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When Starting a GLP-1 for Weight Loss

Sep 11, 2018

Although GLP-1’s don’t usually cause hypoglycemia except when given with insulin or a sulfonylurea, I have found that when patients who do not have diabetes are started on a GLP-1, some can have symptoms of hypoglycemia and/or more untoward GI side effects if they start when they come in the office fasting.

Therefore, I teach about the medication-effects and side effects, have them practice with the two clicks to prepare the pen, and teach them how to properly administer their injection after they have had something to eat. It doesn’t have to be immediately after, but within about four hours after eating, AND I often recommend 1/2 of the recommended starting dose when I know the person has had experience with GI side effects on other medications. Then, depending on response, start to increase as recommended or go a bit slower on the escalation.

If a person has untoward side effects on a medication that could be beneficial for them in the long run, I’d rather they start even lower than the recommended dose and go slowly. In the end, it seems like “slow and steady wins the race” rather than start too high or go too fast for that particular patient, risking that patient never wanting to hear about or look at that medication again.

Lessons Learned:

  • When starting a GLP-1 on a patient who does not have diabetes, but has obesity or excess weight, if the patient is fasting, start first dose non-fasting and start at a lower dose than recommended.
  • Teach patients who start on a lower dose that they may not feel the effects of decreased appetite or satiety at first because they are on a lower-than-recommended dose because you want to make sure they tolerate, and increase slowly.
  • I’ve seen recommending to do this be effective.

Joy Pape, FNP-CDE
Medical Editor, DiabetesInControl.com

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