My Story So Far: T1D & Ozempic for Cardiac Reasons

A couple of weeks ago, my endocrinologist started me on Ozempic–not for blood glucose control or weight loss as it’s normally intended, but because it’s been shown to reduce cardiovascular risk somewhat. Here’s a link to Ozempic’s site so you can see what they say. As far as the clinical research goes, I’m sure you can find it yourself.

(It’s kind of funny. I went straight from syringes to an insulin pump. This is the first time I’ve ever used a pen to inject anything.)

The jury seems to be out as to whether it has benefits for Type 1, but in folks with Type 2 who have established cardiac issues, it appears to be somewhat beneficial.

The primary benefits attributed to Ozempic for folks like me appear to be: reduced risk of MACE (major adverse cardiac events) like reductions in sudden cardiac arrest and heart attacks, and better blood sugar control after eating, all of which I could reasonably benefit from.

The side effects, for the most part, appear to cluster into nausea, appetite and digestive issues, fatigue, dizziness, headache, and occasional tachycardia. Again, I’m not reporting clinical findings here but just listing what I’ve heard.

It’s usually taken as a once-a-week injection of gradually-increasing dose, starting around 0.25 mg/week and leveling off around 0.5-1.0 mg/week if you’re doing it for cardiovascular reasons. (I think the weight-loss dose typically tops out at 2 mg/week.)

Part of the reason for these two doses is that starting at a low dose helps the body get used to the drug with fewer side effects, and the 0.5 mg dose is where most of the heart-related benefits have been documented in research.

My Own Curiosity

As a cardiac patient, I was guardedly curious about trying Ozempic when my endo suggested it might be worth starting, at least while I’m waiting for a definitive answer from my cardiology team on next steps to address a CTO (chronic total occlusion) of my obtuse marginal 2 cardiac artery and the 14% of my heart that it supplies. That area is currently being roughly 50-60% supplied by 3 collateral vessels that have grown since the problem first appeared.

As a Type 1 diabetic, I was of course very curious about how it would affect blood sugars.

By way of background: prior to starting Ozempic, I had adopted an aggressive blood sugar management regime that, while hard to maintain, kept my glucose in range close to 90% of the time, often even in the high 90s. I’ve even had multiple stretches of several days during which they NEVER got out of range – I stayed in range 100% of the time.

For someone diagnosed with Type 1 as a kid over half a century ago, that’s relatively rare and for me at least, it has not been easy.

I attribute a good part of that to diligently adhering to a consciously low-carb diet, especially during days I’m not working out. By the time of my Texas and USA runs back in 2019 and 2020-2021, I had realized that long-distance endurance exercise needs more than just gels for a variety of reasons. For my exercise-day diet that means plenty of carbs plus a fair bit of protein and fat, and a rest-day diet that’s largely low-carb.

So one of the issues I was very curious about related to the so-called “delayed gastric emptying” effect and generally slowed digestion.

What I’ve experienced is that Ozempic slows digestion of pretty much everything down – not just carbs, which normally digest fast, but also protein and fat, which normally digest more slowly anyway.

So if your high-carb diet tends to “hit hard” an hour after lunch, Ozempic tends to stretch it out to 3 hours or longer.

If you eat keto, carnivore, or low-carb, it slows things down even more.

As a result, blood glucose theoretically doesn’t “spike” as much, which should be great for BG control, all other things being equal.

My Experience

More Lows? Not So Far

My endo anticipated that I’d have a lot of lows. That hasn’t happened at all, probably because I mostly eat and therefore mainly dose for protein and fat which digest slowly anyway. I think my way of eating is already pretty well matched to the “Ozempic curve.”

My guess is that if I did routinely eat a higher percentage of carbs, I might well have a lot of lows if I didn’t step down my usual insulin. The insulin would start working right away, but the BG-raising effect of the carbs would be pushed out.

My own experience is that the digestive delay just tends to flatten out the short-term post-meal blood glucose a bit. I’m not sure what the effect would be for someone eating a high-carb diet; but for me at least, I’ve seen at best a mild improvement on the BG curve right after meals.

However, that’s come with a tradeoff that I’m not at all comfortable with, and I’ll talk about that in just a minute (it’s #5 in the list below).

Digestive Issues? Not So Far

I’m still on the lowest dose, so this could change – but so far, even though my meals tend to be comparatively high-fat, I haven’t experienced any digestive distress.

That may change in a couple weeks when I titrate up to .5 mg/week.

Or it may not. My meals are typically quite small, so I think that may be helping.

What I Have Noticed

Here’s the first notable effect I’ve seen from the digestive delay, and it’s a pretty anxiety-producing downside.

Ozempic makes everything digest more slowly – including the glucose you take to treat a low.

If you are trying to treat a low blood sugar, that’s a problem. You want it to hit IMMEDIATELY, and it just…doesn’t.

I’ve had two fairly hard lows recently that were difficult to treat, because I had to wait 15-30 minutes for a liquid glucose “shot” to kick in. Nothing that was an actual emergency, but pretty frightening. If you’re already in tight control of your blood sugars, this can throw you for a loop.

The good news, though, is that it does not slow down emergency glucagon absorption.

The second notable effect I’ve seen is that because food is absorbed more slowly, it can be difficult to get enough energy on board to start a workout right away. EVERYTHING moves in slow motion. You get some carbs for your workout, then you sit around for half an hour waiting for them to kick in, OR you head out the door and have to deliberately hold back on exertion in order to avoid going low quickly.

That’s not such an issue for me, because I’m slow as molasses, but if you’re a hardcore athlete, it might crimp your style a bit.

The third notable effect I’ve seen is that again, because food absorbs more slowly, if you end a workout early, your blood glucose takes a LONG time to come down.

The fourth notable effect I’ve seen regards satiety. I find that I feel full earlier, for longer, and I just don’t eat as much.

I’m not trying to lose weight, but I’ve already lost almost five pounds in the first two weeks. I can maybe stand to lose another 5 pounds or so, but if you’re not trying to lose weight, I think it’s going to be hard not to on Ozempic.

You might want to look at adjusting the ISF (insulin sensitivity factor) and CF (correction factor) on your pump or tweaking your MDI dosing, as the drug may alter it.

The fifth notable effect – and this is the one I’m most concerned about – is that I’m actually having more very persistent highs since I started taking Ozempic, and it’s taking more insulin than I would expect to get them down.

It’s like I developed insulin resistance overnight.

And since I started Ozempic, I’ve spent 26% more time in the 181 – > 250 range.

Definitely not cool. I’ve worked hard on TIR, and I can’t afford to give that up.

But I’m also not someone who rage-boluses, and it makes me very anxious – for good reasons – to have to keep adding more and more on-board insulin to get even a modest high down.

Even exercise doesn’t seem to have much effect on my BG.

I’m looking into the reasons behind all of this and continuing to experiment with various tweaks.

Right now the jury’s out on how to fix this part, so I’ll share more about this as I understand it better.

Final Thoughts

It’s early days yet, and I don’t know whether I’ll stay on Ozempic or not.

I like the idea of cardiac benefits, even if they’re marginal; but they have to be balanced against greater difficulty in managing BGs.

Meanwhile, I continue to be on the lookout for other weird or unanticipated effects. One thing I’ve noticed is that since my food is absorbed more slowly, I’ve had to approach my eating and workout schedule more holistically, as part of the day’s broader flow.

This reinforces a mindset change that’s been underway for awhile. Toward the end of my USA run, I was just beginning to tap into the rhythm of the seasons, not just the minutes or days or hours, and had arrived at some insight into why paying attention to the daily-ness of something mattered.

So slower food absorption has pushed me yet again to ease into eating, ease into working out, and the psychology of “easing into things” has actually brought a measure of deliberation and perhaps even grace to the doing.

I hope that as this grand experiment continues, I’ll have similar insights to report.