What Exactly is Ozempic and Who Is It For? From Diabetes to Diet Trends

0:00
Welcome back to another episode of the Diabetes Digital Podcast.

Today we are thrilled to have such an important conversation, and this is something that every single time we’re interviewed on a podcast, people are asking us about.

0:17
And that is the whole Ozempic and Wacovi and GLP 1 phenomenon.

And in this episode, we’re going to discuss GLP ones for their original intended use, which it was for people with diabetes.

A lot of folks aren’t really aware of that, but we want to talk a little bit about the history for GLP ones for diabetes, when they first came to the market, if they’re effective, how effective they are, why that treatment might be a little bit different than how we’re seeing GLP ones use now, which is more for weight loss and some of the side effects.

0:50
So we are super excited to have this conversation and Wendy’s going to introduce our guest.

Yes, we’re going to be chopping it up with Erin Phillips, who’s a registered dietitian, diabetes specialist and private practice owner based in Seattle.

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Her work focuses on the intersection of diabetes and eating disorders and she supports both living with diabetes, both one-on-one and group setting.

She’s passionate about increasing access to weight inclusive diabetes care and supports clinicians who are looking to increase their knowledge in this intersection through clinical consultation.

1:26
Welcome to the Diabetes Digital Podcast.

I’m Wendy.

And I’m Jess, and we’re best friends, registered dietitians and diabetes educators.

Through our telehealth platform, Diabetes digital.co, we offer accessible and personalized virtual nutrition counseling for people with diabetes and pre diabetes.

1:43
Visit diabetesdigital.co That’s Co to book your first appointment.

We accept insurance and offer affordable self pay options.

Now let’s get into today’s episode.

Erin, welcome to the podcast.

Thanks so much for having me.

1:59
I was so pleased that you reached out.

I love your work and have admired you guys for a while.

Oh wow, thank you so much.

That means a lot.

And you are the perfect person to talk to about this.

You even have a course on GLP ones for diabetes, for clinicians.

2:17
So we were just like, absolutely, please, come on, ’cause it seems like there’s a lot of confusion out there.

Yeah.

So First off, can we talk about what is Ozempic?

Or maybe just like, what are GLP ones in general, and why do you feel like they’re so hot, so hot off the press right now?

2:37
It just seems like they’re everywhere, from Oprah Special to Hulu Special.

Every other YouTube video is like something about GLP One.

So tell us like, yeah, a little bit of background.

Yes, GLP one’s another name for them as incretin receptor agonist.

2:55
So they function as a type of hormone, type of hormone that humans already have in the body, and that’s a hormone that people with type 2 diabetes often have decreased levels of.

Yes, exactly.

That’s such great information.

3:11
And I want to even add a little bit more for the science nerds out there who might be curious about, well, what exactly is this medication doing in the body and why is it helpful for people who have diabetes?

So there’s essentially 4 things that GLP One agonists like Ozempic do in the body.

3:33
Number one is they increase insulin secretion.

So for those who don’t know, insulin is a hormone that helps lower blood sugar levels by allowing it to enter cells where it can be used for energy.

So insulin helps the glucose in your blood enter your cells, and these medications will stimulate the pancreas to release insulin when blood sugar levels are high.

3:56
So it helps increase insulin secretion so that more glucose can get into the cells instead of floating around in your blood.

The second thing that they do is decrease Glucagon production.

So Glucagon is also a hormone, and this hormone in particular causes the liver to release stored glucose into the bloodstream.

4:15
And so GLP.

One agonists can reduce the amount of Glucagon produced by the pancreas, and by reducing that Glucagon they can help to lower your blood sugars.

The third thing they do is slow gastric emptying.

So these medications can slow down the rate in which your stomach empties food into the small intestine, which helps to decrease the speed at which the glucose is absorbed into the bloodstream.

4:40
And this will result in a more gradual increase in blood sugar levels after meals, which of course for people with diabetes, they want a more gradual release of blood sugar after meals.

And the last thing that this medication does, and this is the reason why a lot of people are also using this for weight loss, which we’re going to talk about, is that it affects the brain by increasing feelings of fullness to reduce appetite.

5:06
And for a lot of folks, this appetite suppression can lead to weight loss.

Yes.

In terms of why they’re hot in the press right now, I really think it’s because Novo Nordisk and Eli Lilly have spent an absolute exorbitant amount of money promoting them because they’ve been around.

5:24
Ozempic was FDA approved for diabetes in 2017.

I looked it up to double check and I had been working in diabetes care.

I’m sounds like you two had been too.

And probably we’re seeing folks on these meds, but we go V the version of smaglutide that was FDA approved for Bunny ear quotes, chronic weight management was FDA approved in 2021.

5:53
And that’s when we really started to see things shift in terms of how people talk about these meds.

With Ozempic, because on the website it says that it’s specifically for type 2 diabetes, that it’s not recommended solely for weight loss.

6:09
So where did the shift happen?

Because Ozempic has just like taken off like wildfire.

And so is it that these pharmaceutical companies have been funding marketing for people who don’t have diabetes?

Because on the website it says that it is intended for people with diabetes?

Or is it that, like the celebrities you know, started trying it and then it gained popularity that way?

6:30
Like, where did the shift happen with Ozempic?

But that was like the brand name Ozempic in particular.

Yeah, just like the Ozempic craze, because it’s like everyone’s talking about Ozempic and everyone wants to get on Ozempic for weight loss.

And I’m just like, well, when what happened?

6:46
And it could honestly, even just GLP ones in particular, because I think people use the name Ozempic, but like in my experience they mean this class of medication.

So, yeah, just kind of a broader take on that.

Yeah, yeah, yeah, yeah it’s it.

7:03
For some reason grinds my gears when Ozempic is used as this, like catchall.

I don’t know why I gotta look into that in myself, but it seems to really have taken off when some maglutide, which is the active ingredient in both Ozempic and We Go VI took off when We Go V was FDA approved for weight loss in 2021.

7:28
And that’s when I really started to see things more on social media and in the media.

And then just ever since then it’s just taken off so much.

And I hear from folks who folks in larger bodies who are influencers or work in the space talking about body positivity or body liberation that they are getting reached out to by.

8:03
Oh, wow.

By not necessarily Novo Nordisk and Eli Lilly, but people who are hired by them to like, hey, we’ll give you these drugs for free if you talk about us, if you talk about how great the drug is.

8:19
So I don’t know if that’s legal.

Right.

I was just gonna act like a lot, even legal.

I don’t know.

I’ve heard it many times.

Many, many times.

Yeah.

I also think Tiktok plays a role because now everything can go viral or there’s a lot of people sharing their stories or injecting themselves with the shots on Tiktok.

8:43
And oh, wow.

Oh yes.

And not on Tiktok.

Yeah, I just joined last week.

Better, better to stay off So many, yeah.

There’s just so many people sharing this information, sharing their journeys.

8:59
And so I feel like that’s part of why it’s become so viral.

I’m curious like as somebody who is a diabetes educator who has been working with drugs like Ozempic for diabetes, is this a drug that you typically, and I know as a dietitian, we don’t usually recommend drugs, but like is this something that you see your patients with diabetes doing well on and can Co sign on it for people who are on diabetes?

9:26
Like, what’s your experience?

Yeah, both yes and no.

I talk about this class of medications in.

I say I’m agnostic about them.

Like I try to just be really neutral about them and talk about all the pros and cons along with all the other diabetes medications that are out there and there’s so many.

9:46
So we can really, you know, talk about, I talk about them in just like, OK, here’s your list, Here’s your menu of medications for diabetes and here’s the pros and cons of all of them.

And some folks have really, really positive outcomes with whether it’s Ozempic or Trulicity or Minjaro.

10:09
They have, yeah, really positive experiences with them.

And then other folks do not have positive experiences.

And then some people are kind of neutral.

So it really depends.

Depends on the individual.

What do you know?

Yeah.

And just a follow up question to that.

10:27
What would you say is a positive experience?

Like for example, if somebody is on the drug and they’re doing quote well on it, does that mean like they’re A1C, which is their average blood sugar over three months for people who are not familiar, is it decreasing by 5 percentage points?

10:43
Like what do you typically see as like, success with this drug?

So I don’t know.

There’s so, you know so many factors that go into what whether an A1C goes up, goes down, stays the same.

So it’s hard to say in my clinical practice what I see.

11:02
But in the research, what they found is on average for folks who tolerate smaglutide or ozempic, their A1C will drop about 1.5 percentage points on average.

So going from an 8.5 to A7, for example, what I really look at in my clinical practice is how much, how much of A decrease in diabetes distress and just the burden of managing diabetes every day, how much people see with that.

11:31
And so if they see a huge, you know, like I don’t have so much daily tasks, so many daily tasks that are required to manage my diabetes.

And now I just not just but like it’s this one injection a week.

11:47
And then a lot of what I see is instead of these I call them mountains and valleys that we see with blood sugar, we’re seeing more like rolling hills with with these medications.

And in that sense, even if there isn’t a huge decrease in A1 CI, see that if someone’s tolerating it and feeling positive about it or neutral about it, then we talk about that and that could be a definite benefit or success.

12:16
How does that 1.5% decrease in A1C?

How does that compare to other medications or other oral medications like for example metformin, Things like that like what is your experience is?

Is the 1.5 more significant?

Yeah, it totally is.

12:33
Yeah, yeah, yeah.

And then with Tirzepatide or Monjaro, it that it can be up to two or 2.5.

So there’s depending on the dose and depending on how much people tolerate it.

And with metformin, people get about a one on average A1 percentage point decrease, sometimes up to 1.5.

12:51
But I think the metformin’s about one percentage point, yeah.

I have seen many people who have a diabetes and they want to start ozempic more so because of the weight loss claims than the lowered A1C.

Perhaps their A1C is you know already less than 7 which would be considered well controlled and so their motivation is the weight loss.

13:12
Have you had that experience?

And like as a clinician, how would you approach that situation?

Yeah, that’s a really good question.

I think that’s that is really common.

You know, I think that it’s important for me to name that I’m for folks who are listening well on a podcast and not seeing me, or at least seeing my chest up, that I am in a straight sized body or a thin body and so have a lot of privilege in that way.

13:41
I also am white, so have a lot of privilege in that way as well, just moving through the world.

What I really believe is core to my ethics of my practice is I believe in bodily autonomy.

So whoever I’m sitting across from, I don’t want to make their decisions for them.

13:58
I want them to make decisions for themselves with my support, right?

Like my job is to be there, their team member, to bounce ideas off of.

So in that instance, we talk about all of the pros and cons.

So I was actually just talking with a dietitian about this, this morning.

14:17
She has someone in this exact situation.

And so we were talking about, OK, if they’re on metformin, we might need to like taper metformin as we increase the GLP one because even though in the clinical studies there is a pretty low risk of hypoglycemia or low blood sugars.

14:40
I saw you did an episode on that.

In my clinical practice, I definitely see hypoglycemia when people are using these meds, especially for weight loss.

And so since that’s something we really wanna decrease.

If someone has, you know, weighed all the pros and cons of taking this medication for weight loss and they are committed to doing that, then my job is to help them do it as safely as possible.

15:04
So things I also talk about are making sure that we’re we’re still eating regularly and we’re not just like using this medication to kill appetite rather than cause.

Bodies still need fuel, bodies still need nutrients, so we’ll talk about that as well.

15:23
I’m curious about that aspect of things because you hear in the headlines people who stop taking the drug because of all these side effects and maybe they’re not able to eat.

We were doing a podcast interview the other day and they were saying how one of the housewives, Marlo Hampton on on Atlanta, she stopped taking it because she got severe Constipation.

15:46
I didn’t.

Yeah, your heart just goes out to all these people.

Let’s say someone is taking it and they’re not tolerating it well, or they’re having these side effects with a poor appetite.

Like, what do you tell them in terms of how to eat?

Like, is it six small meals a day, ’cause I I think there’s a lot of people who don’t even know what that looks like.

16:04
So I guess if someone is taking it and having side effects and whether or not they’re taking it for diabetes or for weight loss, like how do you navigate that conversation about like eating?

Yeah, it’s hard.

It’s hard.

For most folks that I work with, the hardest part is the first one to four weeks.

16:24
And so during those times, we’re just really talking about the importance of hydration and electrolytes and just literally eating by the clock.

So I use a lot of timers with people of like, OK, we’re gonna set a timer, we’re gonna set an alarm that goes off every two or three hours, and I don’t care how you feel, you’re gonna eat like, I I’m chuckling when I say that, ’cause I don’t just say it exactly that way.

16:57
I’m like, I don’t care how you feel.

But the sense of like this medication you just went from, especially if you’re someone who has a deficiency of these incretin hormones in your body, which the majority of people with type 2 diabetes do have, you’re going from a deficiency of these these hormones to a supra physiologic level.

17:18
So above the quote normal level of hormones that that you have in your body.

So this is a huge increase in this hormone and it’s gonna throw off all of your hunger cues.

So normally, I really advocate for trusting your body’s cues, but in this sense, we can’t, we can’t rely only on those.

17:39
And I also really drill at home how important it is to do that, because if we’re not doing that, in my clinical experience, it really makes side effects worse.

And as soon as people are eating regularly, just like you said, Jessica, like 6 small meals, really like a little fist full of food every couple hours.

18:03
Sorry, more than a fistful, but you get what I mean.

But side effects really start to improve.

Yeah, that’s a great point because I I think for many people who are on an Ozempic and they want to lose weight, they see it as a good thing that their appetite is suppressed.

18:20
They’re like, Oh my God, it’s great.

I’m not hungry anymore.

Especially for people that have a history of bingeing or you know, report having really strong cravings to certain foods, They’re like, this has been God sent.

These cravings are not coming on as strongly as they used to.

18:37
And of course, of course, people feel that way because their cravings have been demonized for forever.

Their appetite has been demonized for since probably they were young children, you know?

So it makes so much sense that this thing that you’ve had a difficult relationship with for so long because people with authority have been telling you your appetite is wrong for so long, it’s this is now helping with that thing that you’ve been told is wrong for so long.

19:08
So yeah, my heart goes out to those folks so much.

Yeah, yeah.

And can you talk to us about the other side effects aside from decreased appetite And like let’s say that after four weeks, the side effects are not going away, they’re still very uncomfortable.

19:25
Like what do you typically advise from a clinical perspective?

Yeah, yeah.

At four weeks, people are usually on like the starter dose.

Usually we don’t increase to the next dose until week 4, if I’m remembering correctly.

19:40
I’m not, I don’t prescribe, so I might be getting that wrong.

But if there’s still pretty miserable side effects, I I start to talk about, OK, here’s here’s all the pros and cons of this medication and all the other medications, all the other options for managing diabetes.

20:00
And then we’ll talk about if we do wanna stay on this medication here, let’s a let’s not increase yet.

That’s my recommendation.

Again, I don’t prescribe and so I can’t technically advise people, but I do, I I do.

20:17
I help people see all the pros and cons and one of those is.

Like other providers don’t.

Don’t.

Yeah, exactly, exactly.

And something I see a lot is that providers are really pushing increases in dosages of these meds.

20:32
And so I can advocate for my patients by saying let’s just not if we’re still having really terrible side effects, why are we going to increase?

It just doesn’t make sense to me.

So then we’ll also talk about all of the strategies they can try at home that will help them tolerate the meds as well, which again is hydration, hydration with electrolytes if possible, small frequent meals and then maybe some fiber.

20:58
Sometimes a fiber supplement can really help.

Or if they’re experiencing Constipation, there is a supplement that can help with Constipation as well.

Some kind of magnesium, yeah.

I use that Constipation.

21:14
Magnesium citrate. 500 milligrams.

Nice.

OK.

Yeah.

And the fiber?

One thing I want to talk about is dosing differences.

And I don’t think people really understand that the dose for weight loss is different from the dose for diabetes typically with this class of medications.

21:35
And it’s interesting, I saw on your Instagram you, you had posted this headline about people’s stomachs getting paralyzed from these drugs and it was very fear mongering.

And you kind of talked about, wait a minute, like here are actually the facts with people who you work with, with diabetes and why, A, this is potentially an outlier just in general and B, it it’s not as applicable to this group because of dosing differences.

22:01
Can you talk about that?

Yeah, yeah, yeah, yeah.

That is another thing that has really ground my gears around, especially in media and social media about these medications is how much, Yeah, like fear mongering there is in terms of these really scary, like really rare, really scary side effects or complications.

22:25
So there’s three medications that are approved for weight loss now and those doses are either a little bit higher than the diabetes dose or significantly higher than the diabetes dose.

So yeah, it’s kind of apples and oranges.

22:41
You know, like we can’t necessarily, like draw these conclusions, especially from these, like sensationalized media headlines about how these diabetes meds are going to be interacting with bodies that have diabetes.

And then we also like in my clinical practice, what I see is these more severe side effects, like I mentioned before, really is more common.

23:08
I see it more often when people aren’t nourishing their bodies well.

And so I think I talked about this in my Instagram post, which was like, if you’re taking these meds to lose weight, you’re.

And we talked about this too, then you’re gonna see that appetite decrease as this really good thing and maybe go a very long time without eating or go a very long time without eating anything significant.

23:32
And that just feels to me like a double whammy on kind of harming your body.

So yeah, there’s so many nuances to it, Yeah.

And I appreciate this nuanced conversation, ’cause I feel like it’s typically like never do it or it’s surpassing them out the mount like lollipops or something like the shots.

23:54
So I think it’s helpful to, yeah, have your experience as a clinician, as a diabetes educator, you’ve kind of seen all these intersections.

That was such a great answer.

And we have so many more questions.

So we’re going to have you back on next week for a Part 2 where we’re going to get more into the conversation for Ozempic and weight loss and the Oprah special and all these different nuances.

24:19
And I think, again, you’re a perfect person to talk to about this.

But for this week, do you mind sharing for our listeners where they can find you the work that you’re doing within diabetes and eating disorders and whether or not you’re taking new patients?

Yeah, absolutely.

I’m so excited for next time and it’s been such a pleasure.

24:38
So you can find me at my website, which is Erin Phillips nutrition.com.

Phillips has two LS and on Instagram I’m at Erin Phillips Nutrition.

I always have to think about that, even though it’s the same.

24:54
And then I just reopened my wait list.

I don’t have openings for new clients for one-on-one right now, but I just opened my wait list for doing kind of diabetes coaching with me.

So more like short term, a little bit more intensive education.

25:11
I call that my diabetes foundations program.

So that’s one-on-one and then I have a couple couple openings for that in the summer.

And then I also do a six week group that I call navigating diabetes without Diet Culture.

25:30
So that’s a group for folks with type 2 diabetes who just wanna learn more about managing their diabetes and want support from other folks who get it.

And I’m hoping to run that again in the summer, late summer.

And also Erin, a birdie told me that you are starting a podcast.

25:48
Can you tell us a little bit more about that?

Yeah, so I’m starting a podcast with my good friend Kelly Six, who is also a dietitian who has lived experience of type one diabetes and is also body liberation dietitian and it’s gonna be a lived experience podcast.

26:08
So we’re having people on who have lived experience of diabetes, whether it’s type 2 diabetes or type one.

We’re really wanting to feature type 2 diabetes because there’s so few stories out there about people of type 2 who are really thriving without dieting and restricting.

26:27
And it’s not because those people don’t exist.

It’s because of a lot of other reasons.

Mostly the Internet is a mean place that can be a really mean place to be.

So yeah, hopefully it’s also coming out this summer.

Oh my God.

But yeah, stay tuned.

I’m excited.

Such a great idea.

26:43
I love it.

Oh, it’s called glucose riot.

That’s.

What we call it?

Yay.

OK, we’ll include it in the show notes if it’s out.

Incredible.

Thank you so much for joining us this week and we will pick up where we left off next week.

27:00
Thanks for joining us for today’s episode.

If you’re interested in nutrition counseling with one of our expert dietitians to help improve your pre diabetes or diabetes, visit us@diabetesdigital.co.

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27:18
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We’ll catch you later.

Bye.