Guide//5 min
Bloodwork on a GLP-1
Most people on these drugs are monitored on a bathroom scale and nothing else. A short, cheap panel twice a year would catch nearly everything that quietly goes wrong.
Practical
Dosing & Titration
Escalation schedules, missed doses, and the art of going slow.
30 pieces
Explainer//6 min
A1c on a GLP-1
Roughly one and a half to two points for semaglutide, and more than two for tirzepatide. The more interesting question is why the number lags a month behind everything you are doing.
Guide//5 min
GLP-1s before surgery
In 2023 the advice was to hold your weekly injection for a week. In 2024 a multi-society panel replaced that with something considerably more nuanced. Plenty of pre-op letters have not caught up.
Guide//6 min
GLP-1 dose charts, side by side
Four drugs, four different ladders, and a great deal of confusion about which rung anyone is standing on. Here is every approved escalation schedule in one place, with the reasoning behind the steps.
Explainer//5 min
GLP-1 drug interactions
These drugs are not metabolised by the liver enzymes that cause most interactions, so the usual list is almost empty. What replaces it is a single mechanical problem: everything you swallow now arrives late.
Guide//5 min
GLP-1 pen problems
Almost every device problem people describe turns out to be one of six things, and the one that matters most is knowing when you have actually missed a dose.
Guide//6 min
How long side effects last
Almost every side effect in this class follows the same shape: bad after a dose increase, better within a fortnight, mostly gone by the time you have been at a dose for two months. Almost.
Guide//5 min
How to start a GLP-1
Most of what determines how your first year goes is decided in the fortnight before the first injection, by questions nobody thinks to ask until much later.
Guide//6 min
Ozempic side effects, ranked
Most side-effect lists are alphabetical, which tells you nothing about what will happen to you. This one is ordered by frequency, with the trial numbers attached and the rare ones kept in proportion.
Explainer//6 min
Pancreatitis on a GLP-1
Almost everyone on this drug class gets abdominal pain at some point. A very small number of them have something that needs an emergency department that evening, and the difference is learnable.
Explainer//5 min
Semaglutide, explained
Ozempic, Wegovy and Rybelsus contain the same active ingredient. Almost every argument about which one you should be on is an argument about indications and insurance rather than about chemistry.
Guide//5 min
Switching between GLP-1s
The most common error when moving from semaglutide to tirzepatide is assuming your current dose buys you a head start. It does not, and the week you find that out is memorable.
Explainer//5 min
Tirzepatide, explained
Eli Lilly added a second hormone receptor to the design, largely as a bet. It produced the largest average weight loss of any approved drug, and nobody can yet fully explain why.
Guide//5 min
Travelling with your GLP-1 pen
The pens are more robust than people fear and less robust than a hot car boot. Most travel problems come down to three numbers and one decision about which bag it goes in.
Guide//5 min
Where to inject your GLP-1
Abdomen, thigh or upper arm, and it genuinely does not matter which. What matters is the handful of things people do wrong in the ten seconds before the needle goes in.
Guide//3 min
Best supplement for GLP-1 constipation
The drug slows your stomach on purpose. Constipation is not a malfunction, it is the mechanism doing its job further down the tract than anyone wanted — which is why the fix is mechanical rather than clever.
Guide//2 min
Best electrolytes for GLP-1 users
Thirst tracks eating. Halve the food and you quietly halve the fluid and the sodium that came with it, which is why so much of what gets blamed on the drug is ordinary dehydration wearing a costume.
Guide//2 min
Best supplements: first 30 days
Week one is not the time to build a stack. It is the time to find out how your body handles the drug, with the smallest number of variables you can manage.
Guide//2 min
Best supplements for GLP-1 fatigue
Tiredness on these drugs has four common causes and only one of them is fixed by a supplement you can buy today. Working out which one you have is worth more than anything in this ranking.
Guide//2 min
Best supplements for GLP-1 nausea
Nausea is the mechanism, not a malfunction, which sets a hard ceiling on what any supplement can do. Within that ceiling there is one cheap option with real trial evidence and a great deal of expensive noise.
Guide//10 min
The GLP-1 companion app I recommend
Almost every avoidable failure I see in the first year of treatment traces back to the same thing: nobody wrote anything down. Here is what is worth recording, why it matters more on these drugs than on anything else I prescribe, and the tool I have settled on.
Guide//5 min
How long Wegovy takes to work
Appetite usually changes in the first week. The scale takes considerably longer, and almost everything people believe about the timeline comes from watching someone else's month one.
Guide//5 min
Missing a dose of Mounjaro or Zepbound
The four-day rule, the reason it exists, and why the fix that feels most sensible — doubling up — is the one that puts people in the emergency department.
Guide//6 min
The first eight weeks on a GLP-1
Nobody is short of opinions about these drugs. What people are short of is a clear account of the first two months — what the body does, when, and which parts of it are worth a phone call.
News//3 min
The semaglutide pill arrives
An oral GLP-1 for obesity removes the needle, the fridge and a good deal of the friction. It also comes with rules about how you take it that people underestimate badly.
News//4 min
Contraception, pregnancy, and the four-week rule
Tirzepatide can reduce the effectiveness of oral contraceptives — after the first dose and after every increase. It is printed on the label, it is rarely mentioned in the appointment, and it has a specific four-week window attached to it.
Guide//5 min
How much protein on a GLP-1
The number is not the hard part. Getting a hundred and twenty grams into a body that stops being interested after four bites is a logistics problem, and it deserves to be treated as one.
Deep Dive//5 min
Microdosing GLP-1s
Taking a fraction of the standard dose is now common enough to have its own vocabulary and its own influencers. Some of the reasoning is sound. Almost none of it has been tested.
Deep Dive//5 min
Year two on a GLP-1
Every article about these drugs ends at goal weight. That is roughly the midpoint. The second year is quieter, stranger, and the part where most of the decisions that matter actually get made.
Guide//4 min
Nausea: what's ordinary, and what isn't
Almost everyone is warned about nausea. Almost nobody is told what it should feel like, how long it should last, or which version of it means you should stop reading and call someone.
Also in Practical
On The Jab
The
GLP‑1
Handbook
Dr. Nick Robertson
MD
The book · 14 chapters
The GLP-1 Handbook
Everything I tell my own patients before their first injection. 214 pages of what actually matters in the first year — dosing, side effects, food, muscle, cost, and the part nobody prepares you for: maintenance.
$4Less than your morning coffee.
Priced at four dollars because it should be affordable to everyone taking these drugs — not because it's worth four dollars. No upsell, no course, no supplement line.