Screwing up my dosing schedule :(

[MeedzMoar]

I'm at a loss and hoping for some shared experience, insights, and info.

I was successful on branded Sema in 2024-2025. In May, I lost access. Dose at that time was 2.4mg. Finished up my branded supply in early July. I discussed my options with my PCP in August. He supported my going cash branded either Sema or Tirz. I am T2 diabetic.

When considering how to move forward with grey, I decided Sema was more comfortable for me since I knew what to expect & what to look out for when testing on my RS. Tirz is/was unknown to me. The fewer variables the better for me to get started with grey.

In Sept., began testing grey Sema on my RS. Starting dose; 0.25mg. Have increased since Sept to 2.4mg. From early Sept to late Nov, zero weight loss for my RS.

In late Nov, added 0.1mg Cagri. Have continued with 0.1mg Cagri and 2.4mg Sema. Dropped 2# between 11/25 and 12/10. We've been traveling since 12/12.

I didn't plan well and failed to bring Sema with me. I had a partial dose last Weds plus the Cagri. Nothing yesterday.

I get home tomorrow (Friday). I'm really not sure what to do now. Did I blow it on the Sema with this short dose last week and late dose (if at all) this week?

Do I dose 2.4mg Sema tomorrow and follow with Cagri on Saturday (or Sunday) even though it's really not working for my RS or should I just back off for 5-6 weeks (flush the system) and restart at 2.5mg Tirz in early February?

I'm also reading that new, extended Sema dosing data may be forthcoming...

Mostly, I don't want to harm myself by screwing up my receptors. If I need to stay away from testing for some meaningful period of time to ensure my own good health, I absolutely will. Nothing is worth self-harm. 6 years ago, I was obese and diagnosed with T2 diabetes, fatty liver disease, sleep apnea and high cholesterol.

Today, I am nearly half the size I was then, my liver is healthy, sleep apnea is resolved and my cholesterol and blood pressure are perfect. T2 in remission. Other than losing this last 24#, I have never been healthier.

I am paralyzed with uncertainty.

Any insight or suggestions you can share with me are so very much appreciated. There's so much experience in this forum. I'm still so new and learning all the time.

Thank you for reading this far...

 

[lessthanhalf]

There is essentially no evidence that any of the glp medications screw up your receptors, and almost certainly there is no need for an extended wash out period, even more so if you are relying on the medication to control blood glucose levels. Having glucose levels shoot up for several weeks is best avoided. There is some evidence of tolerance to some effects of glp's , but only really for nausea and vomiting that tend to get better over time and gastric emptying moves a bit more towards normal over months, but no evidence of tolerance to their effect on blood sugar levels, appetite suppression or weight loss for at least 3 years - really long term studies have not yet been done.
Tirzepatide has better blood glucose control than semaglutide and is more effective in producing weight loss, and overall is more tolerable, with less nausea and vomiting. Especially as you are at a point of wanting further weight loss and not getting that from standard maximum dose semaglutide, it would make sense to straight switch to tirzepatide. I do not think any washout is needed and given that you tolerate 2.4mg of semaglutide you could quite safely start at 5mg of tirzepatide with very low but never zero chances of worse side effects than you got from semaglutide. Without knowing if you are taking any other blood sugar lowering medications I cannot recommend increasing doses faster than the standard rate, but if there were no other medications involved and blood sugars were higher than they were, then it would probably be reasonable to increase doses a bit quicker, otherwise if glucose levels are not a problem then the standard increase the dose every 4 weeks.
Continuing to include cagrilintide is up to you , the only real reason not to would be hypoglycaemia episodes, or it might make it harder to work out which drug was having the effects, cagrilintide or tirzepatide. Tirzepatide alone is thoroughly supported by scientific evidence for weight loss and diabetes , unlike the semaglutide and cagrilintide combination, as cagrilintide has not yet made it to market approval stage, but there are no red flags suggesting there are problems with it either. And there have been studies of the combination that were successful, though I think tirzepatide was marginally more effective than cagrisemi for weight loss.

 

[miss-sanne]

I wouldn't 'reset', just go for tirz.
Amazing stuff.
It seems we can only get so much from one drug. Even though you added cagri.