Clinical advisory guidelines for the use of GLP-1 medications
by IDS Director of Lifestyle and Nutrition, Jenny Smith
Use of GLP-1 meds has increased exponentially in the past few years with new and more potent options. These meds have been around a long time – but most people new to using them haven’t heard of the older options such as Byetta or Victoza. What is similar about today’s GLP-1s and the older variety is the lack of good education around use to get the best “bang for your buck”. With today’s version being even more costly to use, depending on insurance coverage, people who do use them should have clear guidance on how they work and how to navigate lifestyle changes to make the most of what is proving to be the best way to manage diabetes and weight.
A new article published at the end of May 2025 now provides clinical advisory guidelines for the use of GLP-1 medications.
It was developed by a joint advisory team from 4 medical organizations. The goal of this guide is to provide support to primary care providers for guiding nutrition information to people who are prescribed GLP-1 meds. I would hope this crosses over to those specialties that help those with diabetes as well – specifically Endocrinology practices.
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- Sensor start-up – Waiting for a sensor to warm up for those still using G6 is a time when you could get in a few hours of evaluation of basal. On the other sensors that allow calibration – there is a time of waiting to ensure it has improved in accuracy. This is a time that many are concerned they don’t have data – but that isn’t true. It is a time that you can revisit the use of your glucose meter and ensure it still has batteries that work!
- Adjustment to settings/doses – Make an adjustment when you see a trend above your target and then use your time for evaluation for meals/foods that are common. Do the post meals now look more in your target? Is there room to adjust for meals that are less common? You might be able to see change in a few hours, or it might take a few days to find the right adjustment.
- Endocrine or Diabetes team visits – the time between visits gives enough room for you to collect data, to be ready to navigate your next visit or e-chart note with more of your own personal input. This puts you in the driver’s seat so you can get what you really need out of the interaction.
- Prebolus for meals/snacks – if you are the one preparing the meal, it gives you time for more precise counting and consideration of what goes into the meal that might impact BG.
- Correction for high BG – Who wants to wait for a high BG to come down? No one! But, because our insulin is not instantaneous in action, we must practice some patience in the time period after we correct. This can be frustrating, but I find it helps to use that waiting time to take care of other things. In the moment I don’t need more insulin, but to take my mind off the annoying high, I can get other things done while waiting.
- Exercise adjustment – the preparation time heading into the workout takes patience to see if the changes set you up for a workout where you don’t have to stop 15 minutes in to treat a low. Even these changes take some patience to find out what works best and/or adjust and try again.
- Addition of alternative tools – Adding in another medication besides insulin has become something more and more people with diabetes are doing to navigate weight and insulin resistance. The use of these is not an overnight fix. Just like lifestyle changes, the use of these medications takes time, analysis and adjustment to find the fit that works best for your goals.
As people with diabetes use this type of medicine more, the fact of proper use begs discussion to ensure long-term health outcomes in the safest environment.
- Do they pack a good hit in terms of diabetes management? Yes!
- Do they assist with weight loss, which helps to further navigate glucose management? Yes!
- Are they an easy solution to both without the person having to make any changes? NO!!
Unfortunately, the introduction of the new GLP-1 meds comes with a common consideration of it being a “magic bullet” which is further emphasized due to lack of proper education when the medication is prescribed.
If you think like this, then you may not understand the use of this med and how it works. You have also not been taught the impact on your health. Without a proper understanding of what YOU need to do for it to work the best it can leave you floundering and can lead to long-term health issues that you didn’t realize could happen.
How do GLP-1 medications affect your body?
This class of medication causes a major impact on how your digestive system functions as well as on how you pay attention to hunger. GLP-1s slow digestion (stomach stays full longer, increasing satiety), block glucagon release from the liver (helps the post-meal glucose stay more stable), and in those with beta cells that are still able to release insulin, it helps to trigger the release of insulin. The medication also has an impact on how the brain signals hunger. Most people note early on that “food fog” disappears and they are finally able to pay attention to hunger cues that were not there before.
As these medications are prescribed, it is important to have an in-depth evaluation of the individual’s nutrient needs and what their current lifestyle includes – active, sedentary, food allergies/intolerances, insulin use, etc. Insulin dose adjustment needs to be discussed right away, given how these medications work in appetite reduction.
These medications will decrease appetite and can lead to some digestive upset initially; thus, it is important for education to be provided to ensure adequate nutrients are taken in as the person loses weight. Specific nutrient intake can drop considerably, and this can lead to long-term issues while seeming to prove beneficial initially as the person sees insulin/medication needs drop and weight loss occur. Common nutrients that are often low in those using GLP-1s include calcium, iron, electrolytes and fat-soluble vitamins like Vitamin D.
Step in the advisory guidelines to ensure the best outcomes.
Nutritional & lifestyle guidelines to use when taking GLP-1 medications include:
- Personalized assessment of nutrient need – meet with a Registered Dietitian or RD, CDCES for those with diabetes
- Quality food intake – less processed food (calorie-rich), more nutrient-dense food
- Protein focused to ensure lean body mass is preserved – muscle mass is important for long-term health outcomes as we age
- Digestive health management
- Evaluation of micronutrient intake
- Evaluation of lifestyle – stress, activity, sleep.
These guidelines focus on individualizing the care to ensure people have the best outcome in use. While it can be easy to prescribe a medication and tell someone to “eat more vegetables and walk more”, what works best is truly bringing the human, personalized aspect back to healthcare. If people are given the right guidelines and support, it will definitely improve how well they are able to implement change.
The key pearl to these guidelines is something that should have been happening for a long time, even before we had use of these new medications. The complementary connection of physician care to the interdisciplinary teams, including dietitians and certified diabetes care and education specialists. Working together will ensure the long-term health of the patient and improve outcomes that health practitioners can be proud to be a part of in the long term.
If you have been using a GLP-1 and feel as though you don’t have a full understanding of your needs, give us a call at 610-642-6055
We have a team of diabetes educators who not only have T1D but have also tried the GLP-1 meds and understand how to personalize use as well as navigate the nutrition and activity pieces while using them successfully.
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