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Nausea represents the most common side effect during the transition

doi: 10.1111/dom.13129 39 NauckMAMeierJJ

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[1] [2] The most commonly reported side effects in clinical trials were gastrointestinal, including nausea (occurring in 12-29% of patients), diarrhea, vomiting, constipation, and abdominal discomfort

Several studies have examined the effect of SGLT2 inhibitors on bone mineral density

Your digestive system is already adjusting to continuous bile flow, and semaglutide slows stomach emptying further, so side effects may be more pronounced