Informed Consent to Participate in Treatment with GLP-1 medications

A GLP-1 (glucagon-like peptide-1) receptor agonist is a hormone that the body naturally produces in the intestines after the intake of food. GLP-1’s help maintain blood sugar levels by stimulating the secretion of insulin as well as slowing gastric emptying. The goal of GLP-1 medications is weight loss.

It is crucial for patients to understand the benefits, risks, and responsibilities associated with GLP-1 agonists to ensure safe and effective treatment.

This consent form represents informed consent for the both GLP-1 injections including Semaglutide or Tirzepatide.

How GLP’s work

GLP-1 receptor agonists bind to and activate GLP-1 receptors on cells in the pancreas that produce insulin. This activation leads to increased insulin secretion in response to food intake, reduced glucagon secretion (which decreases glucose production by the liver), and slowed gastric emptying (which helps to prevent rapid rises in blood sugar after eating). This molecular signaling  “tells your brain” that you are no longer hungry and decreases “food noise” significantly. 

Clinical Use of GLP-1 medications

GLP-1 agonists, originally developed for the management of type 2 diabetes, have also been approved for weight management due to their beneficial effects on appetite control and metabolism.

Reported Benefits of GLP-1 Agonists

GLP-1’s are effective in promoting weight loss by reducing appetite and increased feelings of fullness. GLP-1’s have also been shown to reduce the risk of heart attack and stroke in diabetes, improve insulin sensitivity in diabetes, and may improve cellular health and reduce inflammation.

Side Effects and Risks of GLP-1 Agonists
Mild side effects may include:

Nausea, heartburn, nausea, vomiting, constipation, headaches, bloating, fatigue, injection site reactions, and constipation (treat constipation early!)

In rare cases, serious side effects may include:

• Allergic Reactions: Although rare, allergic reactions including serious hypersensitivity reactions (e.g., anaphylaxis) have been reported with GLP-1 agonists. Patients should seek immediate medical attention if they experience symptoms such as rash, itching, swelling, dizziness, or difficulty breathing.

• Pancreatitis: There is a rare but serious risk of pancreatitis (inflammation of the pancreas) associated with GLP-1 agonists. Symptoms of pancreatitis include severe abdominal pain that may radiate to the back, nausea, and vomiting. Patients should seek immediate medical attention if they experience these symptoms.

• Acute Kidney Injury: In rare cases, GLP-1 agonists have been associated with acute kidney injury. Patients should monitor for signs of decreased kidney function, such as changes in urine output, swelling in the legs or ankles, and fatigue.

• Thyroid C-Cell Tumors: Studies in non-humans have shown an increased risk of thyroid C-cell tumors with some GLP-1 agonists. While this risk has not been definitively established in humans, it is a concern that requires careful consideration, particularly in individuals with a personal or family history of medullary thyroid carcinoma.

• NAION (non-arteritic anterior ischemic optic neuropathy) happens when blood flow to the optic nerve is reduced, starving the nerve of oxygen and causing an "eye stroke". Currently the US is investigating the potential link.

DO NOT TAKE GLP-1 agonist medications if:

• You are allergic to Semaglutide Or Tirzepatide

• You are a Type 1 Diabetic.

• You have a personal or family history of Thyroid C-Cell Tumors, including Medullary Thyroid Carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN-2).

• You have a history of pancreatitis.

• You have a history of gallbladder disease, pancreatitis or kidney disease

• You are pregnant, plan to become pregnant, or are breastfeeding.

Drug Interactions
GLP-1 medications may delay gastric emptying, affecting the absorption of other oral medications. Monitor and report concerning side effects to your clinician. Please inform your provider about any medications you are currently taking that may affect blood sugar levels.