Monitoring Tools: Clinical Blood Work & Safety Protocols

Why Monitoring Matters Beyond Feeling Good

You feel great on GLP-1. Appetite suppressed, energy high, weight dropping. Feels safe.

But you're taking a medication that affects multiple organ systems. Your kidneys filter it. Your liver metabolizes it. Your pancreas, thyroid, bile ducts—all potentially affected. Feeling good doesn't mean all systems are fine.

That's why monitoring exists: catch organ-level problems before they become serious.

The Baseline Assessment (Week 0)

Before starting medication, you need baseline:

Complete Blood Count (CBC)

• What it measures: Red blood cells, white blood cells, platelets
• Why: Establishes baseline. If you develop anemia or infection later, we compare to baseline
• Normal range: Red cells 4.2-5.8 million/mcL, white cells 4.5-11K/mcL

Comprehensive Metabolic Panel (CMP)

• Glucose (fasting): Your baseline blood sugar. Normal <100, pre-diabetic 100-125, diabetic >125
• Kidney function (creatinine, BUN, eGFR): Critical. eGFR tells kidney function. >60 = normal, 30-60 = mild-moderate reduced, <30 = severe. GLP-1 dosing depends on this
• Liver function (AST, ALT, bilirubin): Baseline for later comparison. High levels = liver stress
• Electrolytes (sodium, potassium, chloride): Baseline. Dehydration from medication can affect these

Lipid Panel

• Total cholesterol: Baseline. Often improves with weight loss
• LDL: "Bad cholesterol." Usually improves with GLP-1 + weight loss
• HDL: "Good cholesterol." Usually improves
• Triglycerides: Often elevated in pre-diabetics. Often improves significantly (30-50%)

HbA1c (Glycated Hemoglobin)

Your 3-month average blood sugar. Normal <5.7%, pre-diabetic 5.7-6.4%, diabetic >6.5%. This is crucial if you have any glucose elevation at baseline.

Thyroid Function (TSH, Free T4)

Some GLP-1 medications affect thyroid. Need baseline. If thyroid cancer risk factors present, TSH needs more careful monitoring.

Pancreatic Function (Amylase, Lipase)

Baseline levels. GLP-1 very rarely causes pancreatitis. If you develop severe abdominal pain, these tests determine if it's pancreatitis (emergency).

The Monitoring Schedule

Week 1-2: Clinical Assessment

• Blood pressure, resting heart rate
• Symptom check (nausea, appetite, energy)
• No blood work unless problematic symptoms

Week 4: Check-in

• Weight, blood pressure
• Appetite response assessment
• Side effects review
• Lab work optional (only if abnormal symptoms)

Week 12: First Comprehensive Recheck

• Repeat: CBC, CMP, lipid panel, HbA1c, TSH
• Compare to baseline—assess metabolic improvement
• Check kidney function (if declined, dose adjustment may be needed)
• Check liver function (if elevated, pause and investigate)

Month 3-6: Quarterly Monitoring

• Repeat full panel every 12 weeks
• Clinical assessment monthly (vitals, symptom check)

Red Flag Markers (Require Immediate Action)

Kidney Function Decline

eGFR drops >10 points from baseline = concerning. Drop >20 = urgent. GLP-1 can stress kidneys, especially if baseline already reduced. Action: reduce dose, increase hydration, recheck in 2 weeks.

Liver Enzyme Elevation

AST or ALT rise >2x baseline = pause medication. Investigate. Recheck after 1 week off. If still elevated, GLP-1 may not be safe for you.

Elevated Pancreatic Enzymes + Abdominal Pain

Amylase or lipase >3x normal + severe abdominal pain = possible pancreatitis (emergency). Seek immediate medical care. Stop medication.

Severe Electrolyte Abnormality

Potassium <3.2 or >6.0, sodium <130 or >150 = requires intervention. Usually manageable with IV fluids or dietary adjustment. Rarely dangerous if caught early.

Glucose Too Low (Hypoglycemia)

If you have fasting glucose <70 mg/dL developing on medication = dose too high for you. Reduce immediately.

Expected Changes (Normal Improvements)

Glucose Improvement

Fasting glucose drops average 15-25 points over 12 weeks. HbA1c drops 0.5-1.5%. Pre-diabetics often return to normal glucose.

Cholesterol Improvement

Total cholesterol drops 10-15%. LDL drops 15-25%. HDL increases slightly. Triglycerides drop 20-50% (most impressive improvement).

Blood Pressure Improvement

Average 5-10 point drop in systolic. Weight loss explains most of this.

Liver Enzymes Slight Elevation (Normal)

AST/ALT may rise 10-20% initially (from medication metabolism + weight loss metabolic activity). Then normalize. As long as <2x baseline, completely normal.

Kidney Function Stable

eGFR should remain stable or improve slightly (weight loss + better glucose = better kidney function).

Special Cases: Higher Monitoring

Baseline Kidney Disease (eGFR 30-60)

Monitor kidney function every 4 weeks. Conservative dosing (lower doses, slower escalation). Close coordination with your provider.

Baseline Liver Disease

Monitor liver enzymes every 4 weeks. May need dose reduction or frequent reassessment.

Diabetes with Medication

If on blood sugar medications, GLP-1 improves glucose significantly. Your diabetes meds may need reducing. Close monitoring essential.

History of Pancreatitis

GLP-1 rarely causes pancreatitis, but if you have history, closer monitoring of pancreatic enzymes needed. Immediate medical attention if abdominal pain develops.

Access (Lagos Context)

Baseline labs: Arrange baseline blood work before starting.

Week 12 recheck: Recheck around 8–12 weeks (or as advised by your clinician).

Ongoing quarterly: Repeat testing quarterly during maintenance (or per your monitoring plan).

Clinics: Many clinics can coordinate this as part of a structured monitoring plan.

Home testing option: Finger-prick blood tests exist but are less comprehensive than standard labs.

The Monitoring Benefit: Peace of Mind + Data

You take medication for 12 weeks. Feel amazing. Weight drops 15kg. You want validation that you're safe. Lab work provides it: glucose normalized, cholesterol improved, kidney function stable. Proof that GLP-1 isn't just helping—it's safe for YOU.

That's monitoring's real value: confidence that your weight loss is also health improvement.

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This article is educational. All monitoring must be arranged through your healthcare provider. GLP-1 medications require prescription, medical supervision, and regular clinical monitoring.

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