CONSENT TO GLP-1 MEDICATIONS

I acknowledge that my information is truthful, I have reviewed and will follow all program guidelines, and accept the terms & conditions linked here. I understand that providing false or incomplete information may impact my eligibility. I agree to the following:

Why Semaglutide Injections?

The main benefits may include:

1. Semaglutide (Semaglutide) is 94% similar to natural human GLP-1 and therefore acts as a physiological regulator of appetite and thereby reducing food intake by reducing feelings of hunger and increasing feelings of fullness/satiety. 

2. Semaglutide is a newly licensed medication indicated for the treatment of type-2 diabetes. It was approved by the FDA in June 2021 for chronic weight management. 

3. For long term success the treatment needs to be combined with lifestyle changes including nutritional, exercise and behavioral habits.

4. Weight loss can lead to secondary benefits by improving weight loss related health problems such as cardiovascular risk factors (including hypertension, blood glucose levels and waist circumference) and physical health-related quality of life.

Why Tirzepatide Injections?

The main benefits may include:

1. Tirzepatide is the next generation of GLP-1 injections. It works similarly to Semaglutide, but operates on two pathways in the body by mimicking both the GLP-1 AND GIP hormones that are naturally secreted by the intestine after a meal, which prompts the body to release the right amount of insulin. Tirzepatide was FDA approved for diabetes in 2022 and for chronic weight management in 2023.

2. Like Semaglutide, Tirzepatide reduces appetite by slowing down the time it takes the stomach to empty and interacting with areas in the brain harboring GLP-1 receptors to signal satiety. Tirzepatide has been found to result in slightly more weight loss with slightly fewer side effects than Semaglutide. Link to study on Tirzepatide: https://www.nejm.org/doi/pdf/10.1056/NEJMoa2206038?articleTools=true

Compounding Medications

Due to the shortage of branded weight loss medications, such as Wegovy, Ozempic and Zepbound, You may be prescribed a compounded drug. Drug compounding is the process of combining, mixing, or altering ingredients to create a medication tailored to the needs of an individual patient. For more information on drug compounding, You can ask questions to you your prescribing provider and/or visit the following: Compounding and the FDA: Q & A

I agree that I have been informed of the procedure, any feasible alternative options, and the risks and benefits. Except in emergencies, procedures are not performed until I have had an opportunity to receive such information and to give my informed consent. Since every human being is unique, we cannot guarantee any specific result from GLP-1 treatment. Medication and or medical conditions may have a negative impact on the outcomes as well as lifestyle factors. Treatment should be discontinued after 12 weeks if the patient has not lost at least 5% of their initial body weight. Patients need to follow the instructions carefully as provided separately in the patient instruction sheet. Patients must agree to notify their practitioner of any contraindications or side effects of the treatment.

We will write to your GP to notify them of details of the program and any blood results (if completed).

It is essential to engage with your weight loss coach/clinician as outlined by Modern Thyroid Clinic. 

HEALTH CONCERNS: If you suffer from a medical or pathological condition, you need to consult with an appropriate healthcare provider such as your GP or Consultant. If you are under the care of another healthcare provider, it is important that you inform your other healthcare providers of your use of GLP-1 injections. If you are using medications of any kind, you are required to alert us of. Note: If you have any physical or emotional reaction to GLP-1 treatment, discontinue use immediately, and contact your PRACTITIONER or GP to ascertain if the reaction is adverse or an indication of the natural course of the body's adjustment to the treatment.

Of course in an emergent situation you agree to call 911 or report to your nearest emergency department. Laboratory testing may be done to any patient identified at risk to determine areas of dysfunction, not to diagnose or treat. Potential blood tests:

• Full blood count

• Liver function test

• Kidney Function Test

• Cholesterol levels, HbA1c, Glucose

Patient groups who may require additional blood test monitoring:

• Age 50 or above

• High blood pressure

• Pre-Diabetics

• Any significant medical problem

Every client is an individual, and it is not possible to determine in advance how your system will react to the treatment. It is sometimes necessary to adjust your program as we proceed. It is your responsibility to do your part by following healthy dietary guidelines, exercise your body and make necessary behavioral modifications.

1. Alternatives to GLP-1 therapy are surgical procedures, oral medical treatments (including Orlistat) and / or dietary and lifestyle changes alone.

2. Several weeks to months of treatment may be required depending on your individual response.

3. If a missed dose is more than 5 days late, the missed dose should not be taken, and the next dose should be taken at the normal time.

4. It is essential to combine eating, exercise and behavioral modifications with GLP-1 treatment.

5. GLP-1 treatment should not be used in combination with another GLP-1 receptor agonist, insulin or insulin secretagogues (such as sulfonylureas) due to the risk of hypoglycaemia.

6. Upon initiation of GLP-1 treatment in patients on warfarin or other coumarin derivatives more frequent monitoring of International Normalised Ratio (INR) is recommended.

7. GLP-1 treatment causes a delay of gastric emptying and has the potential to impact the absorption of concomitantly administered oral medications. Monitor for potential consequences of delayed absorption of oral medications concomitantly administered with GLP-1 injections.

8. There are several special warnings and precautions with the use of GLP-1 injections including warnings on pancreatitis, cholelithiasis and cholecystitis, thyroid disease, heart rate, dehydration and hypoglycaemia in people with type 2 diabetes.

9. Thyroid adverse events, such as goiter have been reported in rare cases in particular in patients with pre-existing thyroid disease. GLP-1 treatment should therefore be used with caution in patients with thyroid disease.

10. A higher rate of cholelithiasis and cholecystitis (gallstone and gallbladder disease) has been observed in patients treated with GLP-1 treatment. Cholelithiasis and cholecystitis may lead to hospitalization and cholecystectomy (surgery to remove the gallbladder Patients should be aware of the characteristic symptoms of cholelithiasis and cholecystitis.

11. Signs and symptoms of dehydration, including renal impairment and acute renal failure, have been reported in patients treated with GLP-1 injections. Patients treated with GLP-1 should be advised of the potential risk of dehydration in relation to gastrointestinal side effects and take precautions to avoid fluid depletion. Patients should also be aware of the symptoms of increased heart rate.

12. Acute pancreatitis has been observed with the use of GLP-1 treatment. Patients and their carers should be told how to recognise signs and symptoms of acute pancreatitis and advised to seek immediate medical attention if symptoms develop. If pancreatitis is suspected, GLP-1 treatment should be discontinued; if acute pancreatitis is confirmed, GLP-1 injections should not be restarted.

13. GLP-1 treatment may cause dose-dependent and treatment-duration-dependent thyroid C-cell tumors at clinically relevant exposures in both genders of rats and mice. It is unknown whether GLP-1 treatment causes thyroid C-cell tumors, including medullary thyroid carcinoma (cancer, MTC), in humans, as the human relevance of semaglutide-induced rodent thyroid C-cell tumors has not been determined. Patients should be aware of symptoms of thyroid tumors (such as a mass in the neck, difficulty swallowing, difficulty breathing or shortness of breath, persistent hoarseness.

I acknowledge that I have adequately received and understand the risks/benefits/alternatives to GLP-1 treatment within the weight loss program at Modern Thyroid Clinic,  I agree to this consent and I am willing to undergo treatment.