Starting GLP-1 Treatment: Complete Checklist

Most people think starting GLP-1 treatment is as simple as getting a prescription and taking the medication. Show up, get the pen, inject, lose weight. The internet makes it look that way.

In practice, the patients who get the best results from semaglutide or tirzepatide are the ones who prepare properly before their first dose. That means knowing what side effects to expect in the first week, how dose titration works over months, what dietary changes to make early, and when something warrants a call to your doctor versus when it is normal.

This checklist covers every stage of starting GLP-1 treatment, from what to gather before your consultation to what your first three months should look like. If you are starting Ozempic, Wegovy, or any GLP-1 medication in Singapore, this is the practical guide you will actually want to reference.

Before your consultation: what to prepare

Your doctor needs specific information to prescribe the right GLP-1 medication and dose. Having this ready saves time and leads to better treatment decisions.

Medical history to gather:
- Current medications, including supplements and over-the-counter drugs
- Conditions relevant to GLP-1 prescribing: type 2 diabetes, hypertension, high cholesterol, PCOS, fatty liver (MASLD), sleep apnoea
- Any history of pancreatitis, gallbladder disease, or thyroid cancer (specifically medullary thyroid carcinoma, which is a contraindication for all GLP-1 medications)
- Known drug allergies
- Previous weight loss attempts and what happened

Health metrics to have ready:
- Your current weight and height (or recent BMI calculation)
- Recent blood test results if you have them: HbA1c, fasting glucose, lipid panel, liver function, kidney function (eGFR)
- Blood pressure readings if you track them at home

Eligibility basics:
In Singapore, GLP-1 medication for weight loss is typically prescribed for BMI 30 or above without other conditions, or BMI 27.5 and above with weight-related conditions like diabetes or hypertension. Trimly's eligibility criteria start at BMI 27.5 without conditions, or BMI 24 with conditions like T2D, hypertension, or PCOS. Your doctor will assess your full picture during the consultation.

Questions worth asking your doctor:
- Which GLP-1 medication do you recommend for my situation, and why?
- What dose will I start on, and what is the titration schedule?
- What side effects are most common in the first few weeks?
- How will we monitor my progress?

What happens during your first consultation

A good GLP-1 consultation is not a 5-minute rubber stamp. Your doctor should spend time understanding your medical history, weight history, and goals before recommending a specific medication and dose.

At Trimly, consultations happen over video call with a licensed Singapore doctor. Here is what typically happens:

1. Medical review. Your doctor reviews your health history, current medications, and any contraindications. They will ask about thyroid cancer history, pancreatitis, and pregnancy status.
2. Goal setting. Not just a target weight, but what health improvements matter to you. Lower blood pressure, better blood sugar control, improved mobility, or reduced joint pain are all valid goals beyond the number on the scale.
3. Medication selection. Based on your profile, your doctor recommends either oral GLP-1 (daily semaglutide tablets) or injectable GLP-1 (weekly semaglutide or tirzepatide injection). If you are unsure which format suits you, see our comparison of oral vs injectable GLP-1.
4. Dosing plan. All GLP-1 medications start at a low dose and increase gradually. Your doctor will explain the titration schedule and when dose increases happen.
5. Side effect preparation. What to expect, what is normal, and what is not.

After the consultation, your medication is delivered to your door. No clinic visits, no pharmacy queues.

Your first week on GLP-1 medication

The first week on semaglutide or tirzepatide is an adjustment period. Most patients experience a version of the following.

If you are starting injectable GLP-1 (weekly semaglutide or tirzepatide):
- Your starting dose is deliberately low. For semaglutide (Wegovy), that is 0.25mg weekly. For tirzepatide, 2.5mg weekly.
- Pick a consistent day of the week for your injection. Many patients choose a day when they can rest the following day, since some people feel mild fatigue after the first few doses.
- Inject in your abdomen, thigh, or upper arm. Rotate sites each week.
- Store your pen in the fridge at 2-8 degrees Celsius. Do not freeze it.

If you are starting oral semaglutide (Rybelsus):
- Take the tablet first thing in the morning on an empty stomach with a small sip of water (no more than 120ml).
- Wait at least 30 minutes before eating, drinking, or taking other medications.
- This timing matters. Food in your stomach reduces absorption significantly.

What to expect in the first few days:
- Reduced appetite. This is the medication working. You may notice you are less interested in food, or that you feel full faster than usual.
- Mild nausea. Affects roughly 40-50% of patients. Usually worse after eating too much or too quickly. Eating smaller meals helps.
- Some fatigue or mild headache. Usually resolves within a few days.
- Constipation or loose stools. GLP-1 slows gastric emptying, which can affect digestion initially.

What is NOT normal in the first week:
- Severe abdominal pain that does not go away (could indicate pancreatitis, which is rare but serious)
- Persistent vomiting where you cannot keep fluids down
- Signs of allergic reaction: swelling of face or throat, difficulty breathing
- Severe injection site reaction

If you experience any of these, contact your doctor immediately or go to A&E.

Weeks 2-4: settling in

By the second week, most patients have found their rhythm. The initial nausea usually fades as your body adjusts. This is the checklist for this phase.

Diet adjustments:
- Eat smaller portions. Your stomach empties more slowly now, so large meals will cause discomfort.
- Prioritise protein at every meal. Aim for 80-120g of protein daily to protect lean muscle mass during weight loss. Good options: chicken, fish, eggs, tofu, Greek yoghurt.
- Drink water between meals, not during. Fluids during meals fill your already-slowed stomach and can trigger nausea.
- Avoid greasy, fried, or very spicy food in the first month. These are the most common nausea triggers on GLP-1 medication.

Exercise:
- Start gentle. Walking 20-30 minutes daily is enough for the first few weeks.
- If you already exercise, you may notice lower energy on workout days. This is normal as your body adjusts to lower calorie intake.
- Do not start an intense new exercise programme at the same time as starting medication. One change at a time.

Tracking:
- Weigh yourself once a week, same day, same time (morning, after using the bathroom). Do not weigh daily, as normal fluctuations of 1-2kg will cause unnecessary frustration.
- Note any side effects and their severity. This information helps your doctor at your follow-up.

Months 1-3: dose titration

GLP-1 medications are titrated gradually to reduce side effects and find your effective dose. This is what the first three months typically look like.

Semaglutide (Wegovy) titration schedule:
- Weeks 1-4: 0.25mg weekly
- Weeks 5-8: 0.5mg weekly
- Weeks 9-12: 1.0mg weekly
- Weeks 13-16: 1.7mg weekly
- Week 17 onward: 2.4mg (maintenance dose)

Tirzepatide titration schedule:
- Weeks 1-4: 2.5mg weekly
- Then increase by 2.5mg every 4 weeks
- Available doses: 2.5, 5, 7.5, 10, 12.5, 15mg
- Your doctor determines your maintenance dose based on response and tolerability

What to expect during dose increases:
- Nausea may return briefly after each increase. This usually settles within a few days.
- Appetite suppression tends to increase with each dose step.
- Weight loss typically becomes more noticeable after the first 4-8 weeks.

Progress benchmarks:
In the STEP 1 trial, patients on semaglutide 2.4mg lost an average of 14.9% of their body weight over 68 weeks. Most people see 5% weight loss within the first 3-4 months. If you are not seeing at least 5% weight loss after 3 months on your maximum tolerated dose, your doctor should review your treatment plan.

Follow-ups during this period:
Check in with your doctor after each dose increase, or at least monthly. Trimly includes unlimited free follow-ups, so use them. Your doctor should be reviewing your weight trend, any side effects, and adjusting your plan as needed.

When to contact your doctor

Some side effects are normal. Others need medical attention. The difference matters.

Normal (manage at home):
- Mild nausea after meals
- Reduced appetite (this is the medication working)
- Mild constipation or softer stools
- Fatigue in the first 1-2 weeks
- Mild injection site redness that fades within a day

Contact your doctor (not urgent, but should be discussed):
- Nausea that persists beyond the first 2 weeks at any dose level
- Constipation that does not improve with hydration and fibre
- Hair thinning (reported by some patients, usually temporary and related to calorie deficit)
- Difficulty eating enough to meet basic nutrition needs
- Persistent heartburn or acid reflux

Seek immediate medical attention:
- Severe, persistent abdominal pain (possible pancreatitis)
- Vomiting that prevents you from keeping fluids down for more than 24 hours
- Signs of gallbladder problems: sharp pain in the upper right abdomen, fever, yellowing of skin or eyes
- Signs of allergic reaction: facial or throat swelling, difficulty breathing, rapid heartbeat
- Any symptoms that feel suddenly worse or unfamiliar

For emergencies, call 995 or go to the nearest A&E. For non-urgent concerns, Trimly patients can reach their doctor via WhatsApp or schedule a follow-up consultation at no extra cost.

Building habits that outlast the medication

GLP-1 medication is not a permanent solution for everyone. Some patients stay on treatment long-term. Others taper off after reaching their goals. Either way, the habits you build during treatment determine whether your results stick.

The STEP 4 trial showed that patients who stopped semaglutide without lifestyle changes regained about two-thirds of the weight they had lost. The ones who had built exercise and eating routines during treatment kept more of their progress.

Habits to start building from week one:
- Eat protein at every meal (80-120g daily)
- Walk daily, even if it is just 20 minutes
- Start resistance training by month 2 (bodyweight exercises, resistance bands, or dumbbells, 2-3 times per week)
- Get 7-8 hours of sleep consistently

For a detailed guide on habit building during GLP-1 treatment, see our article on building habits while using GLP-1 medications.

How Trimly supports you through the process

Starting GLP-1 treatment involves more than picking up a prescription. Trimly's model is designed around the reality that the first three months need the most support.

• Video consultations with licensed Singapore doctors who prescribe and manage your GLP-1 treatment, whether that is oral semaglutide tablets or weekly injectable semaglutide or tirzepatide.
• Unlimited free follow-ups throughout your treatment. Dose adjustments, side effect questions, progress check-ins. No extra fees.
• Medication delivered to your door. No clinic visits or pharmacy queues.
• WhatsApp support between consultations for quick questions about symptoms, timing, or diet.

Treatment plans range from $350 to $650 per month, covering consultation, medication, delivery, and all follow-ups. Learn more about what doctors check before prescribing GLP-1.

Frequently asked questions

What should I eat in my first week on GLP-1 medication?

Stick to smaller, protein-rich meals. Chicken, fish, eggs, tofu, and yoghurt are all good choices. Avoid greasy, fried, or very spicy food, which tend to trigger nausea. Eat slowly and stop when you feel 70-80% full. Drink water between meals rather than during meals.

How soon will I start losing weight after starting semaglutide?

Most patients notice some appetite reduction within the first week. Measurable weight loss usually appears within 2-4 weeks. In clinical trials, patients on semaglutide lost an average of 5% of their body weight within the first 3-4 months. The starting dose is sub-therapeutic for weight loss, so the real effect builds as your dose increases through the titration schedule.

Can I drink alcohol while on GLP-1 medication?

Alcohol is not contraindicated with GLP-1 medications, but most patients find their tolerance is lower. GLP-1 slows gastric emptying, which can make alcohol hit faster and harder. Alcohol also adds empty calories and can worsen nausea. If you choose to drink, start with small amounts and see how your body responds.

Do I need to take time off work when starting GLP-1 treatment?

Most patients do not need time off. The starting dose is low enough that side effects are usually mild. Some patients report mild nausea or fatigue in the first few days. If you are starting a weekly injection, consider timing your first dose on a Friday or Saturday in case you feel slightly off the next day.

Key takeaways

Starting GLP-1 treatment goes better when you prepare. Gather your medical history before your consultation, understand how dose titration works, plan for mild side effects in the first few weeks, and start building protein and exercise habits from day one. Track your weight weekly, use your follow-up appointments, and know when to call your doctor versus when to wait it out.