Victoza

[michael8626]

Hi

I’m 51, male uk, type 2, insulin controlled, 6 foot tall, 17 stone. I’ve never really had any side effects to any drugs, I’ve just started on Victoza minimum dose, ten days in I feel lethargic, tired, nauseous, constipated, aching and heavy leg muscles. It might be a coincidence? I’ve tested for covid, it was negative.

I had lost a stone in the six weeks prior to starting Victoza by diet and running and exercise. I was running upto 4 miles at a time, going on Victoza has seemingly put be back 2 months, I’m really struggling for energy.

Do the side effects fade in time, especially when I increase dosage? I’m grateful to be trying the drug but are there any alternatives?

Also what is the suggested best time of day to take it, I’ve currently been administering it around 10am?

I’ve always had an uncontrollable (!) appetite but Victoza is making me struggle to eat a large meal in full but unfortunately I’m still snacking!!

 

[Oldvatr]

This is the BNF entry for Liraglutide

Liraglutide | Drugs | BNF content published by NICE

View liraglutide information, including dose, uses, side-effects, renal impairment, pregnancy, breast feeding, contra-indications and important safety information.

bnf.nice.org.uk

Please read the warning about reducing concommitant insulin too quickly.

There is suggestion that insulin being too low can lead to ketone acid buildup, and maybe the lactic acid from the exercise is also building up causing the heavy legs.

The FDA has USA warnings for this drug that do not correspond to the UK guidelines, so worth a read since their Yellow Card system is more proactive than NICE in the UK.

https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/022341s027lbl.pdf

 

[michael8626]

This is the BNF entry for Liraglutide

Liraglutide | Drugs | BNF content published by NICE

View liraglutide information, including dose, uses, side-effects, renal impairment, pregnancy, breast feeding, contra-indications and important safety information.

bnf.nice.org.uk

Please read the warning about reducing concommitant insulin too quickly.

There is suggestion that insulin being too low can lead to ketone acid buildup, and maybe the lactic acid from the exercise is also building up causing the heavy legs.

The FDA has USA warnings for this drug that do not correspond to the UK guidelines, so worth a read since their Yellow Card system is more proactive than NICE in the UK.

https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/022341s027lbl.pdf

Being naive (or thick!) ‘insulin being too low’ does this mean not taking enough?

Since being on Victoza (minimum dose) I haven’t really reduced my novorapid, when I go for a run I purposely will set out with my sugar levels on a higher side, (say 9 or 10) as I know within half hour of running it will decrease and obviously I’m conscious of them not going too low.

Are you saying low blood sugar can increase the chance of lactic acid?

Thanks

 

[Oldvatr]

Being naive (or thick!) ‘insulin being too low’ does this mean not taking enough?

Since being on Victoza (minimum dose) I haven’t really reduced my novorapid, when I go for a run I purposely will set out with my sugar levels on a higher side, (say 9 or 10) as I know within half hour of running it will decrease and obviously I’m conscious of them not going too low.

Are you saying low blood sugar can increase the chance of lactic acid?

Thanks

As a T2D you are presumably still producing your own insulin as well as the injected insulin. The FDA warning applies to all insulin users to not reduce their insulin dose too fiercely.

The conditions for ketones coming from lipid burning occurs under two basic conditions.

One is low insulin with high blood sugars. We do not know what our iinsulin levels are but symptom of T2D is insulin resistance which keeps insulin levels high (but useless) and also the glucose levels high. So increasing the dose may make this worse.

The second case for ketones is the normal dietary condition where glucose is low and insulin is not able to be used either from being too low or from Insulin resistance. Basically we are designed to use lipid energy instead of glucose when we are deficient in glucose for whatever reason. So your exercise will use up all the local glycogen stores in the muscles, and start demanding more. The liver boosts output to compensate, but after a while most athletes start burning lipid energy instead of glucose. Burning lipids releases ketones. exercise releases lactic acid. Both can build up in the blood, and both are acidic. so lactic acidosis or ketoacidosis are two sides of the same coin,

The problem with a med like Victoza is that it jams a spanner into the pancreas, and pretends its a demand for insulin that is not regulated by the normal feedback path (Glucagon) that turns the wick down, and it will last beyond the normal eating cycle so you have longer to build up problems. Normally the extra insulin will dissipate by going into storage mode so either stores excess glucose in cells (high glucose case), or storing fat and synthesiszing glucose from the ketones and fatty acids in the lipids (low glucose case) But drugs like Victoza are designed for weght loss, and normally get prescribed to sedentary people with a high BMI. Don't think they had many athletes in their studies.. The other problem with athletes is that under intense or stressed workouts the increase in cortizol wll increase and counteract the effect of insulin

So I cannot advise on you changing dosage or regime. Unless you can get a c-peptide test to check your insulin levels then you are in the dark. The advice I will give is that you get hold of weestix to test your urine for ketones. Just in case. Also a low carb diet can reduce glucose levels and add dietary ketosis to the medicated one., and hypoland gets closer

 

[michael8626]

As a T2D you are presumably still producing your own insulin as well as the injected insulin. The FDA warning applies to all insulin users to not reduce their insulin dose too fiercely.

The conditions for ketones coming from lipid burning occurs under two basic conditions.

One is low insulin with high blood sugars. We do not know what our iinsulin levels are but symptom of T2D is insulin resistance which keeps insulin levels high (but useless) and also the glucose levels high. So increasing the dose may make this worse.

The second case for ketones is the normal dietary condition where glucose is low and insulin is not able to be used either from being too low or from Insulin resistance. Basically we are designed to use lipid energy instead of glucose when we are deficient in glucose for whatever reason. So your exercise will use up all the local glycogen stores in the muscles, and start demanding more. The liver boosts output to compensate, but after a while most athletes start burning lipid energy instead of glucose. Burning lipids releases ketones. exercise releases lactic acid. Both can build up in the blood, and both are acidic. so lactic acidosis or ketoacidosis are two sides of the same coin,

The problem with a med like Victoza is that it jams a spanner into the pancreas, and pretends its a demand for insulin that is not regulated by the normal feedback path (Glucagon) that turns the wick down, and it will last beyond the normal eating cycle so you have longer to build up problems. Normally the extra insulin will dissipate by going into storage mode so either stores excess glucose in cells (high glucose case), or storing fat and synthesiszing glucose from the ketones and fatty acids in the lipids (low glucose case) But drugs like Victoza are designed for weght loss, and nornmlly get prescribed to sedentary people with a high BMI. Don't think they had many athletes in their studies.. The other problem with athletes is that under intense or stressed workouts the increase in cortizol wll increase and counteract the effect of insulin

So I cannot advise on you changing dosage or regime. Unless you can get a c-peptide test to check your insulin levels then you are in the dark. The advice I will give is that you get hold of weestix to test your urine for ketones. Just in case. Also a low carb diet can reduce glucose levels and add dietary ketosis to the medicated one., and hypoland gets closer

Thanks for the very detailed reply, that makes sense and has filled in a big grey area.

I love being called an ‘athlete’ by the way!!

I do enjoy running but weight, injury and age has held me back. I’ve never been very quick but running and calorie deficit has helped me lose weight in the past, until I stop and put it all back on. I’m sure I have/do suffer with insulin resistance.

I have had a blood test (where it goes on ice) to determine if I was t1 or t2. I’ve been on insulin for around 18 years, I did start on diet control/metformin and always thought I was t2, until it appeared on my medical records that I was t1? I think the blood test wasn’t 100% conclusive but on the basis of evidence I am now classed as t2, insulin controlled.

 

[Oldvatr]

You should be ok so long as any reduction in insulin dose is gradual (as per FDA). Also by same token avoid fasting. Make sure you do not miss a dose. Remember this med thrashes the pancreas, so may lead to burnout (they still don;t know what causes beta cell failure in T2D)