Liraglutide - Victoza, Saxenda

No personal experience of Saxenda or Victoza
At one point my endo suggested adding Januvia ( same class as Victoza) into the medicine mix - I declined based on stuff I read indicating an increased risk of pancreatic cancer - looks like those concerns are still around
https://www.drug-injury.com/druginj...le-side-effects-june-2017-byetta-januvia.html

DavidGrahamJones said:

If my understanding is correct Liraglutide is available as Victoza and approved for type II diabetes. It is also available as Saxenda which is approved as an adjunct in weight management

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True, but as far as I know Saxenda for weight loss is given in higher dosis than Victoza, which might say something about

DavidGrahamJones said:

A GP that I have consulted privately because she specialises in metabolic problems has suggested Saxenda. The first thing I did when I got home was check out the side effects. With common or very common side effects being asthenia; burping; constipation; diarrhoea; dizziness; dry mouth; gallbladder disorders; gastrointestinal discomfort; gastrointestinal disorders; insomnia; nausea; taste altered; vomiting, and my experience with the side effects of other drugs I'm not so sure that this is such a good idea.

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I haven't checked up on Saxenda, but if it is exactly the same as Victoza apparently there's also a nice little risk of pancreatic cancer. I'm on Victoza, and my next goal is to get off it because of this risk. Initially when I started taking it in March 15, I felt it did help reduce my appetite, but that effect has waned and is now non-existant. Either that, or I've got used to that feeling, I'm not sure, but according to my DN they often see this happening. She's keen on getting me on something called Ozempic instead. It's Victoza's equally evil sister, so I don't really see the point. Ozempic also reduces appetite, which I really don't need as I eat something like 13-1400 cals./day. I shouldn't be eating less.
Conclusion: As a weight loss crutch I wouldn't recommend Victoza. The effect is insignificant if there at all. I actually managed to gain 44lbs while taking it. I'm sure it's great for Novo Nordisk, though.
As for side effects ... I do have diarrhoea occasionally and with great unpredictability. This could be down to Victosa, or the metformin I'm also taking - or both. It might have improved since my Victosa dose was decreased by 1/3rd, but its difficult to say because it's so difficult to find a pattern.
Insomnia, yes, but again difficult to say if it's caused by the Victosa or not. Apparently women my age often have this problem. I often worry about going to sleep because of the diarrhoea, but I also often wake up for no apparent reason at the most ungodly hours. So that's a big 'maybe'.
As for the rest of the side effects you mention, no I can't say that any of them have caused me any problems, to the best of my knowledge.

DavidGrahamJones said:

Liraglutide binds to, and activates, the GLP-1 (glucagon-like peptide-1) receptor to increase insulin secretion, suppresses glucagon secretion, and slows gastric emptying. I wonder how increased insulin secretion helps with weight problems?

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Good point!

DavidGrahamJones said:

Just wondering if anybody has any experience of Saxenda? Also, I've read that several forum members have tried Victoza so I'd appreciate your experiences as well.

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Well, here's my experience, but please feel free to ask again. I'm only too happy if I can be of any help.

I had Victoza for a while. Not the happiest of experiences. But that is just me. I am one of those people who has a sensitive tummy! It was certainly very good at getting the blood sugars down and it also killed my appetite stone dead. Unfortunately the gastro-intestinal problems (i.e. the raging gallops) hit and it was all very unfortunate, including me having to jump out of my car and disappear behind a tree on a public common! Fortunately I was a bit of a wild camper in my youth so I knew what to do....but all in all not a pleasant experience. I am now a legend in my own right down at the doctor's surgery and finally they put me on insulin and I haven't looked back.

Obviously, just because I had problems with Victoza doesn't mean it is going to happen to everyone. I have a close friend who takes Victoza who takes the full whack dose with no gut problems and is delighted with it. She has also managed to shift 5 stone and looks marvellous.

I think that like other medications, give it a go. You will be eased on to it and if you have any sensitivities they will become apparent quite quickly.

Best of luck.

P

Interesting question. In a normal person, after food, insulin increases and glucagon decreases, to sort the glucose load from the meal. In folk with T2DM, this is reversed - the insulin level does not rise after food and the glucagon level does not drop - GLP-1 RAs like liraglutide reverse this abnormality. So the insulin secretion is purely in relation to a meal.

But the liraglutide also makes one feel full up quicker, and reduces appetite - so the weight loss is probably due to the decrease in food intake, and the insulin release is in response to food, so not particularly detrimental eg no weight gain, and no hypos.

So, liraglutide is a useful jab for T2DM, but also has been found to decrease risk of heart attack and stroke

When I last looked at the published data in early 2015 or 2016, the weight loss on Saxenda was similar to the weight loss in folk with T2DM and victoza 1.8 mg. It is clear the the purchaser in the UK is unlikely to pay for saxenda, so one would need a private prescription, but an NHS prescription for victoza may do just as well for weight lose as a private prescription for saxenda.

The larger dose of liraglutide in saxenda than victoza may increase risk of side effects. The GLP-1 RAs and gliptins are aunder close scrutiny by the EMEA, and FDA, and risks of pancreatitis and pancreatic cancer do not appear increased

best wishes

SimonCrox said:

Interesting question. In a normal person, after food, insulin increases and glucagon decreases, to sort the glucose load from the meal. In folk with T2DM, this is reversed - the insulin level does not rise after food and the glucagon level does not drop

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Please csn you explain this? Surely insulin rises in response to food, whether non-diabetic or T2.

This 2003 paper talks about abnormalities in different phases of insulin secretion in response to food ingestion as being a significant factor in T2 in addition to insulin resistance.
https://www.mayoclinicproceedings.org/article/S0025-6196(11)62824-3/fulltext

DavidGrahamJones said:

I've managed less than 1,000 calories a day for months on end and even now don't go higher than 1500 calories at the weekend. I don't need an appetite suppressant. I have a weight problem, not an eating problem.

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Those words def ring a bell with me. I wonder why the GP suggested Saxenda to you in the first place. Was she aware of your cal. intake? Or could it be that she didn't believe you? Did she give you any reasons for trying it out?

Bluetit1802 said:

Please csn you explain this? Surely insulin rises in response to food, whether non-diabetic or T2.

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I am grateful to Boo1979 for the refereence above.

Considering just T2DM, the initial problem is insulin resistance, ie the insulin does not work so well; so the body compensates by producing more insulin than average and this controls the glucose levels, initially.

But as time passes, the beta cells are less able to produce enough insulin, - the levels of insulin might be raised after glucose load, but not raised enough to suppress glucose levels given the insulin resistance, and given time the insulin levels decline further; finally, the body cannot handle a glucose load eg in a glucose tolerance test or with a meal, the glucose levels rise, and the diabetes has developed.

In T2DM, diagnosis may occur 7-10 years after the T2DM has started. Beta cell function generally continues to deteriorate over the years, although good glucose control can improve beta cell function; hence if left long enough, eg a decade or more, some folk with T2DM end up with very poor beta cell function needing insulin injections and some behave more like a type 1 diabetic person after several decades.

I attach a pdf with a few slides. The Nauck slide shows that after an oral glucose load, the insulin level (measured as C-peptide) goes up in normal folk, and also goes up in T2DM, but not as much; also the response is greater after oral than IV glucose, because the oral glucose stimulates release of GLP-1 from the gut. The last slide, also by Nauck, has the white diabetic no GLP-1 lines showing that the glucose and glucagon levels are raised, and c-peptide (insulin) is low, and giving GLP-1 (pink lines) decreases the glucagon and increases the insulin, ie pushes them towards normal.

I am sorry if I am making this complicated

Best wishes

DavidGrahamJones said:

The suggestion is that apart from injecting Liraglutide I should follow a 500 calorie a day diet so maybe an appetite suppressant is necessary. Even though I have managed 800 calorie a day in the past, 500? We'll see how it goes, it's only for 4 weeks at a time.

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500? Wow. I'll hold my fingers crossed for you and hope that this project solves at least some of your 'challenges' (new speak). Liraglutide will help you reach your goal of 500 cal/day, though for me it would be next to impossible, but I'm a little surprised that you aim to go that low. Are you not worried that your body will go (further?) into starvation mode? I mean, its less than the Newcastle diet ... I'm asking out of sheer interest as you and I might be in roughly the same place.
My weight loss has been very slow on LCHF/keto, and it's been more or less stalled since October. I started logging my foods 5-6 days ago. I didn't use to count cals since everybody said that it wasn't necessary, but maybe it is for me. I aim for 1340 cals and less than 20g carbs day, and attack my scales every morning to see if anything has miraculously vanished overnight, and yesss, so far 200g or less than ½ pound, which is less than the contents of the mug beside me. I don't think I'm about to give in anytime soon, because keto suits my BG levels so well.
I hope you'll keep us posted and let us know if Saxenda works for you Certainly one can't say it's an uninformed decision. I hope it works wonders for you.

DavidGrahamJones said:

I am concerned about such a low calorie intake which isn't my idea, but has been suggested to me by two doctors independent of each other.

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I'm interested to know what they think 500cals will do that 800cals hasn't? I'd fear even worse metabolic slowdown. Sounds like they have little to know idea about what to suggest.
Would alternate day fasting possibly be easier and more effective as it has been demonstrated to provide a slight metabolic boost? Just a thought..

DavidGrahamJones said:

I am concerned about such a low calorie intake which isn't my idea, but has been suggested to me by two doctors independent of each other.

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I expect they would also recommend statins. Doctors are not always right. Go by your own instincts.

DavidGrahamJones said:

Many thanks for sharing your experiences, it's my experience with Rosiglitazone (insulin sensitizer) and Gliclazide (increases insulin released by pancreas) that makes me very cautious about anything to do with insulin. I'm having several tests that haven't been done before like thyroid function (disappointed that my NHS GP has never suggested that) and adrenal function. Also cortisol levels, estrogen and testosterone levels (done before when I was actually losing weight).

What is also very strange is that patients are expected to follow a very low calorie diet as well as inject Saxenda. It's because very low calorie isn't working that I'm looking around in the first place. I'll get there eventually.

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@DavidGrahamJones I hope that you finally find the answer to your weight problems although I’m surprised they haven’t tested you for thyroid probs before now. Mine was tested every couple of years but was always ‘borderline’ or slightly over until about 6 years ago when it was under active enough to require treatment and, for the first time in my life, I was able to lose weight. Just a thought but I note that you are contemplating going down to 500 cals per day however if, like me, your metabolism is so efficient that it goes into starvation mode would you be better off upping the calories to ‘kick start’ it again? A 600 cal diet nearly killed me and I only lost 7lb in about 2 months so it’s something that I have been advised by an endocrinologist never to attempt again - tbh I felt so ill that I wouldn’t even contemplate it.

The only time I was on diabetic meds was after statins increased my Hba1c from 48 to 54 within 3 months of starting them and my DN prescribed Janivia but I was only on them for a few months because once I stopped taking the statins my Hba1c dropped into the pre then non diabetic zones so I cannot comment on the insulin aspect.