Tirzepatide (Brand Name: Mounjaro) and Semaglutide (Brand name Rybelsus, Ozempic, Wegovy) are medications which, when used in combination with a medically supervised diet, exercise and weight management program, help with blood sugar control in type 2 diabetics, but also have been shown to cause weight loss. Tirzepatide and Semaglutide belong to class of medications called glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonists, which mimic hormones in your body to lower blood sugar levels, reduce appetite, slow down the gastrointestinal tract, and make you feel fuller after you’ve eaten a meal.

These hormones cause huge effects on the regulation of blood sugar by stimulating glucose-dependent insulin secretion. Insulin is a hormone that promotes sugar uptake by the cells, stores sugar as glycogen, promotes the building of fat, and signals the body to build skeletal muscle. In addition, GIP and GLP-1 inhibits glucagon release (which slows down the release of sugar into the blood so that you burn more fat), slows down gastric emptying (makes you feel full), and lowers the desire for food intake (because you feel full).

No, Tirzepatide and Semaglutide are not types of insulin or a substitute for insulin. They stimulate your pancreas to release insulin when glucose (sugar) is present. Because they rely upon your body’s own insulin to have this effect, Terzapetide and Semaglutide are not used when your pancreas can’t make insulin, such as in patients in type 1 diabetes.

No, they not stimulants. While other weight loss medications, such as phentermine, have stimulating effects that help curb your appetite, Tirzepatide and Semaglutide work very differently (see above).

GIP and GLP-1 agonists help to control your blood sugar, but people taking them also tend to lose weight. GLP-1, the key hormone involved, slows down how fast your stomach empties food (called gastric emptying). And in addition to causing your pancreas to release insulin, they also block a hormone that causes your liver to release sugar (glucagon). Together, these functions can help you feel less hungry, causing you to eat less food and lose more weight.

YES, it is believed that GIP/GLP-1’s can help curb your appetite. In addition to slowing gastric emptying to make you feel full for longer, GLP-1 also plays a direct role in how your appetite is regulated.

With these medications, you will slowly work your way up to the target dose at which time you will see the most amount of weight loss. This was the case in clinical trials, where participants had their dose adjusted until they reached maximum dose injected once weekly. In the GLP-1 phase 3 trial that measured outcomes at 20 weeks, most participants were able to reach the full dose and also lost weight as their dose was increased. They saw additional weight loss over the remaining 48 weeks at the full dose. It is important to keep in mind that weight loss can take time, and you’ll see the best results when you are using your medication in combination with a medically supervised program, a healthy diet and exercise. Sometimes the medication may not work for you, or you may not be able to tolerate the full dose due to side effects.

Yes. Both are considered to be safe and effective when used as indicated. But safe doesn’t mean that there aren’t risks. Both also carry a boxed warning about thyroid C-cell tumors occurring in rodents (with unknown risk in humans), and both shouldn’t be used if you or your family have a history of certain thyroid cancers. They should not be used in people with type-1 diabetes, history of pancreatitis or if you are pregnant. They should be used cautiously for people on other blood sugar lowering medications.

The dose is usually started at a low level and titrated upward so that any side effects are minimized. This will vary from patient to patient.

It depends. Both may not be covered by insurance for people who are not diabetic type 2 or have morbid obesity. However, if the medication is denied by your insurance, we will take the time to file an expedited pre-authorization request. If this fails, we have options to order these medications at a significantly lower cost. As an example the monthly cost for Semaglutide may be $900/month for the injection. We have been able to order Semaglutide for $150-$260/month for the injection (based on dosage required).

If you have taken recent blood tests with your doctor, we may be able to use them. We can send an order for you to do your labs at your closest Quest or LabCorp, with your primary care provider, or at another local health care facility. Below is a quick recap of the labs we require, as well as the labs that are optional but highly encouraged.

Required:

· Kidney function test (Cr/GFR) taken within the past 12-months

· Hemoglobin A1c (HbA1c) or fasting glucose test taken within the past 6 months

· Thyroid-stimulating hormone (TSH) test taken within the past 6-months

Optional, but recommended:

· Lipid panel (to check cholesterol levels)

· Comprehensive metabolic panel (to assess your baseline kidney and liver function)

· High sensitivity C-reactive protein test (Hs-CRP, to evaluate inflammation)

· Vitamin D3 level

You can use your Health Savings Account (HSA) or Flexible Savings Account (FSA) funds to pay for this weight loss program, but please confirm this with your specific HSA or FSA program. Your payments may be reimbursable depending on your plan’s submission process. We can also provide a super bill if necessary.

Once enrolled in the program and evaluated by our medical provider, the medication and supplies will be ordered to the pharmacy. If you are paying cash or your insurance does not cover the cost, we can order and ship the medication and supplies directly to you.

Here are a few things to keep in mind if you are on the ACHIEVE Health and Weight Loss program:

First, you’ll want to limit how much alcohol you’re drinking while on the Program, especially if you are diabetic. Alcohol can have an effect on your blood sugar, and there is a risk that it may drop too low in combination with Tirzepatide or Semaglutide, especially if you are drinking on an empty stomach. Alcohol can irritate your stomach, too. This might make you feel worse in combination with some of the GI side effects from the medication.

You’ll also want to exercise caution if you are taking any oral medications. Since Tirzepatide and Semaglutide slows down gastric emptying, this can potentially impact the amount of oral medication your body is absorbing. And while trials haven’t shown this to be significant with Tirzepatide or Semaglutide, you’ll want to make sure your provider is aware of any other medications you are taking before starting Tirzepatide or Semaglutide.

The common side effects of Tirzepatide and Semaglutide are:

· Nausea

· Vomiting

· Diarrhea

· Stomach pain

· Constipation

Yes. Tirzepatide or Semaglutide may cause serious side effects, including:

· Prolonged vomiting. Patients can develop gastroparesis where the stomach stops moving, and patients vomit considerably. This can lead to dehydration and electrolyte imbalances. Stop using Tirzepatide or Semaglutide and call your health care provider right away if you have vomiting that persists more than a day.

· Inflammation of your pancreas (pancreatitis). Stop using Tirzepatide or Semaglutide and call your health care provider right away if you have severe pain in your stomach area (abdomen) that will not go away, with or without vomiting. You may feel the pain from your abdomen to your back.

· Changes in vision. Tell your health care provider if you have changes in vision during treatment with Tirzepatide or Semaglutide

· Low blood sugar (hypoglycemia). Your risk for getting low blood sugar may be higher if you use Tirzepatide or Semaglutide with another medicine that can cause low blood sugar, such as a sulfonylurea or insulin. Signs and symptoms of low blood sugar may include: dizziness or lightheadedness, blurred vision, anxiety, irritability or mood changes, sweating, slurred speech, hunger, confusion or drowsiness, shakiness, weakness, headache, fast heartbeat, and feeling jittery.

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