Semaglutide (Ozempic, Rybelsus, Wegovy) is a GLP-1 receptor agonist used for the treatment of type 2 diabetes and, more recently, weight management. Due to its efficacy in weight loss, semaglutide has gained worldwide popularity, particularly the branded version Ozempic, resulting in off-label use by people seeking rapid weight loss. The resulting high demand has led to an increase in falsified products sold by unregulated online marketplaces. We present a case of a 31-year-old woman who was admitted to the emergency room in a hypoglycaemic coma after self-administrating semaglutide (Ozempic) obtained from a website. Toxicological analysis showed that the vial contained insulin instead of semaglutide, therefore leading to severe hypoglycaemia. This case highlights the growing concern regarding falsified medicines sold in the online drug market and the associated risk of severe adverse events. We reported the case to the Italian Medicines Agency (AIFA) and local authorities. We propose regulatory measures to mitigate similar incidents in the future.