Incretin Medications: Introduction

00:01 Now, I might be more excited about this than you are, but those things that you learned in pathophysiology, here's where you can see where they make sense, because it was the actual discovery of how incretin hormones, the ones made by the body function that led to the important developments in medication development for treating diabetes and obesity.

00:21 So the effects of the endogenous hormones, the ones made by my body can be enhanced or even mimicked by the certain medications that we're discussing.

00:30 When that happens, this will help control blood sugar levels much more effectively.

00:35 Now, the action of GLP-1 and GIPs are part of this sophisticated way.

00:39 Our bodies respond to and process the food that we eat.

00:43 Now, our bodies maintain a balance in blood glucose through a lot of complex interactions between the digestive system, the pancreas, and the brain. So if we have these medications that can mimic the hormones, we can use them to treat both blood sugar control and with weight loss for patients with obesity.

01:03 Now semaglutide that are known as wegovy or ozempic are synthetic hormones that mimic the natural hormone GLP-1.

01:12 So semaglutide these mimic the natural hormone GLP-1. Tirzepatide, also known as mounjaro, is kind of unique.

01:23 It actually is a dual GIP/GLP-1 receptor agonist.

01:28 That means it activates both the GIP receptors and the GLP-1 receptors. So this can make it a more potent option for managing blood sugar and promoting weight loss compared to the traditional GLP-1 agonists alone. But you need to keep in mind I use the word can because the relative efficacy of any drug can vary by individual and specific medication.

01:54 In this video, you'll understand key monitoring parameters for patients on GLP-1 and dual GLP-1/GIP receptor agonists. Now we know that these medications are powerful tools, but they do require that you have some consistent monitoring for both efficacy and for patient safety. So let's start with this overall big picture.

02:16 What are the general monitoring things we'll be looking at.

02:19 Well these meds come with some significant gastrointestinal side effects.

02:24 We want to know that there's weight loss progress, meaning the treatment has been effective.

02:28 If the patient is taking the med for weight loss, we want to watch their blood pressure closely.

02:33 And you'll see what happens with fluid volume shifting.

02:35 And if it's a diabetic patient we want to monitor their blood glucose.

02:39 And we're going to break that down specifically on what the monitoring schedule is and what you should be doing.

02:45 Now let's look at red flags.

02:47 These are things that require immediate attention.

02:50 So I want you to know that if your patient develops any of these, they're at risk and needs to contact their healthcare provider immediately.

02:57 So it's important that you know them so you can recognize them in a patient on these medications, and so that you can educate your patients to be on the lookout for these same symptoms in their own bodies.

03:08 Okay. So we've got things that kind of have to do with G.I tract.

03:13 We've got severe abdominal pain that because they're at a risk of pancreatitis.

03:19 Show us any signs of gallbladder disease.

03:21 That's another digestive problem that is known to happen with these medications.

03:25 And the third is if they have severe nausea, bad enough nausea to affect the hydration. This can really put your client at risk.

03:33 So those are the three that kind of involve the GI tract.

03:36 Severe abdominal pain might be pancreatitis signs of gallbladder disease and nausea so severe that it's going to affect their own hydration.

03:45 The last one has to do more with the brain because a client can experience significant mood changes.

03:52 If your client has any of these four symptoms, please make sure that you're always assessing for them.

03:58 You recognize them when they develop, and you make sure the patient understands they should reach out and contact their healthcare provider immediately.

04:06 Now we're going to break those down more specifically.

04:09 And we'll look at the four core monitoring parameters because you're aware of what the red flags are. We'll go into detail on the gastrointestinal effects, what you do and how you monitor weight loss, what you should do specifically with blood pressure monitoring, and what you should do for blood glucose monitoring for patients who are diabetic. So let's start with a gastrointestinal effects.

04:29 This is most common. And they usually have things like nausea vomiting or diarrhea. None of those sound pleasant, but this is usually most pronounced when you're changing doses.

04:41 When you're titrating up on the patient's dose, they usually start at a lower dose and then slowly work up to higher doses.

04:49 So typically this will improve over time as long as the patient can adjust to it.

04:54 If they can't, you'll look for another medication or another strategy.

04:59 Now, for those that have just what you would expect typical gastrointestinal effects, let's look at some management strategies that you can teach them.

05:08 So if the titration went up too fast and they had really kind of obnoxious GI Symptoms, then you kind of back off on the titration, maybe go up a little less the next time, go back to the previous dose.

05:20 That'll be a decision made between the client, the healthcare provider and the rest of the team.

05:25 You might encourage them to take the medication with meals that may help them, encourage them to stay hydrated.

05:33 They don't have much margin for error here. They need to stay well hydrated all the time, and that may also help with their gastrointestinal effects.

05:41 And if they do end up with nausea, they're going to have enough fluid on board that they don't get severely intravascularly dehydrated.

05:49 Now, the last piece is you want them to avoid trigger foods, particularly during the initial weeks of treatment.

05:55 So there are certain foods that do trigger the side effects more than other foods for people who are taking incretin medications.

06:02 So there's a pretty long list here.

06:03 And unfortunately, most of them are delicious.

06:06 So let's start with three of the biggies.

06:09 There's high fat foods.

06:10 Those could be a definite trigger.

06:13 So think fried foods, fatty cuts of meat, full fat dairy and processed foods. These are difficult and triggers for clients on these medications. High sugar foods is the next group, so soda, juices, cakes, cookies, and even some of the sports drinks could also become a trigger for this severe GI distress.

06:34 Now the third one refined carbohydrates.

06:36 So think of things like white bread, pasta, crackers and pastries. Now, that's not all.

06:43 Any of the ultra processed food, chips and other processed foods can also be triggers. And believe it or not, some vegetables made the list.

06:52 Starchy vegetables can also increase the side effects of these medications.

06:56 Hey and fruits they're not off the hook either.

06:59 You want to avoid acidic fruits.

07:01 Oranges and grapefruits can definitely make the GI side effects even worse.

07:06 Now finally, this is bad news for some of you.

07:08 Spicy foods can also make GI intestinal side effects even worse. So that's quite a list.

07:16 High fat foods. High sugar foods, refined carbohydrates, ultra processed foods, starchy vegetables, acidic fruits and spicy foods. That really limits what someone is going to be able to eat to try to minimize those side effects.

07:32 Now here's the big one.

07:34 Alcohol is something else they should avoid because it can actually suppress GLP-1 secretion. So another thing these foods have in common is that they can cause rapid spikes in blood sugar levels, and that can make it harder for the medication to control blood sugar.

07:50 They also all of these foods can slow down gastric emptying, which can also further increase the GI side effects.

07:58 So what's the answer? What can they eat? Well, bland foods and plain water are the least likely to cause GI discomfort. Now, when it comes to GLP-1,