Understanding GLP1s with Nurse Practitioners from Acton Medical Associates

Watch our new video featuring two of our nurse practitioners as they walk through the basics of GLP1 medications and take a closer look at some of the more important details patients should know. They cover how these medications work, what to expect, and the role they can play as part of a thoughtful weight management plan.

Watch the video or read the transcript below!

“Hi, I’m Chelsea and I’m Christie. We’re nurse practitioners at Acton Medical. You’ve probably heard a lot about a variety of medications lately online or on the news, such as Wegovy and Zepbound. We wanted to take a little bit of time to give you some information from our perspective as medical providers and primary care who prescribe these medications a lot so that we can clear things up for you or provide a little bit more clarity about what you might be hearing. I think there’s a lot of inaccurate information online that people are getting these days, and we just really want to clear that up for patients. So you know that this if these are appropriate medications for you and what’s actually indicated with these medications.

Now let’s talk about a little bit about how these medications, GLP one receptor agonists, which are often called GLP one and how they work. So these medications mimic a natural hormone that’s released in your body typically after you eat. These send a message to your brain that indicate that your stomach is full, so it stops you from eating too much at once. They also slow down how quickly your body digests food and how quickly the stomach empties. Because of that, you tend to eat smaller portions at one time. The other way that these medications work is they help improve your body’s sensitivity to insulin. They can also help decrease the amount of sugar that your body releases. When blood sugar tends to start getting low or you run out of fuel. So because of that, these medications help people feel fuller more quickly with smaller portions, and they help to regulate the blood sugar. I think another important thing to mention about that too, is with this, it helps to calm the food noise down in your brain. So cravings, things like that. Sometimes your stomach feels full, but your brain is still telling you to eat. And this medication helps with that too. So it really complements in a lot of ways where you’ll feel full not only in your stomach, but in your brain as well.

So like all medications, there are benefits, but there are certainly side effects to consider. Some of the most common side effects that we see with these medications are bloating, nausea, vomiting, which is typically only seen if people are eating past the point of fullness or have a pretty significant response to these medications. Other potential side effects are increase in heartburn, gas, and sometimes constipation. Rarely, we see diarrhea. These medications are managed typically by slowly titrating the medication, and only after we’ve assessed that these are working well for you, we wouldn’t want to go up on the dose if you’re having any of these side effects. So we’ll take a pause here.

And just to review titration is when we either slowly increase or decrease the dose of medication.

So Chelsea went over the most common side effects that we can see with these medications. Some other things that we can see with these are increased risk of gallbladder disease pancreatitis acute kidney injury. And for these reasons we expect patients to come back in for regular follow up visits so we can monitor lab work, assess how people are feeling and make sure people are doing okay on these medications. These medications also come with a black box warning for something called c-cell thyroid tumor. This was seen in the early animal trials when the medication was being developed.

Thus far we have not seen this demonstrated in humans. However, it’s important that if you have a personal history or first degree relative with a history of c-cell thyroid tumor or multiple endocrine neoplasia, type two that you discuss this with your provider as these may not be a good medication choice for you. And additionally, these medications can come with other risks. Like if we lose weight too quickly, we can see subsequent muscle loss with this.

So it is really important that we’re careful with what we’re picking to eat. We will go over with you at additional follow ups and with medical oversight to ensure that we’re losing weight at a slow, steady rate and that we’re eating properly to really minimize that risk of muscle loss for patients long term. The other thing that helps prevent this is regular exercise. So for some people that looks like cardio, but it’s always important to have at least some resistance or strength training while you’re taking these medications to help preserve your muscle mass. Absolutely. And important to exercise muscles all over the body. But the area that we do tend to see the largest amount of muscle loss with is the big muscles in the thighs. So adding in squats, or even if you’re going for a daily walk to try to incorporate a hill into there, something that utilizes those muscles a bit more will help reduce that risk of muscle loss.

Remember, these medications are not meant to work alone and are not a quick fix. They act as one tool, in addition to a number of other measures that can help optimize your weight and maintain a healthy weight. These include managing your stress well, maintaining good sleep quality and duration, good physical activity, including resistance and strength training and optimizing your nutrition, among other healthy life measures. So many patients feel that they know exactly what they should be eating when they come in for these visits, but as we talked about, GLP one can really alter how much you’re eating and what your brain is telling you to eat.

So we do make it mandatory that patients that are going to be started on a GLP one do need to meet with our dietary team or one of our registered dietitians prior to starting these medications. Portions are going to be down and you’re going to be eating significantly less than you normally do. And a lot of times we need to or not. A lot of times, all the time, we really need to figure out what needs to go in the body first to fuel the body properly. Patients need to realize that protein is very important, and the dietitians can help discuss with how much protein you should be getting in each day. The other thing that’s important is ensuring that your nutrition is balanced. So it’s protein forward, fiber forward, and also working with the dietician to make sure that you’re not putting yourself at risk of nutritional deficiencies such as vitamin D or calcium, as these can have really long term.

In addition to short term effects such as bone loss, reduction in immunity, and an overall reduction in energy, which is not something that we want to see. And there are other things that people that we have seen reports now that these medications have been out for a while, patients who are not eating properly and are nutrition deficient. We’ve seen hair loss. We have some concerns with dental issues going forward. So really important that we meet with the dietician and that you’re eating properly each day while you’re on these medications to help prevent any short or long term effects. And of course, nothing is one hundred percent. So the goal is, you know, at least eighty percent of the time that you’re having balanced meals and snacks, protein and fiber with every meal and snack is a general rule of thumb. These can help also with managing, um, some of the side effects that we see.

Your nutrition needs may change over time as you may be seeing yourself doing more activity, doing less activity. Um, and depending on how things are going, which is why continuing with the nutritionist is the best way to ensure successful results. And finally, we want to make sure people are eating consistently. Your appetite is going to be down, but just because you’re not feeling hungry doesn’t mean we can go and just cut down to one meal a day. We need to make sure we’re eating consistently through the day, and that those food choices are healthy and optimal for your body. So a key part of this management plan that we feel really strongly about is consistent follow up. So certainly when you’re titrating adjusting the doses of the medications in the beginning or ongoing, it’s important that you’re seen in the office at least every couple of months. This helps us to measure your weight, to measure your blood pressure, which sometimes we see decrease with weight loss. So we may be able to adjust some other medications before you become symptomatic.

It’s really important that we’re managing and monitoring your lab results. So the kidney function that you mentioned is really important because that often doesn’t have symptoms. So staying well hydrated and we like to remind you of these things every time you come in. So while weight loss is the primary goal in this, we also want to monitor things very closely so that we can ensure we’re actually improving your quality of life and your overall health. The weight is one tiny measurement that isn’t everything. We want people feeling better. The whole picture. We’d love to get medications down. We want you feeling better. We want you more active. We want the weight down as part of it. But like Chelsea said, it’s not the whole picture and we really want to be involved with that care so we know it’s done properly. So our overall goal is to partner with you so we can be on a team together so that we can make sure we’re both taking an active role in this. So like anything, insurance coverage can vary greatly with these medications. So it is really important that patients we ask them to follow up with their insurance company prior to making visits to assess coverage. And it’s important to ask questions of your insurance company.

Not only is the medication covered, but what will the monthly cost be? Because this can vary really greatly for some patients. So we want to make sure this is something that we can get you monthly and that you’re on it consistently. So following up with the insurance company is very important. Sometimes people opt for an out of pocket option. This is something that may be feasible for you, but we want to make sure that it’s something that you can maintain long term. Although we do expect some changes to come with insurance, it’s ever changing and evolving. So we’re trying to stay on top of that as best we can. But it’s really important that you play an active role in that as well. Yeah, and like Chelsea said, the insurance companies do change pretty, pretty quickly on this now.

So continual follow up for you or if there is a question about cost or if something does change when you pick it up from the pharmacy. Again, we recommend following up with the insurance company because they would have that cost information for you where we would not. So if you’re interested in exploring some of these options, we recommend that you schedule a visit with your healthcare provider to have a more personalized conversation, as these are not one size fits all. It’s important to remember that these would be considered a life long or long term medication, and that it’s only one piece of the puzzle. When we think about managing weight and overall success and long term health. Perfect. So please feel free to call the front desk if you feel like this would be a good fit for you, and we can definitely get you scheduled in with either your primary care provider or one of the nurse practitioners to review this further. Thanks for listening.”