Beginning a GLP-1 Medication Support Guide: Practical Advice for A Smooth Start
By Layne A. Gritti DO, Adult, Addiction, and Perinatal Psychiatrist
Glucagon-like peptide-1 receptor agonists (GLP-1s) are medications that help lower blood sugar and support weight loss. They do this by affecting several key functions: helping you feel fuller longer, controlling blood sugar and reducing food cravings, and improving insulin function. They’re commonly used to treat Type 2 diabetes and obesity. They are helpful for medication-induced weight gain and used off-label for binge eating, addictive disorders, PCOS, and more.
Before we can even talk about the nitty “Gritti” for this medication, there is first some other information about insurances, brand names, and compounding.
A healthy, protein-rich diet is necessary to complement a GLP 1 agonist medication for optimal health and safe weight loss.
Insurance Coverage is Spotty
Getting insurance coverage for GLP-1 medications can be one of the most frustrating parts of starting treatment. These medications are expensive, and insurance companies do not make getting them covered easy.
First of all, insurance coverage varies widely depending on your plan, diagnosis (diabetes vs. obesity), and the specific medication. On top of that, most insurance plans will require a prior authorization (PA), meaning paperwork has to be submitted and approved before the prescription is filled. What is a PA? They are a process where health insurance plans review proposed medical care before it's provided, ensuring coverage and “confirming that a procedure or prescription is necessary, effective, and cost-efficient.” (Yes, even though the doctor and patient have already decided it would be beneficial for the patient. How weird!)
Your pharmacy should tell you if there is a PA, but ask your pharmacist if you are not sure. If they tell you there is, you must contact the office to inform us that there is a PA! Even if the pharmacy says they sent us a message, sometimes it is not received. Even with insurance, there may be high out-of-pocket costs (such as if you have not met your medication deductible for the year).
This can be discouraging. Please don’t give up or assume the answer is final. Appeals are common, and it may take several rounds of back-and-forth before coverage is approved. Fighthealthinsurance.com may be able to help you plead your case.
Let us know if your pharmacy has issues, and we can help navigate the steps. If your insurance doesn’t cover one GLP-1, we may be able to try a different one, apply for a manufacturer savings program, or explore compounding (see below).
What’s the Difference?: Brand-Name vs. Compounded GLP-1 Medications
You may hear about compounded versions of GLP-1 medications, especially online or through wellness clinics. It’s important to understand the differences between these and the FDA-approved, brand-name versions. “Brand name” medications are the original version of a drug developed, manufactured, and sold by a pharmaceutical company. It’s the version that goes through clinical trials and FDA approval and it is typically protected by patents for some years. This means no other company can make or sell the same drug under a different name while the patent is in effect. FDA approval means the medication is manufactured under strict quality controls, consistently dosed and tested for safety, and may be covered by insurance.
“Brand-Name” GLP-1s
Ozempic®, Wegovy® (semaglutide)
Mounjaro® (tirzepatide)
Victoza®, Saxenda® (liraglutide)
Trulicity® (dulaglutide)
Compounded GLP-1s: What is compounding?
Compounding medication is the process of creating custom medications by combining, mixing, or altering ingredients to meet a patient's specific needs, often when a commercially available medication is not suitable (or, in this case, unattainable through insurance without astronomical cost to a patient). These are versions of GLP-1s made by “compounding pharmacies.” They may be offered at a lower cost, but they come with important risks and limitations:
Not FDA-approved: The compounding pharmacy creates these formulations outside of the usual approval process.
Cannot be “essentially copies” of commercially available drugs: Doses must vary by more than 10% from commercially available options.
Quality and purity can vary: There’s less oversight, and formulations may not be identical to brand-name versions.
Not guaranteed to be the same medication: Some compounded versions may contain semaglutide salts instead of the active form used in FDA-approved products.
Insurance does not cover compounded medications.
Who shouldn’t take a GLP-1?
Those with a history of pancreatitis, diabetes-related retinopathy, medullary thyroid cancer (this is due to a potential risk of thyroid C-cell tumors, although this risk has not been confirmed in humans), multiple endocrine neoplasia type 2, inflammatory bowel disease, have a GLP-1 allergy, or who are currently pregnant should avoid GLP-1s.
Injection Logistics
Inject in the abdomen or thigh, rotating sites each week to reduce irritation. Most people find it easiest to inject at the same time and day weekly to stay consistent. You can take it with or without food. Depending on the injection site, some individuals have minor differences in absorption. For example, some may feel the medicine absorbs better in the arm and less in the stomach and leg. You can try different injection sites and see how it feels for you.
The official recommendation on missing a dose is if you miss a dose and it is within 3 days of your scheduled time, go ahead and take it. If more than 3 days have passed, skip that week and resume at your next scheduled dose. Do not double up doses. If more than 2-3 doses are missed, you may want to restart at a lower dose to minimize gastrointestinal side effects.
If you have a fear of needles, you are not alone. Most people find the auto-injector pens very manageable. If compounding, the insulin needles used are so tiny you can hardly feel them. It can help to get education and guidance on administering the first dose and, if needed, we can talk about desensitization strategies.
When You Finally Start, Stick With Each Dose for 4 Weeks
Now we finally get to talk about how to start these medications. As a matter of setting expectations, there is something important to understand: this process will be slower than you want it to be. To reduce side effects and help your body adjust, it is important to stay on each dose for 4 weeks before increasing to the next step, even if you feel fine. Increasing too quickly can cause more nausea and vomiting.
At the lower doses, you may not have any weight loss at all. This is normal. Starting low and going slow improves how well your body tolerates the medication. Most of the weight loss happens at higher doses, so don’t expect major changes in the first couple of months.
Hurry Up and “Weight”: Weight Loss Takes Time
It is normal to *not* lose weight right away. I cannot emphasize this enough: the early weeks are focused on helping your body get used to the medication. The appetite-suppressing and weight loss effects become more noticeable at higher doses, usually after the first few months. Even then, it is normal to feel like weight loss is taking too long. Give yourself and your body time and grace. Weight neither comes on nor off overnight.
What to Expect: Common Side Effects
During the first few weeks, it’s common to have gastrointestinal side effects. These usually improve with time. Nausea, vomiting, and diarrhea are the most common side effects and can be managed with medications like ondansetron and loperamide.
Side Effect: What Helps
Nausea: Small meals, ginger, peppermint, ondansetron
Vomiting: Rest stomach, hydrate, ondansetron, call if ongoing
Diarrhea: Hydration, bland foods, loperamide (Rx only) if needed
Constipation: More fiber, water, movement, polyethylene glycol (Miralax)
Fullness: Don’t force meals, eat slowly
Low appetite: Prioritize protein, set regular mealtimes
Dizziness: Hydrate, check blood pressure if ongoing
Headache: Hydration, rest, acetaminophen
Injection site reaction: Rotate sites, ice briefly if bothersome
Visual changes: Contact your clinician right away, especially with diabetes
Medullary thyroid Cancer: Let us know if you feel a lump or have voice changes
Common Concerns About Specific Side Effects:
Thyroid cancer sounds scary. It is worth mentioning that the occurrence of medullary thyroid cancer in patients treated with GLP-1 receptor agonists is exceedingly rare, and current clinical evidence does not support a clinically meaningful increase in risk. This risk comes from animal studies.
I heard it increases the risk of pancreatitis. The risk of pancreatitis with GLP-1 RAs is not increased, and the frequency of pancreatitis in treated patients is approximately 0.1–0.3% over several years.
Can GLP-1s cause gallstones? Yes, there is a 0.13% increase in overall risk for gallstones when using a GLP-1 over placebo. The risk is higher with higher doses, longer duration of use, and when used for weight loss rather than glycemic control. Monitor for upper right quadrant pain.
Can I drink alcohol on a GLP-1? Avoiding alcohol is best when on a GLP-1 because it can worsen dehydration and increase nausea. Some people reduce their alcohol intake while on GLP-1s without trying.
Will a GLP-1 make my hair fall out? Hair loss is an uncommon but well-recognized adverse event from GLP-1s. While this can be upsetting for patients, it is not a safety concern. Luckily, hair generally grows back. We need more studies about why this is happening, but it could be due to the drug itself or from rapid weight loss.
Will this affect my mood? Some patients report feeling less pleasure in their daily life, such as emotional blunting or apathy. Studies, however, have not found this effect. In fact, they more often find GLP-1s are associated with neutral or modestly beneficial effects on mental health-related quality of life and emotional eating behavior. Of all the adverse events that occur, approximately 1.2% are psychiatric in nature. Regarding suicidal ideation specifically, while there were some concerns about this initially, further studies have found that the frequency of suicidal ideation with GLP-1s is very low and not higher than other antihyperglycemic agents.
When to Get Help Right Away
Reach out or seek immediate care if you experience:
Severe stomach pain
Ongoing vomiting or signs of dehydration
Allergic reactions (such as rash, swelling, or difficulty breathing)
Vision changes
Symptoms of low blood sugar (shakiness, sweating, fast heartbeat), especially if you're also taking insulin or medications that increase insulin levels
Prioritizing Protein
Protein is important for everyone, but it is extra important to be deliberate about nutrition when eating fewer calories overall. If protein intake is inadequate, GLP-1s can result in muscle breakdown as the body will use the muscle for energy instead of fat. This is because the body may not have the necessary building blocks to preserve lean muscle mass during weight loss, causing muscle loss instead of fat loss. Getting enough protein in your body will prevent muscle breakdown and allow fat breakdown. As a bonus, it will help you feel fuller for longer.
A good rule is that whenever you are eating anything, make sure you have protein as part of the meal. Even just a little bit. It will help to eat the protein portion of the meal first. Protein shakes are a quick, easy-to-digest, and convenient way to ensure good protein intake. There are many types of them out there, but I prefer Premier Protein Shakes because they have a good ratio of protein, sugar, and fiber (I don’t get paid to recommend this brand. I just like it.).
Working with a dietitian or nutritionist can help you optimize your diet as well.
Do I Need To Be On This Forever? What Happens If I Stop?
If someone loses weight using a GLP-1, they usually need to stay on it long term to keep the weight off. Studies show that when people stop taking these meds, they often gain back most of the weight they lost, sometimes up to two-thirds or more. Their health improvements, like better blood pressure or blood sugar, can also disappear.
This is because obesity works kind of like other long-term health problems, like high blood pressure. You usually need to keep taking medicine to manage it, not just stop once things look better. That’s because after weight loss, your body “fights” to gain it back by making you hungrier and burning fewer calories. So quitting the meds once hitting a "normal" BMI isn’t the right move to maintain the gains from the medication. The goal should be to stay on the lowest dose that works, while keeping an eye on side effects and quality of life.
Keep Moving Forward, Even When Progress Feels Slow
GLP-1s have a variety of uses and are not a quick fix for weight loss. They are a long-term tool that works best when you stay consistent, take your time, and stay connected with support. The early phase is not about dramatic weight loss. It is about helping your body adjust and building a foundation you can maintain.
Educate yourself on side effects. Ensuring adequate protein intake will help give your body the energy it needs. Your body may resist change. That is normal. Progress often feels slow before it starts to add up. If something feels off or isn’t working, say something. We can adjust the plan, manage side effects, or talk through next steps.
You are not doing this alone. We are here to help you stay with it for the long run.
Sources:
1. 2020 Expert Consensus Decision Pathway on Novel Therapies for Cardiovascular Risk Reduction in Patients With Type 2 Diabetes: A Report of the American College of Cardiology Solution Set Oversight Committee. Das SR, Everett BM, Birtcher KK, et al. Journal of the American College of Cardiology. 2020;76(9):1117-1145. doi:10.1016/j.jacc.2020.05.037.
2. 8. Obesity and Weight Management for the Prevention and Treatment of Type 2 Diabetes: Standards of Care in Diabetes-2025. Diabetes Care. 2025;48(Supplement_1):S167-S180. doi:10.2337/dc25-S008.
3. 13. Older Adults: Standards of Care in Diabetes-2025. Diabetes Care. 2025;48(Supplement_1):S266-S282. doi:10.2337/dc25-S013.
4. AGA Clinical Practice Guideline on Pharmacological Interventions for Adults With Obesity. Grunvald E, Shah R, Hernaez R, et al. Gastroenterology. 2022;163(5):1198-1225. doi:10.1053/j.gastro.2022.08.045.
5. American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. Blonde L, Umpierrez GE, Reddy SS, et al. Endocrine Practice. 2022;28(10):923-1049. doi:10.1016/j.eprac.2022.08.002.
6. Approach to Obesity Treatment in Primary Care: A Review. Yanovski SZ, Yanovski JA. JAMA Internal Medicine. 2024;184(7):818-829. doi:10.1001/jamainternmed.2023.8526.
7. Association of Glucagon-Like Peptide-1 Receptor Agonist Use With Risk of Gallbladder and Biliary Diseases: A Systematic Review and Meta-analysis of Randomized Clinical Trials. He L, Wang J, Ping F, et al. JAMA Internal Medicine. 2022;182(5):513-519. doi:10.1001/jamainternmed.2022.0338.
8. Compounded GLP-1 and Dual GIP/GLP-1 Receptor Agonists: A Statement From the American Diabetes Association. Neumiller JJ, Bajaj M, Bannuru RR, et al. Diabetes Care. 2025;48(2):177-181. doi:10.2337/dci24-0091.
9. Discontinuation and Reinitiation of Dual-Labeled GLP-1 Receptor Agonists Among US Adults With Overweight or Obesity. Rodriguez PJ, Zhang V, Gratzl S, et al. JAMA Network Open. 2025;8(1):e2457349. doi:10.1001/jamanetworkopen.2024.57349.
10. Effect of Continued Weekly Subcutaneous Semaglutide vs Placebo on Weight Loss Maintenance in Adults With Overweight or Obesity: The STEP 4 Randomized Clinical Trial. Rubino D, Abrahamsson N, Davies M, et al. JAMA. 2021;325(14):1414-1425. doi:10.1001/jama.2021.3224.
11. Efficacy of GLP-1 Receptor Agonists on Weight Loss, BMI, and Waist Circumference for Patients With Obesity or Overweight: A Systematic Review, Meta-Analysis, and Meta-Regression of 47 Randomized Controlled Trials. Wong HJ, Sim B, Teo YH, et al. Diabetes Care. 2025;48(2):292-300. doi:10.2337/dc24-1678.
12. GLP-1 Receptor Agonists for the Treatment of Alcohol Use Disorder. Petrie GN, Mayo LM.
13. GLP-1-based Therapies for Diabetes, Obesity and Beyond. Drucker DJ. Nature Reviews Drug Discovery. 2025. doi:10.1038/s41573-025-01183-8.
14. GLP-1a: Going Beyond Traditional Use. Laurindo LF, Barbalho SM, Guiguer EL, et al. International Journal of Molecular Sciences. 2022;23(2):739. doi:10.3390/ijms23020739.
15. Glucagon-Like Peptide-1 Receptor Agonists and Alcohol Use Disorders: An Emerging Unexpected Beneficial Effect. Scheen AJ. Diabetes, Obesity & Metabolism. 2025. doi:10.1111/dom.16453.
16. Glucagon-Like Peptide-1 Receptor Agonists in the Management of Type 2 Diabetes Mellitus and Obesity: The Impact of Pharmacological Properties and Genetic Factors. Klen J, Dolžan V. International Journal of Molecular Sciences. 2022;23(7):3451. doi:10.3390/ijms23073451.
17. Glucagon-Like Peptide-1 Receptor Agonists, but Not Dipeptidyl Peptidase-4 Inhibitors, Reduce Alcohol Intake. Farokhnia M, Tazare J, Pince CL, et al. The Journal of Clinical Investigation. 2025;135(9):e188314. doi:10.1172/JCI188314.
18. Honigberg MC, Chang LS, McGuire DK, et al. Use of Glucagon-Like Peptide-1 Receptor Agonists in Patients With Type 2 Diabetes and Cardiovascular Disease: A Review. JAMA Cardiology. 2020;5(10):1182-1190. doi:10.1001/jamacardio.2020.1966.
19. Hach M, Engelund DK, Mysling S, et al. Impact of Manufacturing Process and Compounding on Properties and Quality of Follow-on GLP-1 Polypeptide Drugs. Pharmaceutical Research. 2024;41(10):1991-2014. doi:10.1007/s11095-024-03771-6.
20. Lim CE, Pasternak B, Eliasson B, Ueda P. Treatment Discontinuation Among Users of GLP-1 Receptor Agonists and SGLT2 Inhibitors in a National Population of Individuals With Type 2 Diabetes. Diabetologia. 2025. doi:10.1007/s00125-025-06439-x.
21. Management of Hyperglycemia in Type 2 Diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Davies MJ, D'Alessio DA, Fradkin J, et al. Diabetes Care. 2018;41(12):2669-2701. doi:10.2337/dci18-0033.
22. Management of Hyperglycemia in Type 2 Diabetes, 2022. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Davies MJ, Aroda VR, Collins BS, et al. Diabetes Care. 2022;45(11):2753-2786. doi:10.2337/dci22-0034.
23. McCall KL, Mastro Dwyer KA, Casey RT, et al. Safety Analysis of Compounded GLP-1 Receptor Agonists: A Pharmacovigilance Study Using the FDA Adverse Event Reporting System. Expert Opinion on Drug Safety. 2025. doi:10.1080/14740338.2025.2499670.
24. Mechanisms of GLP-1 Receptor Agonist-Induced Weight Loss: A Review of Central and Peripheral Pathways in Appetite and Energy Regulation. Moiz A, Filion KB, Tsoukas MA, et al. The American Journal of Medicine. 2025;138(6):934-940. doi:10.1016/j.amjmed.2025.01.021.
25. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes-2025. Diabetes Care. 2025;48(Supplement_1):S181-S206. doi:10.2337/dc25-S009.
26. Powell J, Taylor J. Use of Dulaglutide, Semaglutide, and Tirzepatide in Diabetes and Weight Management. Clinical Therapeutics. 2024;46(3):289-292. doi:10.1016/j.clinthera.2023.12.014.
27. Yanovski SZ, Yanovski JA. Approach to Obesity Treatment in Primary Care: A Review. JAMA Internal Medicine. 2024;184(7):818-829. doi:10.1001/jamainternmed.2023.8526.
28. Elmaleh-Sachs A, Schwartz JL, Bramante CT, et al. Obesity Management in Adults: A Review. JAMA. 2023;330(20):2000-2015. doi:10.1001/jama.2023.19897.