What To Do When You Can’t Stay on a GLP-1

For people with diabetes, GLP-1 drugs like Ozempic can help make managing diabetes less challenging. Yet a large 2025 study reported that nearly 47% of people with type 2 diabetes stopped taking these medicines within one year. A Cleveland Clinic study found that cost and side effects were among the top reasons people said they discontinued them.

After living with type 1 diabetes since childhood, my family doctor recommended that I start taking a GLP-1 drug because injected insulin is associated with weight gain. I was also interested in the heart and kidney health benefits of these medications.

Because GLP-1 medicines can also reduce insulin resistance, I had to reduce my long-acting insulin by about 20% to avoid hypoglycemia, which can be severe unless insulin therapy is modified before starting. 

Unfortunately, due to an insurance change, I needed to go off the GLP-1 drug I was taking, and over several months, I watched my total daily insulin needs climb steadily. Blood sugar spikes were more common after meals, and my weight crept back up. I’ve since worked through my insurance issues and am glad to be able to take one again.

My experience made me wonder what proactive steps people with diabetes can take when they have to come off a GLP-1 drug – even temporarily – because of cost, side effects, or other reasons. For guidance, I reached out to Dr. Jaime Almandoz, professor of internal medicine and medical director of the Weight Wellness Program at UT Southwestern Medical Center.

Dr. Almandoz emphasized that for people who need to come off these drugs, lifestyle changes like diet and exercise may help lower risk and preserve some benefits, but they can’t fully replace the way GLP-1 drugs affect appetite, metabolism, and blood sugar. 

“I would be careful not to conflate supportive lifestyle strategies with the impact of these therapies, which is a key reason they have been so widely adopted,” he said.

In your clinic, what are some reasons people discontinue GLP-1 therapy?

The most common are cost and insurance coverage changes. We also see discontinuation related to tolerability, particularly gastrointestinal side effects, and less commonly when patients reach a weight or glycemic goal and want to stop. More broadly, this reflects a larger issue that obesity is a chronic and complex disease, and we need to do a better job ensuring consistent access to evidence-based therapies.

What dietary approaches have the strongest evidence for helping maintain weight loss after stopping medication?

There is no single dietary strategy that consistently prevents weight regain, but higher protein intake and attention to total energy intake are among the more evidence-based approaches. In practice, sustainability is key. Patients who maintain structured eating patterns, prioritize protein, and minimize highly processed, energy-dense foods tend to do better, although the effect is often modest without ongoing pharmacotherapy.

What practical advice would you give someone transitioning off medication who hasn’t been exercising regularly?

I would frame this as building physical activity as a core health behavior rather than focusing on exercise solely for weight maintenance. Physical activity supports the preservation of lean mass, improves cardiovascular health, and contributes to overall metabolic health. Starting with achievable, structured goals, such as regular walking combined with resistance training (like weight lifting) a few times per week, is a practical approach. 

Is there evidence supporting maintenance on a lower dose rather than complete discontinuation?

We do not yet have robust data specifically addressing lower-dose maintenance strategies. However, from a clinical standpoint, maintaining some degree of medication support is often more effective than complete discontinuation. If cost is a barrier, a lower or less frequent dose may be a reasonable, pragmatic approach, recognizing that this needs to be individualized with close monitoring.

What misconceptions do people have about stopping GLP-1 therapy?

A common one is that stopping the medication will not meaningfully affect weight or metabolic health. In reality, many patients experience some degree of weight regain, and there can also be deterioration in cardiometabolic markers. This reflects the chronic biology of obesity rather than a failure of the individual and reinforces that long-term treatment is often needed.

Is it helpful for those going off these medicines to talk with a healthcare provider and develop a plan?

Yes, absolutely. If patients are considering discontinuation, it should ideally be done gradually with close clinical monitoring rather than abruptly. These decisions should be made in partnership with a clinician, with a clear follow-up plan. We can see worsening in cardiometabolic parameters, including glucose levels, that may occur even before significant weight regain. Patients do better when discontinuation is intentional and supported rather than abrupt.

The bottom line

If you need to stop taking a GLP-1 medicine for any reason, the goal is not to replace the medication, but to make the transition safely to minimize impacts on health until the next best option is clear. Some effects of these medicines cannot be replaced by other means.

Prioritizing protein, cutting back on highly processed and higher-calorie foods, and staying active with regular walking or resistance training may help preserve some benefits.

Looking to the future, researchers are actively working to develop new drugs aimed at reducing GLP-1 side effects, which may help address one of the top reasons people say they stop taking GLP-1 medicines.

The most helpful next step if you're planning on stopping a GLP-1 is to work with your healthcare provider on a realistic plan to protect your blood sugar, weight, and overall health.

Learn more about GLP-1 drugs here:

• Dealing With Unexpected Effects of GLP-1s
• 6 Benefits of Combining Insulin and GLP-1 Drugs
• How To Stay Strong on a GLP-1