Incretin Medications: Patient Monitoring

00:00 Now, as a patient is losing weight, here's one of the funnest things to monitor.

00:05 You're going to help them be encouraged and motivated to stay on the track on their journey toward health by tracking their weight loss.

00:14 So first you start obviously with a baseline weight documentation.

00:17 You know, something to consider.

00:19 The patient may or may not want to know what that starting number is.

00:24 Always offer them the opportunity to not look.

00:28 You document it, but they may not want to see that.

00:31 And it might not be best for their mindset that they do initially, but you'll be able to determine that through your communication with them.

00:39 Now you want regular weight measurements.

00:41 Daily measurements are typically not a good idea.

00:44 So once a month is likely better because you can have fluctuations with weight, particularly with fluid.

00:50 So once a month is a nice range.

00:53 Now the rate of weight loss that's expected that's healthy would be half to two kilograms a week particularly initially.

01:01 The pattern of weight loss is not linear.

01:04 We usually want it to be like I start here and I end up way down here and it just goes right like this. But it's typically not linear like that.

01:11 So you want to help prepare your patient for that and level set with expectations so they know that, hey, this is going to be a journey.

01:20 And it's okay because we're looking at trends not exactly what happened with this measurement. Now another important monitoring parameter is blood glucose, particularly for your diabetic patients of course.

01:32 So you want the patient to be able to do self monitoring blood glucose.

01:36 We we shorten that to SMBG.

01:40 Now the reason we want them to do this is because we want to keep a close eye on any changes that are happening with that glucose.

01:47 So we'd like them to do a fasting glucose daily.

01:50 That means they take it first thing in the morning when they get up.

01:53 It's also helpful to do pre-meal and two hour post-meal or postprandial checks initially when the medication is starting out now.

02:01 Also, if they are noticing any signs and symptoms of hypoglycemia, they should also self-monitor their blood glucose level.

02:10 Now here's an example of target ranges.

02:12 We've got those on the screen for you there. So you can see those. Those are pretty standard. But keep in mind the accredited standards can change all the time.

02:20 But this is a good example of what we're usually shooting for as a target.

02:25 Now the patient may have some other factors and the healthcare team decides they have different targets. But this just gives you a rough idea of what it would be.

02:33 Now, hemoglobin A-1c monitoring is critically important for any diabetic client.

02:37 You want to have a baseline measurement of where they are, and then you want to keep checking this lab value every three months until stable.

02:45 Remember the hemoglobin A1c lets you know what the patient's average blood sugar is for the last 2 to 3 months.

02:51 So it's really helpful.

02:53 Now once it's stable you can do this reading the hemoglobin A1c lab work every six months. Now patients at risk of hypoglycemia are especially those who are on insulin or sulfonylureas.

03:07 Okay. So if your client is on insulin and type two clients can be on insulin or they're on sulfonylureas, you want to make sure that they know that hypoglycemia is going to be anything less than 70.

03:21 And severe hypoglycemia is less than 54.

03:25 So they need to know they're in an even higher risk to have really low, low blood sugar if they're on either of those medications.

03:34 Now as the patient progresses and they're making progress, what are some medication adjustments you might see the healthcare team make? Well, they may consider reducing insulin doses by up to 20% when they first start initiating these medications.

03:48 They also might need to decrease the sulfonylurea dosing, and they're going to have to monitor them very closely.

03:54 Anytime these medications are titrated.

03:59 In conclusion, as we wrap up this portion of the video series, let's take a look at what we know.

04:05 We now know that incretin hormones, primarily GLP-1 and GIP, are crucial metabolic regulators that are produced by specialized neuroendocrine cells that are found predominantly in the intestinal tract.

04:20 Now, it's this understanding of this intricate relationship between nutrient sensing, hormone production, and metabolic control that has revolutionized both diabetes and obesity treatment through the development of incretin-based therapies that harness these natural physiological pathways.