Smart Dosing: Personalized GLP-1 Escalation Algorithms

Why Standard Dosing Fails 40% of Patients

Standard approach: 0.25mg week 1, 0.5mg week 2, 0.75mg week 3, 1.0mg week 4. Same protocol for everyone.

Reality: Some patients reach optimal appetite suppression at 0.5mg and develop intolerable nausea at 0.75mg. Some never reach adequate suppression below 1.5mg. Some achieve metabolic improvement at 0.75mg and plateau there, escalation unnecessary.

Standard dosing ignores individual variation. Smart dosing responds to it.

The Three Variables That Matter

1. Appetite Suppression Response

Rate: None (0%) | Mild (25%) | Moderate (50%) | Strong (75%) | Excessive (90%+)

Target: Moderate to strong (50-80%). Optimal balance—significant appetite reduction without feeling starved.

Protocol response: If mild after 1 week at dose → escalate. If strong after 2 weeks → maintain. If excessive (can't eat enough) → reduce.

2. Side Effects Tolerance

Track: Nausea (0-10), GI upset (0-10), fatigue (0-10), other (describe).

Threshold: Mild side effects (nausea 2-4) acceptable. Moderate (5-7) manageable with slowing escalation. Severe (8-10) requires dose reduction.

Timeline: Most side effects resolve in 5-7 days at same dose. If persistent, escalate slowly or maintain.

3. Metabolic Response

Primary: Weight loss rate (ideal 1-2kg/week sustained). Secondary: Glucose response (should trend down), energy levels (should improve week 3+).

Protocol response: If weight loss adequate but appetite suppression excessive → plateau dose, don't escalate. If weight loss insufficient at current dose for 3 weeks → escalate.

The Smart Dosing Algorithm: Decision Tree

Week 1 (Starting 0.25mg)

Assessment: Appetite suppression rate? Side effects? Energy level?

• If: Appetite mild, no side effects → Escalate to 0.5mg week 2
• If: Appetite strong, no side effects → Consider maintaining 0.25mg vs escalating (depends on weight loss goals)
• If: Appetite adequate, mild nausea → Escalate slowly (0.375mg or maintain 0.25mg another week)
• If: Any severe side effects → Maintain 0.25mg, reassess week 2

Week 2-3 (Dose escalation phase)

Decision point: Does current dose achieve moderate appetite suppression without severe side effects?

• If YES: Continue with current dose for 1 more week to confirm, then decide escalate vs maintain
• If NO—appetite insufficient: Escalate 0.25mg (or 0.5mg if no side effects)
• If NO—side effects severe: Maintain dose, reassess week 4

Week 4-8 (Titration to therapeutic dose)

Decision point: Weight loss trajectory adequate? Appetite suppression optimal? Side effects manageable?

• If weight loss 1-2kg/week, appetite 60-80%, side effects minimal: Escalate another 0.25mg. This is optimal response.
• If weight loss adequate but appetite excessive (80%+) and no side effects: Plateau dose. Appetite is more than adequate.
• If weight loss inadequate after 3 weeks at dose: Escalate 0.5mg (double increase). May have dose tolerance or adherence issue.
• If side effects increasing despite no dose change: Likely tolerance developing. Slow escalation or plateau.

Week 8+ (Maintenance phase)

Decision point: Have you reached optimal dose?

• If weight loss sustaining, appetite optimal, side effects absent: You're at optimal dose. Maintain indefinitely.
• If weight loss stalling, appetite normalizing: May escalate one more time or plateau depending on side effect profile.
• If side effects worsening or metabolism concerns (glucose rising, kidney function declining): Reduce dose 0.25mg or pause medication. Consult provider.

Real-World Dosing Trajectories: Four Patients

Patient A: Standard Responder

Week 1: 0.25mg → appetite mild, no side effects → escalate

Week 2: 0.5mg → appetite moderate, mild nausea → escalate

Week 3: 0.75mg → appetite strong, nausea resolving → continue

Week 4: 0.75mg → weight loss 2kg, appetite strong, nausea gone → escalate

Week 5: 1.0mg → appetite very strong, no side effects → continue to week 6

Week 6: 1.0mg → weight loss 2kg sustained, energy high, appetite strong → OPTIMAL DOSE. Plateau here.

Final dose: 1.0mg weekly. Timeline: 6 weeks to optimal.

Patient B: Rapid Responder (Lower dose needed)

Week 1: 0.25mg → appetite strong, zero side effects → escalate

Week 2: 0.5mg → appetite very strong, mild nausea → continue, reassess

Week 3: 0.5mg → weight loss 2kg, appetite excessive, nausea resolved → OPTIMAL. Plateau.

Final dose: 0.5mg weekly. Timeline: 3 weeks to optimal. Same weight loss, half the dose.

Patient C: Slow Responder (Dose tolerance)

Week 1: 0.25mg → appetite minimal, zero side effects → escalate

Week 2: 0.5mg → appetite minimal, severe nausea → maintain, slow

Week 4: 0.5mg → nausea resolved, appetite moderate, zero side effects → escalate slowly

Week 5: 0.625mg → appetite strong, mild nausea → continue

Week 7: 0.75mg → appetite strong, zero nausea, weight loss 1.5kg/week → OPTIMAL.

Final dose: 0.75mg. Timeline: 7 weeks. Slower escalation due to side effect sensitivity, but achieved therapeutic result.

Patient D: High Responder (Needs higher dose)

Week 1: 0.25mg → appetite minimal, zero side effects → escalate

Week 2: 0.5mg → appetite minimal, zero side effects → escalate

Week 3: 0.75mg → appetite mild, zero side effects → escalate

Week 4: 1.0mg → appetite moderate, zero side effects → escalate

Week 5: 1.5mg → appetite strong, mild nausea → continue

Week 6: 1.5mg → weight loss 2kg, appetite strong, nausea resolved → OPTIMAL.

Final dose: 1.5mg. Timeline: 6 weeks, but required higher dose.

Advanced: Pharmacokinetic Dosing

For patients with kidney or liver impairment, standard dosing may be unsafe. Smart dosing adjusts:

• eGFR 30-60 (moderate kidney impairment): Start 0.1mg, escalate 0.1mg weekly (slower)
• eGFR <30 (severe kidney impairment): Consult provider. May not be safe.
• Liver impairment (elevated transaminases): Conservative dosing, close monitoring
• Age >65: Often slower metabolism. Conservative escalation standard practice.

The Data That Drives Dosing Decisions

Daily logging: Weight, appetite rating (0-10), nausea (0-10), energy (0-10), adherence (yes/no)

Weekly assessment: Average appetite, average nausea, weight loss that week, overall trend.

Decision point weekly: Does current data support escalation, maintenance, or reduction?

This is how smart dosing works—data-driven decisions at every step, not fixed protocols.

Safety Net: When to Pause Escalation

• Persistent severe nausea (7+): Maintain dose, reassess in 1 week. If persists, reduce.
• Vomiting or inability to eat: Reduce dose immediately. Unsustainable.
• Signs of pancreatitis (severe abdominal pain, elevated amylase): Stop immediately. Seek emergency care.
• Declining kidney function (eGFR dropping): Reduce dose, monitor closely. May need to pause.
• Severe hypoglycemia (blood sugar <55): Immediate food intake. Reduce dose. Consult provider.

Optimization: Fine-Tuning Within Your Dose

Once at optimal dose, micro-adjustments maximize results:

If weight loss stalling: Increase injection frequency (every 5 days instead of weekly) or increase volume slightly. Check adherence first.

If side effects emerging at stable dose: Reduce injection volume 10-20%, slower escalation if needed.

If metabolism optimized (glucose normal, energy high) but weight loss continues: You're at sweet spot. Don't change.

Bottom Line

Smart dosing replaces "one-size-fits-all" with "optimized-for-you." Your baseline determines starting dose. Your response determines escalation rate. Your data determines final dose. This is how you reach optimal results safely.

---

All dosing must be supervised by licensed healthcare providers. This article is educational only. Do not change dosing without medical guidance.