CLINICAL CORNER
GLP-1 Therapy: Initial Labs, Follow-Up Schedule & Monitoring Plan
GLP-1 program details
GLP-1 Therapy: Initial Labs, Follow-Up Schedule & Monitoring Plan
**Your doctor will order baseline lab work and review your medical history before prescribing a GLP-1 medication. This ensures the medication is safe for you and gives us a starting point to track your progress.
Baseline Labs (Before Starting or Within the Past 6 Months)
The following labs should be completed before or shortly after starting treatment:
- Complete Metabolic Panel (CMP) — includes kidney function (creatinine, eGFR) and liver enzymes (AST, ALT)
- Fasting lipid panel (total cholesterol, LDL, HDL, triglycerides)
- HbA1c (hemoglobin A1c — average blood sugar over 3 months)
- Fasting blood glucose
- CBC (complete blood count)
- Vitamin D level (25-OH vitamin D)
- Vitamin B12 level (especially if also on metformin)
Thyroid Screening:
- TSH (thyroid-stimulating hormone)
- Important: Your doctor WILL ask whether you or any close family member has a history of medullary thyroid cancer or a condition called MEN2. These are absolute reasons NOT to use a GLP-1 medication. Common thyroid conditions like thyroid nodules, goiter, or Hashimoto's thyroiditis are NOT reasons to avoid these medications.
If you are on levothyroxine (thyroid medication): GLP-1 medications can affect how your body absorbs thyroid pills. Your TSH should be rechecked 6–8 weeks after starting or changing your GLP-1 dose.
Follow-Up Visit Schedule
Timepoint | What Happens |
Month 1 | Phone or virtual check-in: Review side effects (nausea, vomiting, constipation), confirm medication tolerance, discuss diet tips (small meals, avoid high-fat/spicy foods, stay hydrated). Dose increase if tolerated. |
Month 3 | Office visit: Weight check, blood pressure, review side effects, dose adjustment. Labs: HbA1c (if diabetic), CMP. Assess weight loss response (goal: at least 5% body weight loss by 3–6 months). |
Month 6 | Office visit: Weight, blood pressure, waist circumference. Labs: HbA1c, fasting lipid panel, CMP, fasting glucose. Review overall progress and adjust dose. |
Month 12 | Office visit: Comprehensive review. Labs: HbA1c, fasting lipid panel, CMP, CBC, vitamin D, vitamin B12. TSH if on levothyroxine or clinically indicated. |
Every 6–12 months thereafter | Ongoing monitoring: Weight, labs (HbA1c, lipids, CMP), medication tolerance, nutritional status, and functional assessment. |
Red Flags — Contact Your Doctor Right Away If You Experience:
- Severe or persistent nausea, vomiting, or abdominal pain (could indicate pancreatitis or gallbladder problems)
- Signs of low blood sugar (shakiness, sweating, confusion) — especially if you also take insulin or a sulfonylurea
- Lump or swelling in your neck, difficulty swallowing, or hoarseness
- Rapid or unexplained weight loss (more than 5% in one month)
- Signs of dehydration (dark urine, dizziness, dry mouth)
- Feelings of depression, anxiety, or thoughts of self-harm
What We Are Monitoring and Why
What We Check | Why It Matters |
Weight & BMI and Body Composition | Track treatment response; goal is sustained weight loss |
Blood pressure | Often improves with weight loss |
HbA1c & blood sugar | Monitor diabetes control or prediabetes status |
CMP | GLP-1 medications are generally safe for kidneys, but dehydration from nausea/vomiting can affect kidney function. Monitor liver health, especially if you have fatty liver disease |
Lipid panel | Cholesterol and triglycerides often improve with treatment |
Vitamin D | Important for bone health, especially with significant weight loss |
Vitamin B12 | Can be low, particularly if also taking metformin |
TSH | Only if on thyroid medication or symptoms suggest thyroid problems |
Lifestyle Recommendations While on GLP-1 Therapy
- Protein intake: Aim for adequate protein daily (at least 60–80 grams/day; your doctor may recommend more) to help preserve muscle mass during weight loss.
- Resistance exercise: Strength training at least 2 days per week helps maintain muscle and bone health.
- Hydration: Drink plenty of water — these medications can reduce your sense of thirst.
- Calcium & Vitamin D: Ensure adequate intake to protect bone density during weight loss.
- Eating tips for side effects: Eat slowly, choose smaller meals, avoid greasy/spicy foods, and limit carbonated drinks and alcohol.
