% on placebo, 0% on 0.5 mg and 0% on 1 mg [1].

What changes when insulin or a sulfonylurea is added?

In the label's 30-week trial of Ozempic added to basal insulin, with or without metformin (131 to 132 people per arm), documented symptomatic events at or below 70 mg/dL occurred in 15.2% on placebo, 16.7% on 0.5 mg and 29.8% on 1 mg. Severe or blood-glucose-confirmed symptomatic events at or below 56 mg/dL were 5.3%, 8.3% and 10.7%. Severe hypoglycemia, defined as an episode requiring assistance, was 0% on placebo, 0% on 0.5 mg and 1.5% on 1 mg [1].

The label notes that hypoglycemia was more frequent when Ozempic was combined with a sulfonylurea, and says that when Ozempic is started, consider reducing the dose of the sulfonylurea or insulin [1]. When Ozempic is used with insulin, the label says to give the two as separate injections and never mix them [1].

What do food studies show?

The Ozempic label says to inject once weekly, at any time of day, with or without meals [1]. Glycemic-index tables rate carbohydrate-containing foods on a 100-point glucose scale and are not hypoglycemia studies, so they do not show which foods prevent a low on Ozempic. The 2021 international tables, listing more than 4,000 items, rate dairy products, legumes, pasta and fruits as usually low glycemic index (55 or less), with consistent values around the world. Cereals and cereal products, including whole-grain versions, varied widely, and most potato varieties were high-GI, though some low-GI varieties have been identified [2].

In a crossover study of 30 adults with obesity, semaglutide 1 mg lowered the first-hour gastric emptying measure (paracetamol absorption) to a ratio of 0.73 versus placebo, about 27% lower, while emptying over 5 hours was not statistically different. The authors suggested the first-hour delay may have contributed to the smaller post-meal glucose rise they saw with semaglutide [3].

What does the label say to watch for?

The label directs prescribers to inform patients using Ozempic with insulin or a sulfonylurea about the risk of hypoglycemia and to educate them on its signs and symptoms [1]. Severe hypoglycemia in the trials meant an episode needing help from another person [1].

Frequently asked questions

Can Ozempic cause low blood sugar without insulin or a sulfonylurea?
In the label's 30-week monotherapy trial, documented symptomatic events at or below 70 mg/dL occurred in 1.6% on 0.5 mg and 3.8% on 1 mg versus 0% on placebo, and no severe events occurred in any arm [1].
Which foods have a low glycemic index?
Dairy products, legumes, pasta and fruit were usually low glycemic index, 55 or less on the 100-point scale, while cereals varied widely and most potato varieties were high [2]. These tables are not hypoglycemia studies.
Does Ozempic need to be taken with a meal?
No. The label says to give it once weekly, at any time of day, with or without meals [1].
Does the label single out sulfonylureas?
The label's hypoglycemia warning names insulin secretagogues such as sulfonylureas, and insulin, and notes that hypoglycemia was more frequent when Ozempic was used with a sulfonylurea [1].

References

  1. U.S. National Library of Medicine, DailyMed. Ozempic injection (Novo Nordisk) prescribing information. Ozempic injection (Novo Nordisk) label
  2. Atkinson FS, Brand-Miller JC, Foster-Powell K, Buyken AE, Goletzke J. International tables of glycemic index and glycemic load values 2021: a systematic review. Am J Clin Nutr. 2021;114(5):1625-1632. International tables of glycemic index and glycemic load values 2021: a systematic review
  3. Hjerpsted JB, Flint A, Brooks A, Axelsen MB, Kvist T, Blundell J. Semaglutide improves postprandial glucose and lipid metabolism, and delays first-hour gastric emptying in subjects with obesity. Diabetes Obes Metab. 2018;20(3):610-619. Semaglutide improves postprandial glucose and lipid metabolism, and delays first-hour gastric emptying in subjects with obesity
Evidence overview for Foods That Help Prevent Hypoglycemia on Ozempic (Semaglutide 0.5 to 2 mg)