GLP-1 Monitoring & Spring Allergy Updates

March 15, 2026 • 4 min read

🎯 Clinical Focus: GLP-1 Therapy Monitoring

With GLP-1 receptor agonists becoming first-line for both diabetes and obesity, monitoring parameters are evolving beyond just glucose and weight.

Key Monitoring Parameters:

• GI Tolerance: Nausea/vomiting (especially first 4-8 weeks)
• Injection Site Reactions: Rotate sites, use cold packs
• Pancreatitis Symptoms: Severe abdominal pain radiating to back
• Gallbladder Disease: RUQ pain, fever, jaundice (especially with rapid weight loss)
• Thyroid Symptoms: Neck swelling, difficulty swallowing, hoarseness
• Renal Function: Monitor in CKD patients (dose adjustments may be needed)

Patient Counseling Pearls:

• "Take it on the same day each week"
• "Start low, go slow - side effects usually improve"
• "Contact us if you have severe stomach pain"
• "Report any neck swelling or difficulty swallowing"

🌸 Spring Allergy Management Update

First-Line Approach:

1. Intranasal corticosteroids (fluticasone, mometasone) - start 2-3 weeks before season
2. Second-gen oral antihistamines (cetirizine, loratadine, fexofenadine)
3. Allergen avoidance - pollen counts, shower after outdoor time

Step-Up Options:

• Add intranasal antihistamine (azelastine) for breakthrough symptoms
• Consider leukotriene modifier (montelukast) if comorbid asthma
• Short course oral steroids only for severe exacerbations

Patient Education:

• Start meds before symptoms begin
• Nasal spray technique: aim outward, away from septum
• Oral antihistamines: cetirizine may be more sedating than loratadine/fexofenadine

📄 New Toolkit: PPI Deprescribing Workflow

This week's clinical toolkit focuses on safely reducing unnecessary PPI use:

When to Consider Deprescribing:

• 8 weeks without clear indication

• Low-risk GERD symptoms controlled on H2 blocker or lifestyle
• Completed ulcer treatment course (typically 8 weeks)

The Workflow:

1. Assess indication - document reason for initial start
2. Step down - PPI → H2 blocker → PRN antacids → lifestyle only
3. Monitor - rebound hyperacidity (weeks 2-4), symptom return
4. Patient handout - includes rebound expectation and lifestyle tips

Monitoring for Rebound:

• Expected 2-4 weeks after discontinuation
• Treat symptomatically with alginates or famotidine PPIs
• Educate patients this is temporary and expected

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