Taking Rybelsus for Type 2 Diabetes
What is Rybelsus?
Rybelsus is the brand name for a medication called semaglutide, which is used to treat type 2 diabetes. It belongs to a class of drugs known as glucagon-like peptide-1 receptor agonists (GLP-1 RAs). Rybelsus is unique because it is the first oral formulation of semaglutide, whereas other GLP-1 RAs are typically administered via injection (Ozempic).
Semaglutide works by mimicking the action of a hormone called glucagon-like peptide-1 (GLP-1), which is naturally produced in the body. GLP-1 helps regulate blood sugar levels by stimulating the release of insulin and reducing the production of glucagon, a hormone that raises blood sugar levels. By activating the GLP-1 receptors, semaglutide helps control blood sugar levels, reduces appetite, and promotes weight loss.
Overview of Type 2 Diabetes Mellitus
Type 2 diabetes is a chronic metabolic disorder characterized by high blood sugar levels (hyperglycemia) resulting from the body's inability to effectively use insulin or produce enough of it. Insulin is a hormone produced by the pancreas that regulates the uptake and utilization of glucose (sugar) in the body's cells for energy.
In type 2 diabetes, the body becomes resistant to insulin, or the pancreas doesn't produce enough insulin to maintain normal blood sugar levels. This leads to an accumulation of glucose in the bloodstream, causing various health complications over time.
Symptoms of type 2 diabetes may include increased thirst and hunger, frequent urination, fatigue, blurred vision, slow healing of wounds, and recurring infections.
Monitoring parameters for type 2 diabetes include blood sugar (a current view of how much sugar is in your blood) and A1C (a parameter that measures how well controlled your blood sugar has been for the past 3 months).
Read more about Medication for Diabetes
Heart-Healthy Benefits of Rybelsus
In addition to managing diabetes, Rybelsus and other GLP-1 agonists have shown extra benefits. Rybelsus has been found to protect against heart and kidney disease, especially in individuals with atherosclerotic heart disease or those over 60 years old with major heart disease risk factors like smoking, obesity, or previous heart attacks. This is one of the reasons why Rybelsus is often prescribed for those seeking better diabetes control.
Typical Side Effects of Rybelsus
Like most medications, Rybelsus has a number of possible side effects. Not everyone who takes this medication will experience any or all of these side effects, but it is important to be aware of how you may feel when starting any new medication.
If your side effects are severe or long-lasting, it’s important to speak with a healthcare provider to see if this medication continues to be right for you.
The most common side effects of Rybelsus include:
- Stomach pain
- Decreased appetite
- Weight loss
Much like the injectable form of semaglutide, Ozempic, Rybelsus can sometimes cause weight loss. While less than Ozempic, it is still a significant amount and something to consider wh en picking which medication is right for you.
Weight Loss: A Desirable Side Effect of Rybelsus
Rybelsus is among the few diabetes medications that cause weight reduction. This is typically considered a side effect of the medication, as it is not an FDA-approved use. However, some healthcare providers still prescribe the drug “off-label” for weight loss, even in those who do not have type 2 diabetes.
How does this weight reduction work? The weight loss is thought to be due to a decrease in appetite, which causes you to both eat less and feel fuller after you eat. Eventually, this then leads to a reduction in your weight.
Rybelsus does not have the same amount of weight-reduction as Ozempic, though it is still significant. Studies looking at weight reduction caused by a high dose of Rybelsus (14 mg per day) indicated a decrease of anywhere from 8.2-9.7 pounds after 26-40 weeks of taking the medication. This can vary depending on which other medications you take as well as your baseline weight when starting the drug.
Do all medications in this drug class cause this same weight loss? Not really – semaglutide (both oral and injectable) cause significantly more weight reduction than all other GLP-1 agonists, such as liraglutide (Victoza) and dulaglutide (Trulicity). The exact reason for this is not known!
Warnings While Taking Rybelsus
As this medication makes changes to the body, it comes with certain possible risks. While very uncommon, these risks can be dangerous, so is it important to be aware and watchful.
Pancreatitis (inflammation of the pancreas – the organ that makes insulin and glucagon) is a rare but serious condition. Signs of pancreatitis include upper abdominal pain, fever, nausea, and abdominal tenderness.
There have been reports of injury to the eye known as “diabetic retinopathy” associated with Rybelsus use. This is typically associated with poor blood sugar control but can sometimes worsen with rapid improvement in blood sugar. Any changes to your vision during therapy should be quickly assessed by a healthcare provider.
Development of certain cancers in the thyroid have occurred in animal studies with Rybelsus, though it is unclear if this occurs in humans. Therefore, to ere on the side of caution those with a history of thyroid cancer should not take this medication. Symptoms of a thyroid tumour include a mass in the neck, throat hoarseness, and trouble speaking or swallowing.
- Rybelsus (semaglutide) tablets, for oral use. Food and Drug Administration. (09/2019). Retrieved July 11, 2023, from https://www.accessdata.fda.gov
- Diabetes Canada Clinical Practice Guidelines Expert Committee. Diabetes Canada 2018 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Can J Diabetes. 2018;42(Suppl 1): S1-S325. Retrieved July 11, 2023, from https://guidelines.diabetes.ca
- Meier JJ. Efficacy of Semaglutide in a Subcutaneous and an Oral Formulation. Front Endocrinol (Lausanne). 2021 Jun 25; 12:645617. doi:10.3389/fendo.2021.645617. PMID: 34248838; PMCID: PMC8269445.
- Blundell, J., Finlayson, G., Axelsen, M., Flint, A., Gibbons, C., Kvist, T., & Hjerpsted, J. B. (2017). Effects of once-weekly semaglutide on appetite, energy intake, control of eating, food preference and body weight in subjects with obesity. Diabetes, obesity & metabolism, 19(9), 1242–1251. https://doi.org/10.1111/dom.12932