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November 3, 2025 17 mins

Ready to start a GLP-1 but not sure what happens after you leave the pharmacy? We walk through the five essentials most people wish they’d heard on day one—how to inject without fear, how to store and warm the pen for comfort, and how to rotate sites to prevent irritation. You’ll hear why a personalized titration plan matters more than a preset calendar, when it’s wise to pause at a lower dose, and how to taper down or restart safely if life gets in the way.

We also tackle two high-stakes areas often overlooked. If you’re taking tirzepatide, we explain how starting and dose increases can reduce the effectiveness of oral birth control for about four weeks, and which non-oral options stay reliable. Planning a procedure? Because GLP-1s slow gastric emptying, we outline why many surgical teams ask you to hold the medication for one to two weeks before anesthesia, and how to coordinate the safest restart afterward to avoid heavy nausea and aspiration risk.

Travel doesn’t have to derail your progress. Zepbound can remain at room temperature for up to 21 days and Wegovy for up to 28, which means most trips only require keeping the pen in your carry-on and avoiding a return to the fridge once it warms. For longer itineraries, a small med cooler is all you need. Along the way, we share simple habits to curb side effects—hydration, protein-forward meals, smaller portions, and mindful pacing—so you can get the benefits with fewer bumps.

If you found this helpful, subscribe, share it with someone starting a GLP-1, and leave a review so others can find clear, evidence-based metabolic health guidance. Your feedback helps us keep these conversations practical and honest.

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Episode Transcript

Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr. Lindsay Ogle, MD (00:00):
Welcome to the Modern Metabolic Health
Podcast with your host, Dr.
Lindsay Ogle, Board CertifiedFamily Medicine and Obesity
Medicine Physician.
Here we learn how we can treatand prevent modern metabolic
conditions such as diabetes,PCOS, fatty liver disease,
metabolic syndrome, sleep apnea,and more.

(00:21):
We focus on optimizinglifestyle while utilizing safe
and effective medicaltreatments.
Please remember that while I ama physician, I am not your
physician.
Everything discussed here isprovided as general medical
knowledge and not direct medicaladvice.
Please talk to your doctorabout what is best for you.

(00:45):
So you've been prescribed a GLP1medication and you picked it up
at the pharmacy, but not quitesure what to do next.
I'll tell you all of thesecrets.
My name is Dr.
Lindsay Ogle and I'm aboard-certified obesity medicine
physician.
And I have five secrets that Iwant to share with you that

(01:06):
really shouldn't be secrets, butsometimes get overlooked when
starting a GLP 1 medication,especially if you are not able
to work directly with aboard-certified obesity medicine
physician.
And to be honest, manyphysicians know and want to tell

(01:27):
you these things, butunfortunately, they don't have
the time in our current medicalsystem.
So I do appreciate you takingthe time today to learn about
these five important things.
And I hope that you could shareit with somebody who you know
is on a GLP1 medication or maybeplan to start a GLP1

(01:51):
medication.
So this is a demo of Zetbound.
It's just a sample here.
I wanted to share it just soyou have an idea of what it
looks like.
Hopefully, you find it not tobe intimidating.
Often when people hear aninjection, they think about a
vaccine or getting their blooddrawn.

(02:11):
This is very, very differentthan that.
You do not have to pull up anymedication from a vial into a
syringe unless you're usingLilyDirect or Novo Care.
That's a little bit different.
But this is what you would pickup from the pharmacy.
And so all of your dose, all asingle dose is in here.

(02:35):
And it comes in a safety cap,and you would take the cap off,
and the needle is hidden.
So you can't even accidentallystick yourself.
The only way the needle comesout is when you press the
injector.
Um, and that is going to besecret number one is how do you

(02:57):
give yourself the injection?
So I was really fortunate toget these samples.
I think they are extremelyhelpful and can clarify this.
I'll also include links belowto the manufacturer's
instructional videos, and so youcan watch their version if you
desire.
But um, like I said, you wouldget your pen.

(03:18):
Actually, I'll take it a stepback further.
So Zetbound and Weakovy need tobe refrigerated.
And so when you get themedication from the pharmacy,
you want to put it in yourrefrigerator.
When you are ready for yourinjection, you want to take the
pen out of the refrigerator andyou just take the one out that

(03:40):
you're going to use that day.
Set it down on the counter forat least a half an hour.
You just want to get it to roomtemperature.
And it is okay for these to beat room temperature for up to 21
days.
So don't worry if you forgetabout it and it's been a few
hours, that's okay.
You can still give yourself theinjection.
Nothing has been damaged in themedication.

(04:03):
So you let it get to roomtemperature, and you do that so
it's less likely to causeirritation and pain when you do
the injection.
So if you do your injection inthe evening, my current
recommendation is when you'recooking your dinner, preparing
your meal, you just take thefound out of the refrigerator,
set it on the counter whileyou're getting everything ready,

(04:24):
you can have your dinner, andthen afterwards you would do
your injection.
That is a perfect way to makesure you have it sitting out as
long as it needs to be, and thenyou remember to take it.
So when you're ready to takeit, what you'll do is you'll
choose your injection site.
So you can use your upper arm,you can use your thigh, or you

(04:47):
can use your abdomen.
Most people that I talk to orpatients that I see use their
abdomen or their thigh.
Um, but you do want to rotateyour injection sites, and so you
want to change it up justslightly to avoid an injection
sight reaction or lower thatchance from happening, which is
just some inflammation in theskin, some irritation.

(05:09):
So once you've chosen yoursites, you will take an alcohol
pad and just clean the skin withalcohol, let that um dry for
about 30 seconds, you get yourmedication, you'll take the cap
off, and then I'm just going touse my hand just so you can see

(05:33):
it, but you will hold the in thepin against your skin, um, just
at a 90-degree angle righthere.
You'll hold it, and again, thisis a demo, so nothing's gonna
be injected into me, um, butyou'll hold it here.
Um, oh, it's unlocked.
You'll unlock it, you'll holdit here, and then you'll press

(05:54):
the button to inject, and you'llhold it.
Um, they recommend about 10seconds to make sure all the
medication is going in, and thenonce you know the 10 seconds is
up, you just move it away.
If you have one drop of umfluid or even a drop of blood,
that is okay, just clean it up.

(06:14):
Um, you don't need to put aband-aid on it, but if you like
to put a band-aid on it, that isfine.
Um, and then you go about yourday, it's as simple as that, and
it's just once a week.

So that is secret number one: how to actually do your (06:24):
undefined
injection.
Secret number two is what doesa titration schedule look like?
A titration schedule is howwe're changing the dose.
This may be provider dependent,but again, if you are working

(06:49):
with a board-certified obesitymedicine physician, we are all
trained the same and I believefollow a very similar approach.
We all start with the startingdose of a medication for Zbound,
that's 2.5 milligrams.
The equivalent dose for Wegovyis 0.25 milligrams.

(07:13):
So you start there and you areon that dose for at least four
weeks.
Each prescription has four pinsin it, so it'll be for one
prescription, you're going to beat the starting dose.
Then you typically have afollow-up appointment with your
provider and go over how thingsare going, positives and

(07:34):
negatives of the medication sofar.
Depending on the positivescompared to the negatives and
how you're just responding ingeneral, the decision will be
made at that time.
Should we go up to the nextdose or do we stay at this dose?
We go up on the next dosetypically if you are tolerating

(07:58):
well without any side effects orvery minimal side effects, but
you're not having very much ofthe positive benefits.
We tend to stay at the currentdose that you're on.
If you're having bothersomeside effects that we we believe
really just need more time foryour body to get used to,

(08:18):
adjustments in some lifestylerecommendations or habits that
may help with the side effects.
Um, or you're having a lot ofpositive benefit on that initial
dose, there's no reason to goup, even if you're not having
any side effects.
I have a few patients who neverwent up past the initial dose,

(08:39):
and that is okay.
Everyone is a little bitdifferent, and I say that all
the time, but it is so true whenyou're seeing patients every
day, it's obvious.
Um, so there's no one titrationschedule for everybody.
That is a red flag if you areseeing a provider and every
single month, no matter what youtell them, they are going up on

(09:00):
the dose all the way up to themax dose.
You do not have to do that, andyou shouldn't do that.
I think I might have had one,maybe two or three, definitely
no more than five, who I've donethat for.
Because most people need tostay at either the starting dose

(09:21):
or one of those mid-doses forlonger periods of time, or they
never need the highest dose.
So red flag if somebody ismaking you follow a titration
schedule that is notindividualized to you.
A little bonus here is that Irecommend doing a titration back

(09:42):
down on your dose if and whenyou ever decide to stop your
medication.
My video last week talked allabout that, so check it out if
you missed it, what to do whenyou've reached your goal on your
GLP1.
Um and if for some reason youever have to stop your
medication, if there is a lapsein insurance, or some other

(10:04):
reason where you have to juststop your GLP1 medication, but
you plan to restart, alwaysrestart at the initial dose, at
the starting dose.
Talk to your doctor about this.
If you did really well at oneof the higher doses, you had to
stop the medication for a periodof time, that medication is out

(10:25):
of your body, and you will verylikely have side effects if you
start back on the dose that youwere on before.
So talk to your doctor if youare restarting after stopping
for a period of time.
Definitely if it's been longerthan two weeks.
GLP1 secret number three.

(10:45):
This one is for the ladies, butalso if you're a male patient
and have a partner who is on aGLP1, oral birth control pills
will be affected specifically byZephund, or if you're on the
type 2 diabetes version,Monjaro.

(11:07):
When you start trazeptide,again, brand names Zephound or
Monjaro, and every time you goup on your dose, you would need
a backup form of contraceptionif you are on an oral birth
control pill.
So if you take an oral birthcontrol pill and you're on

(11:27):
Zephund or Monjaro, or if you'reon a compound version of
trisepatide, you need a backupform of birth control for the
first four weeks of starting andevery four weeks after
increasing the dose.
This effect is not actuallyseen in semaglutide, brand named
Ozempic and Wigovi, but it isseen in trisepatide.

(11:51):
So it's extremely important tobe aware of this.
Other forms of birth control,like a patch or the SHA
depoprevera, or a Nuva ring, orother vaginal rings, or um
Nexplanon that goes in the arm,or any of the IUDs, or FEXI, or

(12:13):
condoms, all of those willcontinue to be effective and are
options for alternativecontraception during this time.
So talk to your prescriberabout this, your family medicine
doctor, your OBGYN, and makesure you are covered to prevent
a pregnancy if that is somethingthat you are wanting to

(12:35):
prevent.

And side notes as well (12:35):
GLP1 medications are not currently
recommended to be taken duringpregnancy.
And so we would recommendstopping the GLP1 medication if
you were to find out that youwere pregnant.
GLP1 secret number four, andthis goes alongside stopping the

(12:56):
medication.
Another reason you would needto stop your GLP1 medication is
if you have a planned surgerycoming up.
You want to tell your surgeonand your anesthesiologist that
you are on a GLP1 medication,because if you continue it prior
to your surgery, it may placeyou at higher risk for an

(13:18):
aspiration.
This is when there are stomachcontents that come up through
your esophagus into your mouthwhen you're under anesthesia.
And then because you're underanesthesia and you can't protect
your airway, then thosecontents go into your lungs, and
that can cause inflammation andbreathing difficulties and

(13:39):
potentially pneumonia.
This happens because of themechanism of GLP1 medications,
they slow the emptying of thestomach, so food stays in the
stomach longer.
This links to the whole reasonwhy you have to fast prior to a
planned surgery.
It's the same thing.
We're trying to prevent thesame thing.
But with GLP1 medications,because food sits in the stomach

(14:02):
longer, even when you fast,it's likely to have some of
those food contents there.
And so what I've heard frommost surgical programs and
centers is one to two weeksprior to surgery to hold the
medication, but check with youknow your surgeon and your
anesthesiologist for what isrecommended for you.

(14:24):
And then also loop in your GLP1prescriber because of what I
talked about earlier.
If you need to hold yourmedication, especially if it's
closer to the two-week mark, isit safe for you to restart at
the dose you're at, or do youneed to start maybe at a
slightly lower dose?
So definitely talk to yourprescriber about that.

(14:47):
The last thing that you wantafter a surgery is to feel
really crummy from a high doseof a GLP1.
Talk to your doctor and makesure it's safe to restart at the
dose you previously were at.
And GLP1 secrets number five.
Now we're ending with a funone.
This is for travel.
Many people think that becauseGLP1 medications need to be

(15:09):
refrigerated, that they cannottravel with these medications
and they may turn downopportunities for fun or for
work because they need to haveaccess to their medication.
The great news is, as Imentioned earlier in the video,
these medications are safe to beout of the refrigerator for 21

(15:30):
days.
And so as long as your travelis within 21 days, you can just
keep it with you.
A couple of key things here.
If you are flying or you'regoing to have your bags stored
anywhere outside of you knowwhere you're at, you want to
keep your medication on you.
So keep it in your carry-on anda backpack and a purse so you

(15:52):
know that it's not going to getlost during baggage claim and
all of that.
The other thing is once themedication has gotten to room
temperature, it should stay atroom temperature.
Do not put it in therefrigerator when you've arrived
to your destination.
That can cause issues with theeffectiveness of the medication.

(16:14):
So if your travel is less than21 days, you can pack it in your
carry-on, keep it at roomtemperature after that, and use
as normal.
If your travel is longer than21 days, all you need to do is
bring with you a medicine coolerto keep the medication cold

(16:36):
until you arrive to a placewhere you can put the root put
it into the refrigerator again.
And when I was saying 21 days,that is specific to Zeppound.
WeGovi can actually be out ofthe refrigerator for a full 28
days.
So there's four weeks ofavailable travel if you are
taking Wigovi.
So now you have my five GLP1secrets.

(16:58):
Please share with somebody whois starting a GLP1 or is
currently on one and wouldbenefit from this information.
Thank you for listening andlearning how you can improve
your metabolic health in thismodern world.
If you found this informationhelpful, please share with a

(17:19):
friend, family member, orcolleague.
We need to do all we can tocombat the dangerous
misinformation that is outthere.
Please subscribe and write areview.
This will help others find thepodcast so they may also improve
their metabolic health.
I look forward to ourconversation next week.
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