Some Ozempic users are administering custom doses, injecting different amounts of the drug than those specifically indicated by the manufacturer’s instructions. They do it by “counting clicks” — hacking the delivery system to draw up ostensibly precise doses that fall between the handful of specifically approved amounts.
Though these in-between doses specifically contradict the manufacturer’s instructions, some patients report that they have the full approval of their doctor, or even that it was their doctor’s idea in the first place.
It’s just the latest sign that the world’s buzziest diabetes and weight loss drug has taken on a life of its own. Semaglutide — named Ozempic when marketed for diabetes treatment and Wegovy when marketed for weight loss — has become so popular that the manufacturer has barely been able to keep it in stock. Doctors have eagerly prescribed Ozempic to patients without diabetes. And a new industry of telehealth services quite plainly markets Ozempic to people without diabetes and even to people without an obvious medical need for weight loss.
Ozempic and Wegovy are delivered with a once-weekly injection. Patients use a “pen,” similar to an insulin pen, to administer the dose, a more user-friendly tool than a syringe. These pens do not automatically deliver the prescribed dose with the click of a single button. Instead, users must prime their pens by rotating a knob or wheel, and, as the wheel rotates, it clicks. An indicator window displays when the desired dose is ready to inject.
Users deduce that if it takes 72 clicks to load a 1.0 milligram (mg) injection, they can use simple arithmetic to dial up any precise dose that they wish. Fifty-four clicks of that pen, for example, would result in a dose of 0.75 mg, an amount that is not officially approved.
The insulin pen, the models for the Ozempic and Wegovy pens, is designed to allow exactly this type of usage. Insulin users are customarily empowered to self-administer doses that vary depending on what they’ve eaten, how much they’ve exercised, the time of day, and many other factors. But it seems apparent that Novo Nordisk, the manufacturer, did not intend for Ozempic and Wegovy users to employ the pen in quite this manner.
The phenomenon has not been widely discussed outside of small corners of the internet dedicated to the details of diabetes management and weight loss. YouTube and TikTok have videos teaching how and why to count Ozempic clicks, and in text-based communities such as Facebook groups, Reddit, and our own Diabetes Daily forum, members share “click charts,” handy reference images that show how much medicine each click dials up. Some of the advice comes straight from doctors and pharmacists with social media followings.
Let’s be absolutely clear: Diabetes Daily has not verified the accuracy of click charts and does not recommend their use. Readers inclined to use a click chart would be well advised to check with their doctors first.
It is also critically important to note that different pens load differing amounts of medicine with each click. A 2 mg pen and an 8 mg pen require different click charts, and using the wrong click chart could result in a very wrong and possibly dangerous dose.
Why Are Users Creating Their Own Custom Doses?
Our review of online diabetes and weight loss communities suggests that Ozempic click counters tend to cite three main justifications for their strategy:
Getting around shortages
Some patients have been instructed by their doctors to use fractional dosages as a way to get around the ongoing Ozempic and Wegovy shortages. Since the beginning of 2022, the manufacturers of these blockbuster drugs have had intermittent difficulty keeping the smaller starter dosages in stock. So, some doctors have prescribed their patients full-strength pens and instructed them to take smaller doses than those officially indicated.
There’s essentially no difference in the sticker price between a pen with 2 mg of semaglutide and one with 8 mg. Who doesn’t want more bang for their buck? Some crafty users, apparently with the approval of their doctors, are filling prescriptions for high-capacity pens and then using click counting to administer smaller doses.
This usage pattern, by the way, threatens to conflict with Ozempic’s stated shelf life. The medicine officially expires 56 days after its first use, whether it’s kept at room temperature or in a fridge. After that point, users are instructed to dispose of the pen and any medicine remaining in it. Anecdotal reports suggest that the medicine remains effective after this point, but users should be aware that they are explicitly ignoring the manufacturer’s specifications.
Managing side effects
Ozempic can result in some pretty nasty gastrointestinal side effects, including diarrhea, nausea, and vomiting. Not everyone experiences these uncomfortable effects, but those that do tend to feel them most severely when they step up to a higher dosage of the medicine. Eventually, their body gets used to it, but those first few weeks can be pretty rough.
For Ozempic, there are four steps up to maximum strength: 0.25 mg, 0.5 mg, 1 mg, 2 mg. Wegovy, which is available at a higher maximum dosage, has five steps.
Some patients — with or without the cooperation of their doctors — have reasoned that a more gradual titration might be easier on the body. Instead of leaping from 0.5 mg to 1.0 mg all at once, why not increase the dose incrementally? If you know how many clicks it takes to administer 0.6 mg or 0.7 mg, you can take baby steps up to the new official dosage.
Likewise, if last week’s dose hit especially hard, some users think nothing of dialing back a little bit. Or, suppose you are scheduled to take your Ozempic shot on the morning of a wedding, examination, job interview, or some other important event: Perhaps a smaller dose will be gentler on your stomach today without setting your progress back.
Click counting — drawing up precise unapproved doses — has emerged as a way to manage the drug shortages, high costs, and side effects associated with Ozempic and Wegovy. The technique is often encouraged by medical professionals.
Readers would be wise to exercise caution, as the practice can conflict with the drug’s stated shelf life and may result in inaccurate dosages. As the use of click charts and custom doses spreads through online communities, it is important that individuals consult their healthcare professionals before making any adjustments to their prescribed treatment.