Is Ozempic Insulin?

Ozempic has become one of the most widely used medications for type 2 diabetes. Between January 2021 and December 2023, Ozempic prescription fills increased by 392%. It also generated approximately 120 billion kroner (~$17-$18 billion USD) in sales in 2024.

Yet many people still wonder—is Ozempic insulin? While both are injectable treatments, Ozempic works very differently from traditional insulin therapy.

In this article, we’ll break down how Ozempic compares to insulin, when the two might be used together, and whether Ozempic can replace insulin. You’ll also learn how their costs differ and why insulin is still necessary for some people with diabetes.

Is Ozempic Considered Insulin?

No, Ozempic is not considered insulin. It is a GLP-1 receptor agonist (glucagon-like peptide-1), which is a non-insulin medication used to lower blood sugar in adults with type 2 diabetes.

This is a common misconception, largely because both insulin and Ozempic are injectable medications used to treat type 2 diabetes. However, their mechanisms of action are fundamentally different.

How Does Ozempic Work for Diabetes?

Ozempic contains the active ingredient semaglutide, which mimics the action of GLP-1. It’s a naturally occurring hormone released in your gut after you eat and performs several critical functions in blood sugar regulation.

Here’s how Ozempic helps bring down blood sugar:

1. Boosts Insulin Production

After you eat, your blood sugar (glucose) goes up. In response, your body releases insulin, which helps move that sugar from your blood into your cells, where it can be used for energy or stored for later.

Semaglutide (Ozempic) attaches to receptors on the cells in your pancreas that make insulin. This tells the cells to release more insulin, but only when your blood sugar is high. Additionally, studies have found that semaglutide can improve how well the beta cells function and may even help prevent further damage.

In type 2 diabetes, the cells in your pancreas that make insulin, called beta cells, stop working properly over time. By the time someone is diagnosed, studies suggest that about half of their beta cell function is already lost. As diabetes gets worse, beta cells keep losing their ability to make enough insulin.

In a 12-week study, people taking semaglutide had a 3x boost in early insulin release and a 2x increase in later insulin release compared to those who took a placebo. Their beta cells worked better overall, and fasting and after-meal glucose levels dropped significantly. They also had lower levels of glucagon, which is the hormone that raises blood sugar.

On top of that, when researchers compared their insulin production to that of healthy people, those on semaglutide had insulin levels that were almost the same.

2. Slows Down Glucagon Production

Glucagon is another hormone made by your pancreas that raises blood sugar levels when they get too low. It works opposite to insulin.

In a healthy body, glucagon helps keep blood sugar balanced by telling the liver to release stored sugar (called glycogen) when needed, like between meals or during sleep. Together, insulin and glucagon keep your blood sugar in balance.

However, in people with type 2 diabetes, the body releases too much glucagon, even when blood sugar is already high. This happens both when fasting and after eating. As a result, the liver keeps putting more sugar into the blood, which makes blood sugar levels go even higher.

As seen in the study mentioned above, semaglutide reduces glucagon levels when they’re not needed, helping to keep blood sugar from spiking.

In the SUSTAIN-3 trial, one of Ozempic’s key clinical studies, researchers compared semaglutide to exenatide ER to evaluate how both drugs affected blood sugar regulation over 56 weeks. Results showed that semaglutide lowered glucagon levels by 11%, while exenatide ER led to only a 4% decrease.

3. Slows Down Food Leaving Your Stomach

Semaglutide delays how quickly food moves from the stomach to the small intestine. This gives your body more time to release insulin and respond to the incoming glucose without causing a spike.

In one study, semaglutide significantly reduced glucose by 5%, glucagon by 14%, increased insulin by 45%, and slowed stomach emptying by 27% compared to placebo during the first hour after a meal.

Another study focused on semaglutide’s effects on gastric emptying. Results showed that compared to baseline, semaglutide slowed the movement of food from the stomach at each time point:

• • 1 hour: 3.5% more food remained
  • 2 hours: 25.5% more
  • 3 hours: 38.0% more
  • 4 hours: 30.0% more

At the 4-hour mark, 37% of the meal was still in the stomach in the semaglutide group, compared to 0% in the placebo group. Also, the time it took for half the meal to leave the stomach was much longer with semaglutide (171 minutes vs. 118 minutes with placebo).

Comparing Ozempic and Insulin

Can You Take Ozempic and Insulin Together?

Yes, Ozempic and insulin can be used together in certain cases.

Type 2 diabetes is a progressive disease, meaning it often gets worse over time. Many patients eventually need more than one medication to keep their blood sugar in the target range.

In the SUSTAIN-5 trial, experts looked at how effective and safe Ozempic is when added to basal insulin therapy for people with type 2 diabetes whose blood sugar was still not well controlled.

A total of 397 patients with uncontrolled type 2 diabetes took part. All were already using basal insulin, and some were also taking metformin. By the end of the study, patients taking Ozempic saw significant improvements in blood sugar levels. The average starting HbA1c was 8.4%, and after 30 weeks:

• • The 0.5 mg Ozempic group lowered HbA1c by 1.4%
  • The 1.0 mg group lowered it by 1.8%
  • In contrast, the placebo group saw only a 0.1% reduction

As for safety, Ozempic caused some digestive side effects and mild low blood sugar events, but it was overall well tolerated. This supports Ozempic as an effective option for patients who need more than just insulin to manage their condition.

ADA Recommendations on Ozempic and Insulin

Traditionally, doctors start with metformin and then add medications one by one. This step-by-step approach helps identify how well each drug works and minimizes side effects and cost. However, new evidence shows that starting with a combination of medications early on can help people reach their blood sugar goals faster and maintain those results longer.

For example, the VERIFY trial showed that people who started with both metformin and vildagliptin (a DPP-4 inhibitor) early in treatment had better long-term results than those who started with metformin alone and added another drug later.

Based on that study, the American Diabetes Association (ADA) now suggests that initial combination therapy should be considered if someone’s A1C is 1.5% to 2.0% above their goal.

Other key points outlined in the ADA’s type 2 diabetes guidelines are:

1. When to Start Insulin

Insulin therapy is considered for any adult with type 2 diabetes who shows signs of the body breaking down muscle or fat for energy (catabolism), which may show up as unexpected weight loss.

It should also be used if the person has symptoms of high blood sugar (like frequent urination or extreme thirst), or if their A1C is above 10% or their blood sugar is at or above 300 mg/dL. These signs suggest that the diabetes is not under control and needs more aggressive treatment.

However, current research shows that starting with an injectable GLP-1 RA or a dual GIP/GLP-1 RA can work just as well or even better than insulin for many people. These medications often lead to better blood sugar control, fewer low blood sugar episodes, and more weight loss.

If you’re already on insulin, adding one of these injectable medications may improve your results more than simply raising your insulin dose. Still, the cost and side effects need to be carefully considered before starting them.

2. GLP-1 RAs Are Preferred Over Insulin

These GLP-1-based medications offer added benefits compared to insulin and sulfonylureas, such as a lower risk of low blood sugar, better support for weight loss, and protection for your heart and kidneys.

For most adults with type 2 diabetes, the preferred treatment before insulin is a GLP-1 receptor agonist (Ozempic, Victoza, Trulicity) or a newer drug that also includes GIP activity (like Mounjaro).

3. Watch for Signs of “Overbasalization”

“Overbasalization” means someone is getting too much basal insulin, which can cause more harm than good. Warning signs include:

• • Basal insulin doses above 0.5 units/kg/day
  • Significant differences between bedtime and morning blood sugars
  • Low blood sugar episodes
  • High swings in blood sugar throughout the day

If you notice these signs, your doctor may need to review and adjust your treatment plan to make sure it still fits your needs.

Will Ozempic Replace Insulin?

It depends. In some situations, Ozempic can reduce or even eliminate the need for insulin, but this isn’t true for everyone.

Cost Comparison: Ozempic vs. Insulin

In the US, the retail price of Ozempic is roughly $900 to $1,200 per month without insurance. Insulin prices vary depending on the type (rapid-acting, long-acting, or premixed), but a single vial can range from $150 to $300, with some patients needing multiple vials monthly. Insulin pens, like the Toujeo SoloStar Pen and Lantus Solostar Pen, are typically more expensive.

If both basal (e.g., Lantus, Tresiba, Basaglar)  and mealtime insulin (e.g., Humalog, Novolog) are needed, the total cost may exceed $1,000/month, putting it in the same range, or higher, than Ozempic.

With insurance, both medications may have variable copays. Ozempic may be placed on higher tiers of drug formularies due to its brand status, resulting in higher copays or prior authorization requirements.

Insulin, especially older or generic forms, may have broader coverage and lower copays, but newer insulins like Lyumjev or Semglee may still be costly.

Although Ozempic has a higher upfront cost, it may be more cost-effective over time for certain patients due to:

• • Once-weekly dosing, reducing the burden of daily injections
  • Lower risk of hypoglycemia, meaning less need for emergency glucose treatments
  • Decreased need for frequent blood sugar monitoring
  • Weight loss benefits, which may reduce the need for other medications

Meanwhile, insulin requires more frequent dosing, glucose testing, and careful meal planning, which may incur additional costs for supplies like test strips, lancets, and glucagon kits.

Cost-Saving Tip!

For a more affordable option, Pharma Giant, an online Canadian pharmacy partner, offers both medications at significantly lower prices. Pharma Giant offers a wide range of insulin types, including vials, cartridges, and pens. Many insulin pens are priced under $200, such as:

• • Toujeo SoloStar Pen – $150
  • Tresiba Flextouch 100 Pen – $149
  • Fiasp FlexTouch Pen – $115
  • Admelog SoloStar Pen – $69.99
  • Basaglar Kwikpen – $115

Ozempic pens are also available starting at $419. Additional savings may apply through bulk orders, coupons, or a 10% discount for new customers.

Summary

Ozempic is not insulin. It works differently by helping your body release insulin only when needed, lowering excess glucagon, and slowing digestion to prevent blood sugar spikes. Unlike insulin, it doesn’t directly replace what your body lacks but supports your existing insulin function.

For many people with type 2 diabetes, Ozempic can be used alone or with insulin. It’s especially helpful in the earlier stages or when weight loss is a goal. However, those with advanced diabetes or very high blood sugar may still need insulin, either temporarily or long-term.

Frequently Asked Questions