Short answer: Low blood sugar risk goes up; the label says to consider lowering the insulin dose.
Semaglutide lowers blood sugar. The Ozempic and Wegovy labels say the risk of low blood sugar, including severe low blood sugar, is higher when semaglutide is used with insulin, and that prescribers should consider reducing the insulin dose when semaglutide is started. The Wegovy label adds that adding Wegovy to insulin has not been studied.
This is one of the few pairs on this page with direct guidance from an FDA label. The labels describe the risk at the start of treatment, when semaglutide is first added. The Ozempic medication guide lists signs of low blood sugar such as dizziness, sweating, shakiness, hunger, confusion and blurred vision. Anyone on insulin who starts semaglutide should agree on a glucose-checking plan and any insulin dose change with the prescriber first.
FDA label. The interaction is described in the FDA-approved prescribing information for at least one of the two. Caution: There is a documented or likely risk to watch for, such as low blood sugar or added side effects. Talk to your prescriber before combining.
Guides: Semaglutide, Insulin. To check this pair alongside others, open it in the peptide interaction checker.