Hyperglycemia (High Blood Sugar)
Users on Reddit report varied experiences with hyperglycemia (high blood sugar) while on GLP-1 medications, often linked to the drug's effect on gastric emptying, especially for those managing diabetes with insulin. Some also report high blood sugar due to ketosis from rapid weight loss or illness.
Experiences with Hyperglycemia:
Difficulty Managing Highs: Correcting these highs can be challenging. The first user also stated, "I have been having an extremely difficult time getting it to come down. I’ve taken well over 40 units of my Fiasp... It has barely budged. "[1] Another user described a similar struggle after eating certain foods: "I tried a few times with a peanut butter sandwich and it took 4-6 hours for it to even start showing up on my meter and then I spent another 4 or 5 hours fighting to get it back down. "[6]
Ketosis-Induced Insulin Resistance: Rapid weight loss can lead to high ketones and insulin resistance, causing high blood sugar. "When I took ozempic (same active ingredient as wegovy), I dropped 7lbs in 4 days after my first injection. The rapid weight loss gave me high ketones, and ketones make you insulin resistant. "[2]
Illness or Nausea: Sickness or side effects like nausea can also contribute to hyperglycemia. "I take mounjaro and had a similar issue; for me it was illness... nausea I had caused the high blood sugars I was battling. "[3]
Food-Specific Spikes: Certain foods might cause more pronounced delayed spikes. One user noted issues with peanut butter. [6]
Rollercoaster Effect: Some users experience an initial drop in blood sugar followed by a persistent high if insulin timing is off. "I’m on Saxenda and had to use extended bolus for everything I ate in the first few weeks... otherwise I will quickly go low after eating and then go persistently high for hours later. "[8]
Diabetic Ketoacidosis (DKA): In severe cases, particularly involving Type 1 Diabetes and mismanagement of insulin (e. g. , not taking it due to illness or inability to eat), DKA, which involves extreme hyperglycemia, has been reported. [9, 10, 11] One user explained a potential mechanism for T1DM: "delayed gastric emptying can delay the absorption of carbohydrates and lead to mismatched insulin dosing. This makes blood glucose control more unpredictable, increasing the risk of both hyperglycemia and hypoglycemia. "[17]
Remedies and Preventions Recommended:
Adjusting Insulin Timing: Due to delayed gastric emptying, users recommend adjusting when insulin is taken. "I used to pre bolus about 10/15 mins before eating and now I don't need to until when I eat. "[7] Another user on Ozempic noted, "no need to pre-bolus for meals really. "[4]
Extended Bolus: For denser meals, an extended insulin bolus might be necessary to prevent an initial low followed by a prolonged high. [8]
Reduced Insulin Needs: Many Type 1 diabetics find they need significantly less insulin. "On ozempic and at an all time low basal rate, all settings are weaker. "[4] Another Mounjaro user reported, "Basal down by 50% and mealtime down by 70% or more. "[14] (See also [13, 15])
Loop Systems for T1DM: Automated insulin delivery systems can help manage the unpredictable absorption. "Ozempic/Wegovy gives me the best control of my life. However, I have a loop setup that only gives me insulin... It slows down the after-meal spikes so that the loop can get them under control before they get too high. "[13]
Dietary Strategies:
Low Carb: Some find a low-carb diet helpful. "Everything has a delayed affect now... It's hard to manage, but low carb as worked for me. "[5]
Managing Ketones with Carbs: If high ketones are present from rapid weight loss, one user advised to "Eat some carbs. "[2]
Avoiding Trigger Foods: Identifying and avoiding foods that cause significant delayed spikes is recommended. [6]
Preventative Diet: One user with reactive hypoglycemia mentioned, "I started Keto to prevent hyperglycemia so that I could prevent hypo ! "[18]
Hydration:
Drinking plenty of fluids, especially water, is advised if experiencing high ketones or nausea. [2, 3]
GLP-1 Dosage Adjustment:
Starting with or staying on a lower dose, or even microdosing, can be considered if side effects are an issue. "I have been on it for 7 weeks and still taking the . 25mg dose and plan on staying there for the near future. "[6] Another user mentioned, "I have taken half of that [starting dose] in an insulin syringe instead. "[12]
Understanding GLP-1 Mechanisms:
Some users note that GLP-1s can help overall glucose control by mechanisms like suppressing inappropriate liver glucose release. "GLP-1 drugs suppress these [inappropriate glucose releases] and are a big part of reducing basal insulin requirements and countering weight gain. "[16]
It's important to note that some users, particularly those not on insulin or those whose bodies adjust well, report improved blood sugar control and reduced hyperglycemia with GLP-1s. [13, 19] However, for others, especially during the initial adjustment period or with certain dietary choices, managing hyperglycemia can be a significant challenge.
Experiences with Hyperglycemia:
- Delayed Blood Sugar Spikes: A primary concern is delayed and sometimes severe blood sugar spikes due to slowed gastric emptying.
Remedies and Preventions Recommended:
- Monitoring and Insulin Adjustments (especially for insulin users):
- Ketone Monitoring: "It could be worth testing for ketones to check if you have something similar going on.
It's important to note that some users, particularly those not on insulin or those whose bodies adjust well, report improved blood sugar control and reduced hyperglycemia with GLP-1s. [13, 19] However, for others, especially during the initial adjustment period or with certain dietary choices, managing hyperglycemia can be a significant challenge.