Semaglutide is a human glucagon-like peptide-1 (GLP-1) receptor agonist primarily used for the treatment of type 2 diabetes mellitus and obesity. This medication mimics the GLP-1 hormone secreted by the intestines, promoting insulin secretion from the pancreas while reducing hepatic glucose production, thereby controlling blood glucose levels. Additionally, its ability to prolong satiety effectively reduces appetite, assisting patients in achieving weight loss goals.
Administered via weekly subcutaneous injection, this long-acting medication can be used alone or in combination with other antidiabetic drugs for diabetes management. For weight loss, it must be combined with dietary and exercise programs and is suitable for patients with a BMI ≥30 or BMI ≥27 with related comorbidities.
Semaglutide belongs to the class of "Glucagon-like Peptide-1 Receptor Agonists" (GLP-1 RAs). These drugs selectively bind to GLP-1 receptors, mimicking the physiological effects of intestinal hormones. Its chemical structure contains 94% of the amino acid sequence of human GLP-1, conferring high selectivity and prolonged action.
This class of drugs differs from traditional oral hypoglycemic agents in mechanism, primarily improving glycemic control through multiple pathways: increasing pancreatic β-cell survival, delaying gastric emptying, inhibiting hepatic glycogenolysis, and regulating appetite centers.
For type 2 diabetes, semaglutide can be used as monotherapy or in combination with other oral hypoglycemic agents such as sulfonylureas or SGLT-2 inhibitors. Indications include glycemic control in adult patients with type 2 diabetes and reduction of cardiovascular and metabolic complication risks.
In weight management, this medication is specifically indicated for obese patients with a BMI ≥30 kg/m² or those with a BMI ≥27 kg/m² with comorbid conditions such as hypertension or diabetes. It should be combined with a low-calorie diet and regular exercise to achieve optimal weight loss.
Mild side effects include gastrointestinal discomfort such as nausea, vomiting, and diarrhea, which usually diminish within a few weeks of starting treatment. About 30-50% of patients may experience injection site reactions like redness or itching; rotating injection sites is recommended to alleviate discomfort.
Contraindications: Patients allergic to semaglutide or its components should not use this medication. Those with severe renal impairment require dose adjustments. Pregnant and breastfeeding women should use it only after risk assessment. Patients with a history or family history of medullary thyroid carcinoma should avoid use.
Close monitoring for signs of pancreatitis (such as persistent upper abdominal pain with fever or vomiting), renal function, and unexplained dysphagia or hoarseness (possible signs of laryngeal edema) is necessary. If planning radiological procedures (e.g., endoscopy), the medication should be discontinued 48 hours prior.
When combined with insulin, the risk of hypoglycemia may increase; insulin doses should be adjusted, and blood glucose monitored. Co-administration with NSAIDs or diuretics may exacerbate gastrointestinal side effects. While it has minimal effects on the CYP450 enzyme system, concurrent use with P-glycoprotein inhibitors (e.g., verapamil) may increase plasma concentrations.
For diabetes, starting dose is 0.25 mg/week, injected subcutaneously on the same day each week, with a maximum dose of 2.0 mg/week. For weight loss, the starting dose is 2.4 mg/week, gradually increased to 2.4 mg/week or up to 2.4 mg/week (once weekly). Injection sites include the abdomen, thigh, or upper arm; oral or intravenous administration is not permitted.
The pen should be stored at room temperature, with the needle inserted vertically into subcutaneous tissue. After injection, hold the needle in place for 10 seconds to ensure complete delivery. Once opened, the medication is stable for 14 days; avoid freezing and regularly monitor blood glucose and weight changes.
If a weekly dose is missed, it should be administered as soon as possible. If less than 3 days remain before the next scheduled dose, skip the missed dose. For weight loss treatment, if a dose is missed, administer it immediately upon discovery and continue with the next scheduled dose; do not double doses to compensate for missed ones.
Patients are advised to use medication calendars or mobile reminders and mark each dose after administration. Irregular use may lead to poor glycemic control or reduced weight loss efficacy; contact your healthcare provider promptly if this occurs.
An overdose may cause severe hypoglycemia, vomiting, or altered consciousness; seek immediate medical attention. Excessive injection can lead to hypoglycemic symptoms such as sweating and palpitations; diabetics should carry glucose tablets or sugar cubes for emergencies.
In weight loss treatment, a single overdose may induce severe vomiting and dehydration; discontinue medication immediately and check electrolyte levels. Severe overdose may require hospitalization and dose adjustment.
How should I properly store the semaglutide injection pen to ensure its efficacy?
Unopened semaglutide pens should be stored in a cool place, away from heat and direct sunlight, and must not be frozen. Once in use, the pen can be stored at room temperature (below 25°C) for up to 4 weeks, kept in its original packaging and protected from light. Improper storage may affect drug stability and effectiveness.
What should I do if I experience nausea or diarrhea while using semaglutide?
Some patients may experience gastrointestinal discomfort initially. It is recommended to start with a low dose and gradually increase to allow the body to adapt. Try eating smaller, more frequent meals, avoid injections on an empty stomach, or discuss with your doctor whether to delay dose escalation. If symptoms persist or worsen, seek medical evaluation for possible dose adjustment.
What drug interactions should I be aware of when using other hypoglycemic agents concurrently?
When combined with sulfonylureas, the risk of hypoglycemia increases; blood glucose should be monitored regularly, and doses adjusted accordingly. α-Glucosidase inhibitors have different mechanisms and generally do not interact directly, but overall glycemic control should be observed and managed under medical guidance.
What are the principles for choosing and rotating injection sites?
Injection sites should include the subcutaneous fat of the abdomen, thigh, or upper arm, avoiding muscle injection. Each injection should be at least 2 cm away from the previous site, and sites should be rotated to prevent lipohypertrophy or lipodystrophy. If redness, swelling, or pain occurs, discontinue use and consult a healthcare provider.
How should diet and exercise be coordinated after starting semaglutide?
This medication helps regulate appetite but should be combined with a balanced diet (low carbohydrate, high fiber) and regular exercise (such as 150 minutes of moderate-intensity activity weekly) to enhance efficacy. Avoid high-calorie foods or sudden increases in activity to prevent blood glucose fluctuations. Consult a nutritionist for a personalized diet plan.
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