amsterdam_pete said:

Oral semaglutide is absorbed in the stomach with the help of SNAC, which locally raises pH and protects the peptide long enough to cross.

I do not accept that the fasting window is a minor inconvenience. Adherence data on daily orals with timing requirements is consistently worse than weekly injections, and a drug you take imperfectly is a lower dose than the one on the box.

Correct me if the detail matters more than I have assumed.

Adding the numbers, since they settle part of this. Say what you would expect to see if you were wrong, before you look. It is a small discipline and it changes what you notice.

labquiet_amy said:

I do not accept that the fasting window is a minor inconvenience.

There is a second half to this that has not been said yet. The honest answer is that the effect is real, the magnitude is contested, and the individual variation is larger than either. Those three things can all be true at once, and most arguments here are two people holding different parts of that.

One thing that is still open after steph_laguna’s answer:

Whether the fasting requirement is as strict in practice as the label implies, and what people actually see when they get it wrong?

Reporting back.

I moved the tablet to the moment I wake up rather than trying to fit it around breakfast, and the difference in the following weeks was obvious. It was a timing problem, not a dose problem.