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With semaglutide, its the same

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If side effects occur, we provide guidance on managing them, such as modifying the diet, drinking plenty of fluids, or gradually adjusting the dosage to help the body adapt to the medication

A 20mg vial reconstituted with 4ml instead of 2ml gives you 5mg/ml instead of 10mg/ml, meaning you would need to inject double the volume at each dose step

2A), which is consistent with some earlier observations 50,51

Additionally, the central nervous system effects on appetite regulation may contribute to feelings of fatigue and general malaise during the adaptation period