GLP-1 (Glucagon-Like Peptide-1) is an incretin hormone that helps regulate blood sugar by stimulating insulin release, suppressing glucagon, slowing gastric emptying, and reducing appetite. Synthetic GLP-1 receptor agonist peptides are used mainly for type 2 diabetes and chronic weight management, often improving A1c and supporting significant fat loss when combined with diet and exercise. They may also offer cardiovascular benefits in high-risk patients, but must always be used under medical supervision.
GLP-1 Dosing Protocol (Educational Overview Only)
| Phase | Time frame | Male dosing (example) | Female dosing (example) | Clinical focus | Safety / monitoring |
|---|---|---|---|---|---|
| Baseline evaluation | Weeks –4 to 0 | No GLP-1 yet. Assess weight, BMI, A1c, kidney function, liver panel, blood pressure, and current meds. | Same as male; no sex-based adjustment. | Confirm indication (type 2 diabetes, obesity, or both). Set goals for A1c and % weight loss. Choose a specific GLP-1 agent (daily vs weekly). | Screen for contraindications such as personal/family history of medullary thyroid carcinoma, MEN2, severe GI disease, or prior pancreatitis. Discuss pregnancy plans. |
| Initiation | Weeks 1–4 | Start at the lowest labeled weekly or daily dose for the chosen GLP-1 (for example, low-dose weekly injection or minimal daily dose). | Same starting dose as male; doses are not weight- or sex-based in most labels, but prescriber may individualize based on frailty, age, or kidney function. | Goal is tolerance, not rapid weight loss. Educate on injection technique, missed-dose rules, and timing relative to meals if applicable. | Monitor for nausea, vomiting, early satiety, and constipation. Encourage small, frequent meals and hydration. Contact prescriber for severe abdominal pain (possible pancreatitis) or persistent vomiting. |
| Early titration | Weeks 5–8 | If well tolerated, increase by one step (for example, from low to medium weekly dose) at intervals recommended in the product label, usually every 4 weeks. | Same titration pattern. Clinician may titrate more slowly in patients with lower body mass or sensitive GI tract, regardless of sex. | Aim for gradual improvement in fasting glucose and post-prandial control while limiting GI side effects. | Re-check fasting glucose and, if needed, adjust concomitant insulin or sulfonylureas to avoid hypoglycemia. Reinforce diet, resistance training, and protein intake to preserve lean mass. |
| Ongoing titration | Weeks 9–16 | Continue stepwise increases toward an effective maintenance dose (for example, higher weekly dose) only if side effects remain acceptable and additional benefit is needed. | Same dose options; escalation is based on individual response, not sex. | Identify the lowest dose that achieves glycemic or weight-loss targets. For some, staying at a mid-range dose is appropriate. | Monitor weight, waist circumference, A1c every 3 months, kidney function as indicated, and mood. Evaluate for gallbladder symptoms (right-upper-quadrant pain). |
| Maintenance | Month 4 onward | Maintain at the individualized effective dose (often low, medium, or high weekly dose depending on agent and response). Avoid frequent, unsupervised dose changes. | Same maintenance approach. Women of child-bearing potential should discuss contraception and stop GLP-1 before planned pregnancy per product labeling. | Maintain achieved weight loss and glycemic control. Reinforce lifestyle interventions; consider dose reduction only if side effects or excessive weight loss occur. | Continue long-term monitoring of A1c, lipids, kidney function, and blood pressure. Review all other medications to minimize polypharmacy and hypoglycemia risk. Educate that abrupt discontinuation may cause weight regain. |
| Special situations | Any time | In men with very low caloric intake or rapid weight loss, the prescriber may pause titration or lower dose to protect lean mass. | In women with nausea around hormonal changes, titration may be spaced out more or temporarily down-titrated. Pregnancy, breastfeeding, or planning pregnancy require prompt prescriber consultation and likely discontinuation. | Adjust dosing schedule and intensity around major surgery, acute illness, or hospitalization. | Never self-start, import, or adjust GLP-1 peptides without a licensed clinician. This overview is not medical advice or a substitute for professional care. |
References
https://www.ncbi.nlm.nih.gov/books/NBK551568
https://www.ncbi.nlm.nih.gov/books/NBK572151
https://www.nejm.org/doi/full/10.1056/NEJMoa1607141
https://www.nejm.org/doi/full/10.1056/NEJMoa2032183
https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/in-depth/glp-1-agonists/art-20468813
