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Many patients taking GLP-1 receptor agonists such as semaglutide (Ozempic, Wegovy), dulaglutide (Trulicity), and liraglutide (Saxenda, Victoza) report feeling colder than usual during treatment. Whilst this sensation is not listed as a formal adverse effect in UK product information, it is commonly experienced and typically relates to weight loss rather than a direct medication effect. Understanding why GLP-1 medications make you feel cold, when this is normal, and when to seek medical advice can help you manage this symptom effectively whilst continuing beneficial treatment for type 2 diabetes or weight management.
Quick Answer: GLP-1 medications typically make you feel cold due to weight loss reducing body insulation and metabolic heat production, rather than through direct drug effects.
Glucagon-like peptide-1 (GLP-1) receptor agonists, including semaglutide (Ozempic, Wegovy), dulaglutide (Trulicity), and liraglutide (Saxenda, Victoza), are increasingly prescribed for type 2 diabetes management and weight loss. Some patients report feeling colder than usual whilst taking these medications, although this is not listed as an adverse effect in the Summary of Product Characteristics (SmPCs) for GLP-1 preparations in the UK.
The sensation of feeling cold whilst on GLP-1 therapy is likely related to several interconnected physiological mechanisms, primarily associated with weight loss rather than a direct medication effect. Weight loss itself is a primary contributor: as body fat decreases, the body loses insulation and stored energy reserves. Adipose tissue acts as both thermal insulation and an active endocrine organ that helps regulate body temperature. When fat mass reduces, the body's ability to maintain warmth may diminish.
Metabolic rate changes may also play a role. GLP-1 receptor agonists work by mimicking the incretin hormone GLP-1, which enhances glucose-dependent insulin secretion, suppresses glucagon release, slows gastric emptying, and reduces appetite through central nervous system pathways. These metabolic shifts, combined with reduced caloric intake, can lead to a decrease in thermogenesis—the body's heat production. Research suggests that significant calorie restriction can trigger adaptive thermogenesis, where the body conserves energy by reducing heat output, regardless of the method of weight loss.
Additionally, reduced food intake means less diet-induced thermogenesis, the temporary increase in metabolic rate that occurs after eating. Patients consuming substantially fewer calories may notice they feel colder, particularly after meals or during periods of fasting between doses.
For most patients, feeling colder whilst taking GLP-1 medications is commonly reported and often related to weight loss rather than a direct drug adverse effect. It typically develops gradually as weight decreases and is usually not medically concerning. However, distinguishing between normal cold sensitivity and symptoms requiring clinical attention is important.
Normal cold sensitivity associated with weight loss during GLP-1 therapy typically presents as:
A general feeling of being cooler than before treatment commenced
Needing extra layers of clothing or preferring warmer environments
Cold hands and feet, particularly in cool weather
Symptoms that correlate with the amount of weight lost
No other concerning features such as extreme fatigue, confusion, or changes in heart rate
These sensations usually stabilise once weight loss plateaus and the body adjusts to its new composition. Patients who lose weight more gradually may experience less pronounced cold sensitivity.
When cold symptoms may indicate a concern, however, is if they are accompanied by other features that could suggest thyroid dysfunction, anaemia, or other metabolic disturbances. There is no evidence that GLP-1 medications cause hypothyroidism. While rodent studies have shown C-cell tumour findings with some GLP-1 receptor agonists, the human relevance is unknown, and routine calcitonin monitoring is not recommended in UK practice. Patients should seek medical review if they develop a neck mass, dysphagia, or persistent hoarseness.
Patients should be aware that severe or progressive cold intolerance—especially when accompanied by significant fatigue, constipation, dry skin, hair loss, or unexplained weight gain despite continued GLP-1 therapy—warrants investigation for hypothyroidism or other conditions. Similarly, feeling cold alongside dizziness, palpitations, or shortness of breath could indicate anaemia or cardiovascular concerns requiring assessment.
For patients also taking insulin or sulfonylureas, it's important to note that hypoglycaemia can cause symptoms including sweating and shakiness, which might be confused with feeling cold. Consider checking your blood glucose if you experience these symptoms.
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Patients experiencing cold sensitivity whilst on GLP-1 therapy can implement several practical strategies to maintain comfort without discontinuing beneficial treatment. These approaches focus on supporting thermoregulation and ensuring adequate nutrition within the context of reduced appetite.
Practical measures to stay warm include:
Layering clothing appropriately: Wearing multiple thin layers traps warm air more effectively than single thick garments. Natural fibres such as wool and thermal base layers can be particularly helpful.
Maintaining physical activity: Regular exercise generates body heat and helps preserve lean muscle mass, which is metabolically active and contributes to thermogenesis. The UK Chief Medical Officers' guidelines recommend that adults aim for at least 150 minutes of moderate-intensity activity weekly, unless advised otherwise by your healthcare team.
Ensuring adequate nutrition: Whilst GLP-1 medications reduce appetite, consuming sufficient nutrients is important. Higher protein intake may help preserve lean mass; discuss an appropriate target with your clinician or dietitian, especially if you have kidney disease.
Staying hydrated: Proper hydration supports all metabolic processes, including temperature regulation.
Adjusting environmental temperature: Using heating appropriately at home and work, and avoiding prolonged exposure to cold environments.
Nutritional considerations are particularly important. Patients should work with their healthcare team to ensure their reduced food intake still meets nutritional requirements. Including warm foods and beverages throughout the day can provide both nutrition and comfort. If you're struggling with dietary planning, ask your GP about referral to a registered dietitian for personalised advice.
Monitoring weight loss rate with your GP or practice nurse is advisable. According to NHS guidance, safe and sustainable weight loss is typically around 0.5-1 kg per week. Weight loss exceeding this rate over several weeks may warrant dose adjustment or additional nutritional support. The goal is sustainable, healthy weight reduction rather than maximum speed of loss, which can help minimise adverse effects including cold sensitivity.
Whilst mild cold sensitivity is generally expected with weight loss on GLP-1 therapy, certain symptoms warrant medical review to exclude underlying conditions or complications requiring intervention.
Contact your GP or diabetes specialist nurse if you experience:
Severe or worsening cold intolerance that significantly impacts daily activities or quality of life
Cold sensitivity accompanied by other symptoms such as extreme fatigue, persistent constipation, unexplained weight gain, depression, cognitive difficulties, or changes in menstrual patterns (which may suggest thyroid dysfunction)
Dizziness, palpitations, or shortness of breath alongside feeling cold (potentially indicating anaemia or cardiovascular concerns)
Rapid or excessive weight loss (more than 0.5-1 kg weekly sustained over several weeks)
Difficulty maintaining adequate nutrition due to severe appetite suppression or persistent nausea
Any new or concerning symptoms that develop after starting GLP-1 therapy
Your GP may arrange investigations to exclude other causes of cold intolerance, which typically include:
Thyroid function tests (TSH, free T4) to assess for hypothyroidism
Full blood count to check for anaemia
Ferritin and iron studies if anaemia is suspected
Vitamin B12 and folate levels, particularly if you're taking metformin (which can reduce B12 levels) or have dietary restrictions
Review of weight loss trajectory and nutritional adequacy
In most cases, reassurance and practical management strategies will be sufficient. However, if investigations reveal thyroid dysfunction, anaemia, or nutritional deficiencies, these can be treated appropriately whilst continuing GLP-1 therapy if clinically indicated. Your healthcare team can also review whether your current GLP-1 dose remains appropriate or whether adjustment might improve tolerability whilst maintaining therapeutic benefit.
If you're also taking insulin or sulfonylureas and feel shaky, sweaty or clammy alongside feeling cold, check your blood glucose as these could be symptoms of hypoglycaemia, and follow your sick-day or hypo management plan.
Remember: feeling somewhat colder during significant weight loss is normal, but your healthcare team is available to ensure this remains a manageable side effect rather than a barrier to successful treatment. Open communication about all symptoms helps optimise your care and ensures any underlying issues are identified promptly.
If you suspect an adverse reaction to your medication, you can report this through the MHRA Yellow Card scheme (yellowcard.mhra.gov.uk).
For most patients, feeling colder whilst taking GLP-1 medications is a normal response to weight loss rather than a serious adverse effect. However, if cold sensitivity is severe or accompanied by extreme fatigue, constipation, or unexplained weight gain, contact your GP to exclude thyroid dysfunction or other conditions.
Practical strategies include wearing multiple thin layers of clothing, maintaining regular physical activity to generate body heat, ensuring adequate nutrition and hydration, and adjusting your home environment. Discuss your weight loss rate and nutritional intake with your GP or practice nurse to ensure safe, sustainable progress.
Seek medical review if you experience severe cold intolerance affecting daily life, cold sensitivity with dizziness or palpitations, rapid weight loss exceeding 0.5-1 kg weekly, or symptoms suggesting thyroid problems such as extreme fatigue, persistent constipation, or hair loss. Your GP can arrange appropriate investigations including thyroid function tests and full blood count.
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