When To Increase Your GLP-1 Dose

If you’ve ever wondered, “Should I increase my GLP-1 dose?” you’re not alone and the right answer is rarely just “go up because you can.” I’m Dr. Lindsay Ogle, a board-certified family medicine and obesity medicine physician, and I’m sharing the same framework I use in clinic to make GLP-1 titration decisions that are safe, personalized, and sustainable.

We start with the most overlooked rule: time. Because injectable GLP-1 medications have a long half-life, I want a full four weeks at a dose before we judge it. Then we walk through the decision points that matter most: GI side effects (nausea, reflux, bloating, constipation or diarrhea), whether you’re getting real appetite control and reduced food noise, and whether you can still eat enough protein, fiber, and overall calories to protect your energy, muscle mass, and metabolism. If a dose makes you skip meals or feel uncomfortably full after a few bites, “stronger” is not better.

We also talk about how to measure progress without getting trapped by the scale: clothes fit, body composition, waist circumference, and for metabolic goals like type 2 diabetes or prediabetes, blood sugar trends like A1C or continuous glucose monitor data. Finally, we address diet mentality, the real-world impact of medication cost, and why obesity is a chronic disease that often requires long-term treatment and a supportive care team.

Subscribe, share this with someone who’s considering a dose change, and leave a review so more people can find reliable, evidence-based guidance on GLP-1 medications and metabolic health.

How to Manage GLP-1 Side Effects:

Nausea: https://youtu.be/07-QFm71YMo?si=ySEQtNdf1Pph9-L2

Constipation: https://youtu.be/rog26mYgg9g?si=ER3jharJZ8F6K4GJ

Reflux: https://youtu.be/cwJfaq6CA-o

Advocacy Groups:

https://www.obesityaction.org/

https://glp1collective.org/

Find a board certified Obesity Physician:

https://obesitymedicine.org/about/find-a-provider/

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Transcript

Welcome And Medical Disclaimer

Dr. Lindsay Ogle, MD 0:00

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 treatment. 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. Let's talk about when you should increase your dose today. My name is Dr. Lindsay Ogle, and I'm a board-certified family medicine and obesity medicine physician. And I see patients in my telehealth practice, Missouri Metabolic Health. And every time I see a patient who is on a GLP1 medication, and that's typically monthly, especially in the beginning, but once we start to get into maintenance, then we space out to every two to three months, we are asking ourselves that question: should we increase the dose? And I, in my head and out loud with my patient, am going through a few questions to determine if it is safe to increase the dose, if it's necessary, and ultimately, are we going to do it at that appointment or not? So, first of all, you should stay at your initial dose or at your next dose for at least a month. You need to give your body that four weeks to get used to that higher dose and to get enough data points over that time to really evaluate: are you having side effects? Are you having appetite suppression, control of food noise, increased fullness? Have there been any weight, body composition, or metabolic changes at that dose? So if you start your GLP1 or you have just increased your dose and you've only been on it for a week or two, that is not long enough to make this assessment quite yet. GLP1 medications, the injectable versions, they have a long half-life. And so it takes some time to reach that steady state and it's going to kind of build up over time throughout that month. So we do not want to make a decision early on. We want to give it at least a month, four weeks total at a dose before we make a decision. Once we've been on a dose for that four-week time frame, then the first question I ask my patients are: Are you having any side effects? And the most common side effects are GI-related. It could be nausea, acid reflux, bloating, stomach upset, queasiness, changes in bowel movements like constipation or loose stools or diarrhea. And I talked about many of these complications in previous videos or podcasts, which I will link below to go into more depth. But most people are going to have some side effects. And it typically occurs when you just start the medication or increase the dose, and most commonly occurs one to three days after your injection. For some people, it may last longer throughout the week, and for others, they may not have any side effects. And those videos that I talked about this before go into more detail on how to mitigate those specific side effects. So I'm not going to get into that today. But part of it is doing the slow titration. So if somebody is having definitely moderate to severe side effects, but even mild side effects on their current dose, I am much more likely to keep them at that dose a little bit longer to allow their body to get used to the medication and also to adjust some lifestyle changes that may help to mitigate those side effects. And so staying at a dose for a longer period of time will help ease the side effects and that transition onto your GLP1 medication. So if you're having side effects, I would not want to increase your dose at this time. The next question I ask is: are we having any of the positive benefits of the GLP1? Are we having appetite suppression, increased fullness, decreased food noise? If the answer is yes to these positive benefits, then there's not really a reason to go up on the dose. This is why we are on these medications. And so if you're getting the positive benefits, even if you're not having side effects, then that means you're at a dose that's really perfect for you. And we can continue on that dose for as long as you're continuing to move towards your goals and to have your symptoms controlled. If you are not having appetite suppression or appetite control, I should say, because we are not looking for total appetite suppression. We want to have some appetite to ensure you're getting adequate nutrition and calories and protein. So we're looking for appetite control. If you are not getting control of your food noise, if you're still thinking about food all the time and having intense cravings, if you are not feeling full at the end of your meal while on your current dose, then those would be reasons to go up again, as long as you're tolerating with very mild or rare side effects. And I mentioned ensuring that we're having adequate nutrition because this is so important. If your dose is too strong for you, if your appetite is too suppressed, if you are very full with a very small amount of food, if you're skipping meals because you can't tolerate eating the medication, that is not the goal. That is too strong of a dose. You need to back down or at least stay at that dose until you get used to it a little bit more. So I always ask my patients what their nutrition has been looking like recently. Are we eating breakfast, lunch, and dinner? Are we getting snacks in if we're hungry between meals? Are we getting protein and fiber and enough water to support our body? Because if we're not, then we cannot increase the dose. Because if we increase the dose, then nutrition is going to decline after that. And our goal is to nourish our body in its appropriate way to have the body function adequately and to prevent complications. If we are not getting enough nutrients in, then we can have nutrient deficiencies, we can lose muscle mass, it can cause our body to go into shock and it can lead to hair loss down the line, it can also decrease our metabolism, we will feel tired. It is not good to skimp out on our nutrition. So that is something that we always want to review when we're deciding should we go up on our dose? And then if you're on a GLP1 medication for the treatment of obesity, we want to know: are we having weight loss or body composition changes? How are you fit? How are you feeling in your clothes? Are clothes starting to feel looser? Um, has the number on the scale gone down? If you're checking body composition, is the percentage of body fat decreasing? All of these signs point towards the medication is effective for you at this dose, and we do not need to increase the dose. If we are not seeing these changes and we are tolerating the medication and our appetite is not too suppressed, then we could consider increasing the dose at this time. But we do want to monitor those metrics either by checking our body weights, body composition, or just how we feel in our clothes. Another thing we can do, especially if we don't want to check our body weight, is we can do waist circumference. That is a great way to monitor progression on a GLP1. If you're on a GLP1 for more of a metabolic benefit for type 2 diabetes or prediabetes, then checking blood sugar can be a great way to monitor your response. And so if blood sugar, whether that's um with a continuous glucose monitor or an A1C or a point of care blood sugar, if that has not changed, if your blood sugar is still running high, then we would consider increasing the dose. If those numbers are declining and improving, then we don't need to increase a dose and it's effective for you at this time. One thing I also ask my patients when we're considering increasing their dose is why they would want to increase their dose. And when I ask this, a lot of my patients do admit that their mindset is probably still stuck in diet mentality and that faster weight loss is better, and that they want to continue to reduce their caloric intake. And once that is acknowledged, then we can address it and we can continue to work on adjusting that mindset to bring it back to a health-focused mindset. Um, so if you find yourself um with those thoughts, it is not your fault. It's what society has kind of programmed us or it's how society has programmed us to think. Um, and it's not healthy, and that's not the goal with these medications. And that is why it is so important to be working alongside a trusted physician, dietitian, trainer, therapist, creating that team around you who is going to keep your mindset health focused and keep your health at the center of your treatment because that is the most important thing. And for your physician who's prescribing your medication, that can be a primary care doctor, but it also can be very beneficial to work with an obesity medicine physician because this is what we do all day, every day. Um, in the upcoming weeks, I'm going to release a discussion about six reasons you should work with an obesity medicine physician. So look out for that. Um, but again, primary care doctors can be great with this if you have a trusted one that you go to. And lastly, in today's day and age, um at least in the American healthcare system, we do have to consider cost. And so, especially if your insurance is not covering your GLP one and you're paying out of pocket, we do have to take that into account because many of the direct-to-consumer programs, especially LilyDirect, you do pay a higher price for higher doses. So that is something to at least take into account when deciding should you go up on your dose or not. Um, hopefully these um price concerns are going to decrease or change or go away in the next several months to years. Um, there's a lot of advocacy efforts going on here. And if you want to join those efforts, I'll provide the links below. Um, but right now that is unfortunately the reality that we do have to take costs into consideration. That being said, we do not want to sacrifice your health for cost savings. So this is not a reason to rapidly increase your dose to quote unquote get the most out of your medication for a short period of time. Obesity is a chronic medical condition and requires chronic treatment for the vast majority of people. And so if you're starting on a GOP1, know that you're probably going to have to continue it long term to maintain control of your disease. So that should be taken into account before and during this journey. So as you can see, there's a lot of considerations going on here. It is not black and white. If you are working with somebody who is following a set structure for titration or is not asking you these questions, then I would consider looking for somebody else to help guide you in your treatment. If you live in Missouri, I would be happy to see you at Missouri Metabolic Health, which is my telehealth practice. Um, but if you don't, there are some search engines to find a board-certified obesity medicine physician in your state. I'll include that below. But definitely subscribe and follow along, and I will continue to share my education and my experience with as many people as possible. So if you found this helpful, please share with somebody who could benefit from this information. And I will see you all next week. Take care. 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.