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c/semaglutide·posted 2 years ago by u/ravi_sandvik

genuine question about Wegovy that I am slightly embarrassed to ask

PSA Clean Column ×6 Slow Clap ×2 The Quiet One ×1

genuine question about Wegovy that I am slightly embarrassed to ask. I would rather ask a basic question now than get this wrong quietly for two months.

Steady state after a dose change takes four to five half-lives, so the fair judgement point on a new step is about a month, not four days.

The escalation schedule in the trials existed to keep people on the drug. It is a tolerability ramp, and it is why the label reads the way it does.

Delayed gastric emptying is most pronounced early and attenuates with continued dosing, which is why the sulphur burps usually fades at a stable dose.

Would rather be corrected in public than confident in private.

14,135 up / 1,293 down92% upvoted55 commentsid 86cq1u10 Jun 2024

55 comments

30 in this archive, depth 5

best — the order this archive was captured in

u/units_not_mgsyringe math1.7k points·2 years ago

On the "everybody ends up at 2.4" claim, which comes up every few weeks.

The escalation schedule in the trials was designed to get people to a fixed study dose. Real use is not a trial. The dose that keeps your appetite quiet with side effects you can live with is the dose, and for a lot of people on this board that has been 2.4mg for a very long time.

The counter-argument, which is fair: some people genuinely do need the top of the range, and staying low out of caution costs them months. That is a conversation with someone who knows your history, not with us.

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u/ravi_sandvikOP2.5k points·2 years ago

sulphur burps made the first fortnight rough at each step up, then flattened out. Predictable enough that I started planning around it.

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[deleted]1.8k points·2 years ago

[deleted]

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u/coa_janitormod · c/coa542 points·2 years ago

Are you measuring anything other than weight? Waist is usually the one that keeps moving.

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u/test_it_yourselfvetting-13 points·2 years ago

The mental model that finally made this click for me: there are two curves, and people watch the wrong one.

The first is exposure, which is set by the dose and smoothed by a week-long half-life. It changes when you change the dose and then settles over about a month. The second is body weight, which is exposure filtered through appetite, food, water, sleep, training and the scale itself, and which moves in steps rather than a line.

Almost every "it stopped working" post is somebody watching curve two over a fortnight and drawing conclusions about curve one. If the appetite effect is still there, exposure is fine. Wait the month.

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u/stubborn_batchlist_only1k points·2 years ago

Weight change and appetite change are different endpoints on different timescales. Conflating them is where most of the confusion on this board starts.

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u/viktor_nkemelu466 points·2 years ago

Weight change and appetite change are different endpoints on different timescales.

Disagree with this specific line. A pause at 1.0mg is not evidence that 1.0mg has stopped working.

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u/nadia_bakker304 points·2 years ago

Careful. A four-week stall is inside normal variation and treating it as failure is how people escalate for no reason.

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u/quiet_moderatormod490 points·2 years ago

nausea that arrives on day two and fades by day four is the standard shape

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u/aleksi_grimaldi327 points·2 years ago

Does food noise track the day after the shot, or is it there all week?

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u/units_not_mgMOD449 points·2 years ago

Removed the dose recommendation. You can describe what you did; you cannot tell somebody else what to take.

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u/hassan_castellanos213 points·2 years ago

Removed the dose recommendation.

This is the part I would underline for anyone skimming. Everything else in the thread is downstream of it.

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u/units_not_mgsyringe math129 points·2 years ago

What dose and how many weeks at it before this started?

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u/bilal_osei231 points·2 years ago·edited

Did protein intake change in the same window?

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u/customs_seizure_sid126 points·2 years ago

Agreed, and the bit people skip is that the ladder is a tolerance ladder. It is not a potency ranking.

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u/camila_sandvik68 points·2 years ago·edited

That figure is the 68-week trial mean, not a weekly rate. Dividing it by the weeks gives you a number that does not mean anything.

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u/rafael_ostergaard52 points·2 years ago

I would push back gently. Going up because the scale paused is the single most common mistake described on this board.

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u/iman_castellanos126 points·2 years ago

Strongly agree on protein. It did more for my muscle cramps than any of the things I bought to fix my muscle cramps.

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u/micro_bump_mick179 points·2 years ago

The weekly interval comes out of the half-life — roughly a week — so you are on a smooth curve rather than a series of spikes. That is also why moving your day slightly does very little.

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u/ahmed_abubakar55 points·2 years ago

week 17 plateau is the most predictable thing in this entire board

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u/aleksi_grimaldi307 points·2 years ago

Sceptical of the mechanism you are proposing. Gastric emptying slows, it does not stop, and the timings you describe do not follow from it.

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u/kenji_vasquez160 points·2 years ago

Not convinced. You changed the dose and the week at the same time, so you cannot attribute the change to either.

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u/rania_diallo52 points·2 years ago

do not chase somebody else’s titration schedule, they are not you

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u/greta_perrin21 points·2 years ago

staying at 1.7mg for an extra month is a legitimate plan

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u/test_it_yourselfvetting9 points·2 years ago·edited

staying at 1.7mg for an extra month is a legitimate plan

Right, and the timescale is the bit that keeps getting lost. Judge a step at a month, not at a weekend.

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u/ravi_sandvik130 points·2 years ago

the scale is the least sensitive instrument you own

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u/ravi_bergstrom105 points·2 years ago

the food noise going quiet is the effect people actually describe

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u/reflux_report67 points·2 years ago

That reads like a titration plan and this board cannot give you one. Somebody who actually knows your history has to.

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