Modern Metabolic Health with Dr. Lindsay Ogle, MD

5 Secrets to Know When Taking a GLP-1

• Lindsay Ogle, MD • Episode 1

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Ready to start a GLP-1 but not sure what happens after you leave the pharmacy? We walk through the five essentials most people wish they’d heard on day one—how to inject without fear, how to store and warm the pen for comfort, and how to rotate sites to prevent irritation. You’ll hear why a personalized titration plan matters more than a preset calendar, when it’s wise to pause at a lower dose, and how to taper down or restart safely if life gets in the way.

We also tackle two high-stakes areas often overlooked. If you’re taking tirzepatide, we explain how starting and dose increases can reduce the effectiveness of oral birth control for about four weeks, and which non-oral options stay reliable. Planning a procedure? Because GLP-1s slow gastric emptying, we outline why many surgical teams ask you to hold the medication for one to two weeks before anesthesia, and how to coordinate the safest restart afterward to avoid heavy nausea and aspiration risk.

Travel doesn’t have to derail your progress. Zepbound can remain at room temperature for up to 21 days and Wegovy for up to 28, which means most trips only require keeping the pen in your carry-on and avoiding a return to the fridge once it warms. For longer itineraries, a small med cooler is all you need. Along the way, we share simple habits to curb side effects—hydration, protein-forward meals, smaller portions, and mindful pacing—so you can get the benefits with fewer bumps.

If you found this helpful, subscribe, share it with someone starting a GLP-1, and leave a review so others can find clear, evidence-based metabolic health guidance. Your feedback helps us keep these conversations practical and honest.

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Dr. Lindsay Ogle, MD:

Welcome to the Modern Metabolic Health Podcast with your host, Dr. Lindsay Ogle, Board Certified Family Medicine and Obesity Medicine Physician. Here we learn how we can treat and prevent modern metabolic conditions such as diabetes, PCOS, fatty liver disease, metabolic syndrome, sleep apnea, and more. We focus on optimizing lifestyle while utilizing safe and effective medical treatments. Please remember that while I am a physician, I am not your physician. Everything discussed here is provided as general medical knowledge and not direct medical advice. Please talk to your doctor about what is best for you. So you've been prescribed a GLP1 medication and you picked it up at the pharmacy, but not quite sure what to do next. I'll tell you all of the secrets. My name is Dr. Lindsay Ogle and I'm a board-certified obesity medicine physician. And I have five secrets that I want to share with you that really shouldn't be secrets, but sometimes get overlooked when starting a GLP 1 medication, especially if you are not able to work directly with a board-certified obesity medicine physician. And to be honest, many physicians know and want to tell you these things, but unfortunately, they don't have the time in our current medical system. So I do appreciate you taking the time today to learn about these five important things. And I hope that you could share it with somebody who you know is on a GLP1 medication or maybe plan to start a GLP1 medication. So this is a demo of Zetbound. It's just a sample here. I wanted to share it just so you have an idea of what it looks like. Hopefully, you find it not to be intimidating. Often when people hear an injection, they think about a vaccine or getting their blood drawn. This is very, very different than that. You do not have to pull up any medication from a vial into a syringe unless you're using LilyDirect or Novo Care. That's a little bit different. But this is what you would pick up from the pharmacy. And so all of your dose, all a single dose is in here. And it comes in a safety cap, and you would take the cap off, and the needle is hidden. So you can't even accidentally stick yourself. The only way the needle comes out is when you press the injector. Um, and that is going to be secret number one is how do you give yourself the injection? So I was really fortunate to get these samples. I think they are extremely helpful and can clarify this. I'll also include links below to the manufacturer's instructional videos, and so you can watch their version if you desire. But um, like I said, you would get your pen. Actually, I'll take it a step back further. So Zetbound and Weakovy need to be refrigerated. And so when you get the medication from the pharmacy, you want to put it in your refrigerator. When you are ready for your injection, you want to take the pen out of the refrigerator and you just take the one out that you're going to use that day. Set it down on the counter for at least a half an hour. You just want to get it to room temperature. And it is okay for these to be at room temperature for up to 21 days. So don't worry if you forget about it and it's been a few hours, that's okay. You can still give yourself the injection. Nothing has been damaged in the medication. So you let it get to room temperature, and you do that so it's less likely to cause irritation and pain when you do the injection. So if you do your injection in the evening, my current recommendation is when you're cooking your dinner, preparing your meal, you just take the found out of the refrigerator, set it on the counter while you're getting everything ready, you can have your dinner, and then afterwards you would do your injection. That is a perfect way to make sure you have it sitting out as long as it needs to be, and then you remember to take it. So when you're ready to take it, what you'll do is you'll choose your injection site. So you can use your upper arm, you can use your thigh, or you can use your abdomen. Most people that I talk to or patients that I see use their abdomen or their thigh. Um, but you do want to rotate your injection sites, and so you want to change it up just slightly to avoid an injection sight reaction or lower that chance from happening, which is just some inflammation in the skin, some irritation. So once you've chosen your sites, you will take an alcohol pad and just clean the skin with alcohol, let that um dry for about 30 seconds, you get your medication, you'll take the cap off, and then I'm just going to use my hand just so you can see it, but you will hold the in the pin against your skin, um, just at a 90-degree angle right here. You'll hold it, and again, this is a demo, so nothing's gonna be injected into me, um, but you'll hold it here. Um, oh, it's unlocked. You'll unlock it, you'll hold it here, and then you'll press the button to inject, and you'll hold it. Um, they recommend about 10 seconds to make sure all the medication is going in, and then once you know the 10 seconds is up, you just move it away. If you have one drop of um fluid or even a drop of blood, that is okay, just clean it up. Um, you don't need to put a band-aid on it, but if you like to put a band-aid on it, that is fine. Um, and then you go about your day, it's as simple as that, and it's just once a week. So that is secret number one: how to actually do your injection. Secret number two is what does a titration schedule look like? A titration schedule is how we're changing the dose. This may be provider dependent, but again, if you are working with a board-certified obesity medicine physician, we are all trained the same and I believe follow a very similar approach. We all start with the starting dose of a medication for Zbound, that's 2.5 milligrams. The equivalent dose for Wegovy is 0.25 milligrams. So you start there and you are on that dose for at least four weeks. Each prescription has four pins in it, so it'll be for one prescription, you're going to be at the starting dose. Then you typically have a follow-up appointment with your provider and go over how things are going, positives and negatives of the medication so far. Depending on the positives compared to the negatives and how you're just responding in general, the decision will be made at that time. Should we go up to the next dose or do we stay at this dose? We go up on the next dose typically if you are tolerating well without any side effects or very minimal side effects, but you're not having very much of the positive benefits. We tend to stay at the current dose that you're on. If you're having bothersome side effects that we we believe really just need more time for your body to get used to, adjustments in some lifestyle recommendations or habits that may help with the side effects. Um, or you're having a lot of positive benefit on that initial dose, there's no reason to go up, even if you're not having any side effects. I have a few patients who never went up past the initial dose, and that is okay. Everyone is a little bit different, and I say that all the time, but it is so true when you're seeing patients every day, it's obvious. Um, so there's no one titration schedule for everybody. That is a red flag if you are seeing a provider and every single month, no matter what you tell them, they are going up on the dose all the way up to the max dose. You do not have to do that, and you shouldn't do that. I think I might have had one, maybe two or three, definitely no more than five, who I've done that for. Because most people need to stay at either the starting dose or one of those mid-doses for longer periods of time, or they never need the highest dose. So red flag if somebody is making you follow a titration schedule that is not individualized to you. A little bonus here is that I recommend doing a titration back down on your dose if and when you ever decide to stop your medication. My video last week talked all about that, so check it out if you missed it, what to do when you've reached your goal on your GLP1. Um and if for some reason you ever have to stop your medication, if there is a lapse in insurance, or some other reason where you have to just stop your GLP1 medication, but you plan to restart, always restart at the initial dose, at the starting dose. Talk to your doctor about this. If you did really well at one of the higher doses, you had to stop the medication for a period of time, that medication is out of your body, and you will very likely have side effects if you start back on the dose that you were on before. So talk to your doctor if you are restarting after stopping for a period of time. Definitely if it's been longer than two weeks. GLP1 secret number three. This one is for the ladies, but also if you're a male patient and have a partner who is on a GLP1, oral birth control pills will be affected specifically by Zephund, or if you're on the type 2 diabetes version, Monjaro. When you start trazeptide, again, brand names Zephound or Monjaro, and every time you go up on your dose, you would need a backup form of contraception if you are on an oral birth control pill. So if you take an oral birth control pill and you're on Zephund or Monjaro, or if you're on a compound version of trisepatide, you need a backup form of birth control for the first four weeks of starting and every four weeks after increasing the dose. This effect is not actually seen in semaglutide, brand named Ozempic and Wigovi, but it is seen in trisepatide. So it's extremely important to be aware of this. Other forms of birth control, like a patch or the SHA depoprevera, or a Nuva ring, or other vaginal rings, or um Nexplanon that goes in the arm, or any of the IUDs, or FEXI, or condoms, all of those will continue to be effective and are options for alternative contraception during this time. So talk to your prescriber about this, your family medicine doctor, your OBGYN, and make sure you are covered to prevent a pregnancy if that is something that you are wanting to prevent. And side notes as well: GLP1 medications are not currently recommended to be taken during pregnancy. And so we would recommend stopping the GLP1 medication if you were to find out that you were pregnant. GLP1 secret number four, and this goes alongside stopping the medication. Another reason you would need to stop your GLP1 medication is if you have a planned surgery coming up. You want to tell your surgeon and your anesthesiologist that you are on a GLP1 medication, because if you continue it prior to your surgery, it may place you at higher risk for an aspiration. This is when there are stomach contents that come up through your esophagus into your mouth when you're under anesthesia. And then because you're under anesthesia and you can't protect your airway, then those contents go into your lungs, and that can cause inflammation and breathing difficulties and potentially pneumonia. This happens because of the mechanism of GLP1 medications, they slow the emptying of the stomach, so food stays in the stomach longer. This links to the whole reason why you have to fast prior to a planned surgery. It's the same thing. We're trying to prevent the same thing. But with GLP1 medications, because food sits in the stomach longer, even when you fast, it's likely to have some of those food contents there. And so what I've heard from most surgical programs and centers is one to two weeks prior to surgery to hold the medication, but check with you know your surgeon and your anesthesiologist for what is recommended for you. And then also loop in your GLP1 prescriber because of what I talked about earlier. If you need to hold your medication, especially if it's closer to the two-week mark, is it safe for you to restart at the dose you're at, or do you need to start maybe at a slightly lower dose? So definitely talk to your prescriber about that. The last thing that you want after a surgery is to feel really crummy from a high dose of a GLP1. Talk to your doctor and make sure it's safe to restart at the dose you previously were at. And GLP1 secrets number five. Now we're ending with a fun one. This is for travel. Many people think that because GLP1 medications need to be refrigerated, that they cannot travel with these medications and they may turn down opportunities for fun or for work because they need to have access to their medication. The great news is, as I mentioned earlier in the video, these medications are safe to be out of the refrigerator for 21 days. And so as long as your travel is within 21 days, you can just keep it with you. A couple of key things here. If you are flying or you're going to have your bags stored anywhere outside of you know where you're at, you want to keep your medication on you. So keep it in your carry-on and a backpack and a purse so you know that it's not going to get lost during baggage claim and all of that. The other thing is once the medication has gotten to room temperature, it should stay at room temperature. Do not put it in the refrigerator when you've arrived to your destination. That can cause issues with the effectiveness of the medication. So if your travel is less than 21 days, you can pack it in your carry-on, keep it at room temperature after that, and use as normal. If your travel is longer than 21 days, all you need to do is bring with you a medicine cooler to keep the medication cold until you arrive to a place where you can put the root put it into the refrigerator again. And when I was saying 21 days, that is specific to Zeppound. WeGovi can actually be out of the refrigerator for a full 28 days. So there's four weeks of available travel if you are taking Wigovi. So now you have my five GLP1 secrets. Please share with somebody who is starting a GLP1 or is currently on one and would benefit from this information. Thank you for listening and learning how you can improve your metabolic health in this modern world. If you found this information helpful, please share with a friend, family member, or colleague. We need to do all we can to combat the dangerous misinformation that is out there. Please subscribe and write a review. This will help others find the podcast so they may also improve their metabolic health. I look forward to our conversation next week.