Understanding Semaglutide: Indications, Lifestyle Changes, Side Effects, and Long-term Effects

Semaglutide is a medicine that has taken the world by storm for the treatment of type 2 diabetes and obesity. It’s effectiveness, paired with society’s desperate need for weight loss in a bottle has made Novo Nordisk, Europe’s most valuable company. It’s also made Novo Nordisk larger than the Dutch Economy (it’s home country).

What We’re Doing Here:

This article considers the SAFE use of semaglutide, dietary and lifestyle changes that become necessary, when used, as well as what kind of side effects are common. Finally, we look at whatever data is available concerning its long-term effects.

What is Semaglutide?

Semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist (promoter), it’s essentially a drug which looks and acts like the natural hormone GLP-1. GLP-1 belongs to a class of hormones called Incretins. They tend to increase insulin levels when blood sugars are high. GLP-1 also has other functions. It slows down the rate at which the gut empties itself. It seems to have some direct and indirect effect on appetite, by decreasing it. The drug has been approved for use in type 2 diabetes and obesity. The drug has been shown to decrease glucose in the blood, help people lose weight, and reduce the risk of cardiovascular events in adults with diabetes.

Semaglutide Uses

  1. Type 2 Diabetes Management: Semaglutide has been proven to effectively manage glycemic responses among adult patients with type 2 diabetes by eliciting increased insulin secretion, suppression of glucagon release, and delay in gastric emptying for the reduction glucose spikes, after a meal. In many practices it’s becoming the first drug to give an obese diabetic patient.
  2. Weight Management: Semaglutide gained approval obesity management after it’s introduction as a Diabetes intervention. Simply put, it helps reduce appetite and caloric intake. Every physicist will tell you that if your calorie intake goes below your calorie burn. You’ll lose weight. At the same time, people report improvement in food choices and a decreased drive for junk food. Considering that almost half of obesity is due to eating disorders, this effect, while not perfectly understood, may be incredibly helpful in a food environment where hyperpalatable are shoved in our face at the checkout line.
  3. Cardiovascular Risk Reduction: Semaglutide has been shown to help reduce the risk of major cardiovascular events, think heart attack, stroke, etc.

Dietary and Lifestyle Changes that Need to Happen along with a Prescription for Semaglutide

If you are obese, it’s very unlikely that the food you normally eat will help you lose weight JUST by eating less. Changes to the Macros and Micros of your diet need to be made. Ideally a nutritionist should be involved. Even if you’re eating very little, you still need top hit, fiber, protein and nutrient goals or you’re just starving yourself with chemistry.

  1. Semaglutide Diet:
    • Low Glycemic / Whole Foods: Such foods include whole grains, legumes, non-starchy vegetables, and fruits.
    • Portion Adjustment: When you’re on Semaglutide, your plate might not look like a normal person’s plate, you might have more chicken and/or beans on your plate along with a healthy portion of veggies and if you’re on the right dose, you’ll have trouble getting all that down.
    • Hydration: Many folks report a fascinating increase in thirst after starting semaglutide and when that happens, go with it. But if you’re not seeing that increased thirst drive, then set up a reminder on your phone or watch to drink as much water as you can. Semaglutide changes the way your stomach empties into the small bowel, where most of your fluid absorption happens. So dehydration can happen if you’re forgetting to have some water intake at regular intervals. If you’re dehydrated, you can’t really burn fat. So if you’re dehydrated and on semaglutide, you’re just torturing yourself with chemistry.
  2. Regular Physical Activity:
    • Cardio Exercise: Introducing mild cardiovascular and strength training while starting semaglutide will prevent some of the muscle loss that happens with rapid weight loss. More intense training should probably be delayed until a steady dose of the drug is determined and the patients hypoxic tolerance is measured.
    • Strength Training: Do it at least two times a week to increase muscle mass and improve metabolic health.
    • Flexibility and Balance: Incorporate flexibility and balance training in one’s routine for overall physical fitness and to reduce the chances of falls, particularly in older people.
  3. Lifestyle Modifications:
    • Stress Management: Weight loss is stressful, you’re aiming for this a sense of feeling well fed, WHILE YOU EAT LESS. The drug helps, but stress-reducing activities, including meditation, yoga, and deep breathing, help big time in flattening out sugar levels as high stress affects sugar levels.

4. Sleep hygiene: Spoke about sleep already, but i really want to emphasise this point. If you can’t get a good nights sleep it gets tougher and tougher to regulate your appetite, even with a medication like Semaglutide. Ensure high sleep quality, and aim for 7–9 hours per night. Poor sleep may affect glucose metabolism and appetite regulation.

Monitoring: You should be monitoring your sleep and eating habits after starting Semaglutide. A simple journal where you mark down how many hours you slept and how you felt when you wake up every day can be incredibly valuable. Noting down any stomach or appetite issues is also helpful in figuring out what the maximum dose of Semaglutide could be.

Side Effects and Potential Down Sides

Like every medication, Semaglutide presents potential side effects and risks. Being aware of these can help in managing and mitigating adverse effects.

  1. Common Side Effects:
    • Gastrointestinal problems: Nausea, vomiting, diarrhea, and constipation frequently occur; especially in the initiation and titration of doses. This is sometimes managed with yet more medication, but if you can find an appropriately easy to digest diet without too much spice, you may not need them.
    • Hypoglycemia: If this drug is being given ALONG with INSULIN or drugs in a class called SULFONYLUREAS (Think Glimiperide), then the doctor needs to rethink the plan or adjust dosages and monitor even more closely for awhile. High doses of Semaglutide along with Insulin or certain drugs like GlimI, etc can cause fatally low sugars.
  2. Severe Side Effects
    • Pancreatitis: After the introduction of Semaglutide on the market, reports mention, uncommon but very severe abdominal pain, which generally radiates to the back. That is pancreatitis and it needs emergent treatment.
    • Kidney Problems: Several cases of acute kidney injury have been reported, usually in such patients with the most severe gastrointestinal side effects leading to dehydration.
  3. Other Potential Risks:
    • Thyroid Tumors: There have been increased risks of thyroid C-cell tumors demonstrated with Semaglutide in preclinical studies conducted in rodents. However, this has not been established in humans, so Semaglutide should not be used in patients with a personal or family history of medullary thyroid carcinoma or patients with multiple endocrine neoplasia syndrome type 2.

Long-term Effects and Data

It’s a fairly new drug. Some studies have been done and There are, ongoing studies on the long-term effect of Semaglutide on different parts of the body and long term weight loss.

  1. Glycemic Control and Weight Loss Long-term studies have revealed that over time, Semaglutide does not lose its efficacy in the improvement of glycemic control or assistance with weight loss. Such sustenance in efficacy is rather vital in treating chronic conditions such as diabetes and obesity. In other words, older diabetes drugs tend to lose effectiveness in individuals, over time. WE’re not seeing that here. I think it has something to do with improved insulin sensitivity when using Semaglutide, but that’s wild speculation.
  2. Cardiovascular Outcomes: The SUSTAIN-6 trial recently proved the that use of semaglutide leads to a significant lowering of the risk for cardiovascular events in patients with type 2 diabetes. Cardiovascular disease and the mircovascular damage that diabetes brings is a bad combination and people with heart disease AND Diabetes are at a very high risk of major cardiac events like a heart attack. Semaglutide helps against this and it’s effect is sustained over the long term, making it a pretty valuable option.
  3. Quality of Life: I dunno how to spell this out. When you’re overweight and you lose that weight, life changes in so many indescribable but positive ways. Semaglutide has allowed people to experience that, in many for the first time in a person’s adult life.
  4. Adherence and Tolerability: Gastrointestinal side effects make adherence to semaglutide for the long term tricky. In most patients, these gastrointestinal side effects are tolerable after the initial adjustment period. Continued education and support for the patient are essential to encourage ongoing adherence and further success.


Semaglutide is so far, our best candidate for weight loss in a bottle. It’s a powerful agent to manage type 2 diabetes and obesity, with significant benefits in both glycemic control and weight loss and the subsequent reduction in cardiovascular risk. But you can’t just start taking it and expect sustained, safe success. It requires profound changes in diet and lifestyle to be effective. It should be ensured that the patient is educated on the drug and what its doing to them while a PCP and their team monitor and management the whole show.