Short answer: The Ozempic and Mounjaro labels say they can be used with insulin, but as separate injections that are never mixed. Both may go in the same body area as long as the shots are not right next to each other. The labels also warn that adding a GLP-1 medicine to insulin raises the chance of low blood sugar and that the insulin dose may need to come down, which is the prescriber's call.
The Ozempic label (section 2) says: when using Ozempic with insulin, give them "as separate injections and to never mix the products. It is acceptable to inject OZEMPIC and insulin in the same body region, but the injections should not be adjacent to each other." The Mounjaro label has the same wording for Mounjaro.
The insulin labels agree from their side. Lantus, for example, says not to mix it with any other insulin or liquid medicine. Ozempic lists the abdomen, thigh and upper arm as sites and says to use a different spot each week within the same area; Mounjaro lists the abdomen and thigh, or the back of the upper arm when someone else gives the shot.
Mixing two injectables in one syringe is covered more broadly in mixing two medicines in one syringe.
The Ozempic label says semaglutide raises insulin release only when blood sugar is high. In its trial without other diabetes medicines, no severe lows were reported. Added to insulin, the picture changes. Both labels (section 5) warn of a higher risk of low blood sugar, including severe lows, and say lowering the insulin dose may be needed. The Ozempic label adds that this can be considered when Ozempic is started.
| Trial arm | Low blood sugar measure | Placebo | GLP-1 medicine |
|---|---|---|---|
| Ozempic, 30 weeks | Symptomatic, 70 mg/dL or below | 15.2% | 16.7% (0.5 mg), 29.8% (1 mg) |
| Ozempic, 30 weeks | Severe | 0% | 0% (0.5 mg), 1.5% (1 mg) |
| Mounjaro, 40 weeks | Below 54 mg/dL | 13% | 16% (5 mg), 19% (10 mg), 14% (15 mg) |
| Mounjaro, 40 weeks | Severe | 0% | 0% (5 mg), 2% (10 mg), 1% (15 mg) |
Severe meant an episode needing another person's help. More on this in can GLP-1 medicines cause low blood sugar.
Two products put a basal insulin and a GLP-1 medicine in one pen, so there is one injection instead of two. Xultophy 100/3.6 combines insulin degludec and liraglutide; Soliqua 100/33 combines insulin glargine and lixisenatide. Both labels say not to use them with another GLP-1 medicine. The Soliqua label adds that more than 60 units a day can overdose the lixisenatide part.
Two injectables with different schedules, often weekly and daily, are easy to confuse. Dose Track logs each one with its own site, so it is easy to see that the GLP-1 shot and the insulin shots went to different spots, and glucose notes sit next to both.
Read more on Dose Track: Ozempic side effects · Xultophy side effects · Soliqua side effects · Injection site rotation