Semaglutide is a relatively new type of diabetes medication, which was approved for use in Singapore in 2021. It’s currently available in two different forms – Rybelsus, which comes in the form of a tablet, and Ozempic, which is given by injection once a week. A similar medication, called dulaglutide (Trulicity), was approved for treating diabetes in 2016, and liraglutide (Victoza) was approved for this purpose in 2020.

All three of these medications are in a class known as GLP-1 receptor agonists, or GLP-1 RAs. This group of medications has been shown to be effective for helping to control diabetes, by mimicking a certain hormone produced in the gut. In this way, it helps to keep blood sugar from rising too high, which in turn can help to reduce cardiac risk, kidney damage, and other complications of diabetes.

As people with diabetes started to use GLP-1 RAs more widely, it became clear that these medications were also capable of stimulating weight loss in many patients. Researchers began to investigate, and discovered that GLP-1 RAs were effective in helping people to lose excess weight. Liraglutide (sold under the brand name Saxenda) was approved in Singapore in 2022 specifically for weight loss, when used alongside lifestyle modifications like exercise and a healthy diet. In the US, a version of semaglutide known as Wegovy is also approved for weight loss, although this is not yet available in Singapore.

GLP-1 RAs have many potential benefits for people with diabetes or obesity. However, with any medication, it’s important to consider what the side effects may be. What side effects can semaglutide, liraglutide, and other GLP-1 RAs cause? How can you manage these?

Key Takeaways

• Mild side effects, such as digestive issues and headaches, are relatively common with semaglutide, liraglutide, and other GLP1-RAs.

• In most cases, the side effects of semaglutide, liraglutide, and other GLP1-RAs will resolve as your body gets used to the new medication.

• Serious side effects are rare, although they can occur.

How do Ozempic, Rybelsus, Saxenda, Trulicity and other GLP-1 RAs work?

GLP-1 receptor agonists mimic a natural hormone called glucagon-like peptide 1, or GLP-1. This hormone is produced in the gut in response to a meal. It stimulates the pancreas to secrete insulin and blocks your liver from releasing sugar, which prevents your fasting blood sugar from rising too high. GLP-1 also slows down the emptying of your stomach and helps you to feel full, and reduces cravings and emotional eating, reducing calorie intake and blood sugar increase after meals.

GLP-1 RAs have been shown to be effective at helping to control blood sugar. Studies have shown that the use of these medications in people with diabetes can decrease the risk of serious complications, including heart attacks, strokes, and kidney failure. GLP-1 RAs can be used on their own, along with lifestyle changes like diet and exercise to further improve diabetes control. They can also be used along with other diabetes medications, like metformin, if needed.

What are the common side effects of Ozempic, Rybelsus, Saxenda, Trulicity and other GLP-1 RAs?

Although GLP-1 RAs can be very beneficial in treating diabetes, they can also have some side effects. One of the rare side effects is delay in gastric emptying (gastroparesis or “paralysis of the stomach”). However, gastroparesis can have many causes, including diabetes.

Some of the more common side effects include:

• Nausea and vomiting

• Abdominal pain and bloating

• Indigestion or acid reflux (heartburn)

• Constipation or diarrhea

• Weakness during exercise

• Headache

Although they can be unpleasant, these effects are generally not dangerous and can be reduced through small adjustments to our lifestyle. 

How can the side effects of Ozempic, Rybelsus, Saxenda, Trulicity and other GLP-1 RAs be managed?

In most cases, the side effects of GLP-1 RAs will resolve on their own within a few weeks, as your body gets used to the new medication. Although the initial period of taking the medication can be uncomfortable for some people, it will often get better over time.

There are also a number of ways to manage the side effects of semaglutide, liraglutide, and other GLP-1 RAs.

• Take smaller meals, and avoid oily or fatty foods. Foods that are high in fat take a long time to digest. Because GLP-1 RAs slow down your digestion, eating large or high-fat meals can lead to symptoms like bloating and indigestion.

• Ensure that you take plenty of fluids. With a slower digestive process, your gut pulls more water out of your food. This can lead to constipation. Making sure that you’re getting enough fluids will help with this issue.

• Take meals at least 3 to 4 hours before lying down. When you lie down while the stomach is full, this can cause reflux and indigestion. Ensuring that you give your system enough time to digest before you lie down will help to avoid these issues.

• If you experience weakness during exercise, take a snack before any intense exercise lasting longer than 30 minutes. Choose a snack with simple carbs, such as a piece of fruit or crackers. This is helpful because GLP-1 RAs reduce the release of glucose from your liver, which can lead to your muscles running out of energy once the circulating glucose is used up. The carbs in your snack will provide your body with the energy that it needs to fuel your activity.

If the side effects of your GLP-1 RA are bothering you a lot, you should discuss this with your doctor. They may be able to help you find ways to help manage these issues.

Can Ozempic, Rybelsus, Saxenda, Trulicity and other GLP-1 RAs cause weight loss?

Weight loss is a common side effect of GLP-1 RAs. By slowing down the emptying of the stomach, these medications help to keep people feeling full longer, which leads them to eat less. Studies have shown that GLP-1 RAs can reduce appetite and food cravings, leading to weight loss as well. Losing excess weight can be helpful in managing diabetes, and can also have other beneficial health effects.

In fact, because of its significant weight loss effect, semaglutide has been approved by the FDA in the US for weight loss and management of obesity. That being said, please note that semaglutide is currently approved only for treating diabetes in Singapore. It is not approved specifically as a weight loss medication. Dulaglutide is also approved only for diabetes management, in Singapore as well as the US.

Liraglutide in the form of Saxenda was recently approved for weight management in Singapore, when used alongside lifestyle changes like healthy nutrition and increased physical activity.

You may wish to discuss with your healthcare provider on other treatment options if you are at a healthy weight and do not wish to lose weight while on treatment.

Are there any serious side effects of Ozempic, Rybelsus, Saxenda, Trulicity and other GLP-1 RAs?

GLP-1 RAs are generally considered to be a safe medication option, but serious side effects can occasionally occur. Some of these include:

• Hypoglycemia (a blood sugar level that’s too low)

• Allergic reactions

• Worsening of diabetic retinopathy (eye disease)

• Acute kidney injury

• Possible increased risk of pancreatic or thyroid cancer

• Interactions with other medications

Because of the results of animal studies, there has been some concern that semaglutide, liraglutide, and other GLP-1 RAs might increase the risk of certain cancers, including thyroid cancer. So far, research hasn’t confirmed that there’s an increased risk in humans, although we can’t yet rule out this possibility. Patients should be aware of this issue, but it’s important to consider the bigger picture. For a person with diabetes, heart disease and kidney failure are much more likely causes of death than these rare cancers.

Low blood sugar is rare when GLP-1 RAs are used alone, but can occur when they’re used along with other diabetes drugs. It’s important to keep a close eye on your blood sugar after you start taking any new diabetes medication, to ensure that it doesn’t go too low. 

Whenever you start a new diabetes medication, diabetic eye disease can sometimes get worse in the short term, particularly if your blood sugar control wasn’t particularly good beforehand. This is something to watch out for, but the long-term effects of improved blood sugar control are likely to be worth the small increase in short-term eye disease risk. 

Kidney damage from GLP-1 RAs is rare, but some cases have been reported. Your doctor will tell you what to watch out for, in case you experience this rare but serious side effect.

GLP-1 RAs affect the digestive system, including slowing down the emptying of the stomach. This can affect how the body absorbs any other medications that you take. It’s important to ensure that your doctor is aware of everything that you’re taking, including any supplements or traditional medicines, because of this possible interaction.

Are you considering GLP-1 RAs for managing your diabetes?

These medications are only available by prescription. If you’re interested in considering GLP-1 RAs as part of your plan for diabetes control, then you’ll need to visit a doctor. Because this is a newer treatment option, not all clinics in Singapore currently offer these medications. If you want to consider this option, then you’ll need to make sure that you choose a clinic that offers it.

Many of our patients receive a GLP-1 RA such as semaglutide, dulaglutide or liraglutide as part of their treatment protocol. Our program includes a consultation with one of our specialist doctors, who will discuss your treatment options and determine whether a GLP-1 would be a good option for you. If so, then you’ll start receiving the medication in our office.

GLP-1 RAs are effective, but they work best when used along with healthy lifestyle changes, like diet and exercise. We understand that this can be challenging in the modern world, which is why we have a strong focus on helping our patients create and stick to a healthy lifestyle plan. Our program includes a consultation with a dietitian, as well as digital health coaching designed to help you stay focused on your goals. To learn more about our diabetes management program, please book a consultation with our team.