When Hypoglycemia on Ozempic (Semaglutide) Becomes a Reason to Stop

What the label's own numbers show

The Ozempic label reports hypoglycemia separately for people taking the drug alone and for people taking it on top of basal insulin, and the two tables read very differently [1].

Monotherapy, 30 weeks, 129 people on placebo, 127 on 0.5 mg and 130 on 1 mg: severe hypoglycemia was 0% in all three arms, and documented symptomatic lows at 70 mg/dL or below occurred in 0% on placebo, 1.6% on 0.5 mg and 3.8% on 1 mg [1]. The label's other monotherapy row, severe or blood-glucose-confirmed symptomatic at 56 mg/dL or below, was 1.6% with placebo and 0% with both Ozempic doses [1].

Add-on to basal insulin with or without metformin, 30 weeks: 132 people on placebo, 132 on Ozempic 0.5 mg and 131 on Ozempic 1 mg. Documented symptomatic lows at 70 mg/dL or below occurred in 15.2%, 16.7% and 29.8%; severe episodes in 0%, 0% and 1.5%; the combined severe-or-confirmed row in 5.3%, 8.3% and 10.7% [1]. The label defines severe as an episode requiring the assistance of another person [1].

Does Ozempic cause low blood sugar on its own?

The label describes Ozempic as stimulating insulin release in the presence of elevated blood glucose concentrations [1]. In the monotherapy trial there were no severe episodes at any dose, and severe or confirmed symptomatic lows at 56 mg/dL or below occurred in 1.6% on placebo and 0% on either Ozempic dose [1].

A 2025 meta-analysis of 10 randomized cardiovascular and kidney outcome trials, covering 71,351 people with type 2 diabetes, found no increased risk of severe hypoglycemia with long-acting GLP-1 receptor agonists as a class [2].

When insulin or a sulfonylurea is involved

The label's hypoglycemia warning covers this combination: people receiving Ozempic with an insulin secretagogue such as a sulfonylurea, or with insulin, may have an increased risk of hypoglycemia including severe hypoglycemia, and the risk may be lowered by a reduction in the dose of the sulfonylurea or insulin [1]. The drug interactions section adds a timing note: when starting Ozempic, consider reducing the dose of the insulin secretagogue or insulin [1].

The Rybelsus label reports a 52-week trial that added oral semaglutide to insulin, in which glucose below 54 mg/dL occurred in 32% of people on placebo, 26% on 7 mg and 30% on 14 mg [3].

What the label says about stopping

The label's stop instructions attach to other situations: suspected pancreatitis, and a serious hypersensitivity reaction [1]. For hypoglycemia, its wording is about lowering the dose of the insulin or sulfonylurea. It also says that when Ozempic is used with insulin, the two are given as separate injections and are never mixed [1].