What Labs Do You Need Before Starting GLP-1? Complete Pre-Prescription Guide
Before starting Ozempic, Wegovy, Mounjaro, or any GLP-1 medication, healthcare providers typically order baseline blood work. Understanding why each test matters, what results mean, and what to expect—plus cost and access options—helps you navigate the pre-prescription process confidently.
Why Baseline Labs Matter: The Medical Foundation for Safe GLP-1 Treatment
Baseline labs serve multiple critical purposes before starting GLP-1 medications. First, they establish your current metabolic and organ function status, creating a reference point to assess whether GLP-1 causes any changes during treatment. Second, they identify contraindications or relative contraindications to GLP-1 use—conditions making the medication risky or inappropriate for you specifically. Third, they quantify baseline disease severity (diabetes severity, cholesterol levels, kidney function) that GLP-1 treatment aims to improve. Finally, they often satisfy insurance requirements for prior authorization approval.
Providers use baseline labs to answer questions like: Do you have underlying kidney disease that might worsen with GLP-1 treatment? Do you have gallstones (increasing risk of cholecystitis on GLP-1)? Do you have pancreatic disease that might be triggered by GLP-1? Do you have thyroid disease or nodules (relevant to GLP-1\'s theoretical thyroid cancer risk)? What is your baseline cholesterol, blood sugar, and kidney function so we can track improvement? Skipping baseline labs creates unnecessary medical risk and often triggers insurance denial of prior authorization.
The Standard Pre-GLP-1 Lab Panel: Tests Your Provider Should Order
While labs vary slightly by provider, most responsible prescribers order a standard baseline panel before GLP-1 initiation. Understanding each test helps you know what to expect and why it matters.
Hemoglobin A1C (HbA1c): Measures average blood glucose over the prior 3 months. Reported as percentage. Normal <5.7%, prediabetes 5.7-6.4%, diabetes ≥6.5%. This test matters because GLP-1s significantly reduce A1C in people with elevated levels (typically reducing by 1.0-1.5 percentage points). Baseline A1C shows your metabolic starting point and guides GLP-1 dosing recommendations. If your A1C is normal (you don\'t have diabetes or prediabetes), GLP-1 indicated for weight loss shows metabolic health despite obesity. If A1C elevated, GLP-1 serves dual purpose (weight loss + diabetes control).
Fasting glucose: Blood glucose measured after 8+ hours without eating. Normal <100 mg/dL, prediabetes 100-125, diabetes ≥126. Fasting glucose is less sensitive than A1C for diabetes diagnosis but provides additional information about baseline metabolic control. GLP-1s improve fasting glucose substantially.
Lipid panel: Includes total cholesterol, LDL cholesterol ("bad" cholesterol), HDL cholesterol ("good" cholesterol), triglycerides. Optimal: total <200, LDL <100 (lower better if cardiovascular disease risk), HDL >40 (men) or >50 (women), triglycerides <150. Lipid abnormalities increase cardiovascular disease risk. GLP-1s significantly improve lipid profiles: triglycerides typically drop 20-30%, LDL drops 10-20%, HDL increases modestly. Baseline lipids establish how much improvement GLP-1 achieves. Very elevated baseline triglycerides (≥500) increase acute pancreatitis risk warranting discussion with provider.
Liver enzymes: Typically includes ALT (alanine aminotransferase), AST (aspartate aminotransferase), alkaline phosphatase, total/direct bilirubin. Normal ranges vary by lab but generally: ALT/AST <40 IU/L, alkaline phosphatase <120 IU/L, bilirubin <1.2 mg/dL. Elevated liver enzymes indicate liver stress or disease. GLP-1s have theoretical liver toxicity risk (though rare). Baseline establishes whether liver disease pre-exists medication. Elevated baseline enzymes may warrant liver ultrasound to assess for fatty liver disease before starting GLP-1.
Kidney function tests: Includes creatinine, BUN, eGFR (estimated glomerular filtration rate). Normal: creatinine 0.7-1.3 mg/dL, BUN 7-20 mg/dL, eGFR >60 mL/min/1.73m². eGFR categories: normal >60, mild reduced 45-59, moderate reduced 30-44, severe <30. Kidney function critical for GLP-1 safety because GLP-1s can precipitate acute kidney injury in dehydrated patients. Pre-existing kidney disease increases risk. Some providers use reduced doses or avoid GLP-1 in severe kidney disease. Baseline establishes kidney function reference point; follow-up labs assess whether GLP-1 causes changes.
Thyroid-stimulating hormone (TSH): Controls thyroid hormone production; elevated TSH suggests hypothyroidism (underactive thyroid), low TSH suggests hyperthyroidism (overactive). Normal range approximately 0.5-5.0 mIU/L (varies by lab). TSH baseline matters because GLP-1s carry Black Box warning for theoretical thyroid cancer risk (no confirmed human cases, but animal studies showed C-cell tumors at high doses). Additionally, some pre-existing thyroid disease affects GLP-1 tolerability or requires monitoring. Free T4 (thyroid hormone level) often ordered if TSH abnormal to clarify thyroid status.
Complete metabolic panel (CMP) or basic metabolic panel (BMP): Often included in baseline labs; includes electrolytes (sodium, potassium, chloride, bicarbonate), kidney function markers, glucose, kidney function. Ensures no electrolyte abnormalities or metabolic derangements pre-existing treatment.
Additional Tests Your Provider May Order
Beyond the standard panel, certain patient situations warrant additional baseline testing:
Lipase and amylase: Pancreatic enzymes. May be checked if you have history of pancreatitis (assesses baseline pancreatic function). Baseline establishes reference for future pancreatitis assessment if you experience concerning symptoms on GLP-1.
Abdominal ultrasound: Not a lab test but imaging sometimes ordered if gallstone disease is suspected or if elevated liver enzymes warrant further evaluation. Useful if you have prior gallstone history or family history of gallstone disease (increased GLP-1 risk for cholelithiasis).
Thyroid ultrasound: If TSH abnormal or thyroid nodules suspected from physical exam, ultrasound may be ordered to visualize thyroid and assess for nodules. Baseline imaging helps distinguish pre-existing nodules from GLP-1-related changes.
Fasting insulin: Measures baseline insulin level; elevated fasting insulin suggests insulin resistance (common in obesity and prediabetes). Some providers measure insulin resistance using HOMA-IR (homeostasis model assessment). Useful for confirming insulin resistance as indication for GLP-1 treatment.
C-peptide: Indicates pancreatic beta cell function; elevated suggests adequate insulin production (rules out type 1 diabetes, which contraindicated for Ozempic/Wegovy used for weight loss—though GLP-1s do treat type 1 diabetes in some cases with provider oversight).
Understanding Your Lab Results: Plain Language Explanations
Lab results often arrive as numbers with reference ranges, which can feel confusing. Here's plain-language interpretation:
A1C example: Result: 6.2%. Reference range: <5.7% normal. This means you have prediabetes—elevated average blood glucose over 3 months. This is an ideal finding for GLP-1 treatment because GLP-1 can prevent diabetes progression and improve A1C by approximately 1.0-1.5 percentage points, bringing you back to normal range.
Lipid panel example: Results: Total cholesterol 240 mg/dL (high), LDL 160 (high), HDL 35 (low), triglycerides 200 (moderately high). This pattern indicates increased cardiovascular disease risk. GLP-1 treatment should improve this substantially: expect LDL drop to ~140-145, HDL increase to ~40-45, triglycerides drop to ~140-150 over 3 months. If lipids don't improve on GLP-1, provider may increase dose or recommend statin therapy in addition.
Kidney function example: Results: Creatinine 1.1 mg/dL (normal), eGFR 65 mL/min/1.73m² (normal-low normal). This means kidney function is adequate for GLP-1 treatment, but on the lower-normal side. Provider should recommend excellent hydration (8-10+ cups daily) to support kidney function. Repeat labs in 3-6 months will confirm kidney function remains stable.
Thyroid example: Results: TSH 2.0 mIU/L (normal). This means thyroid function normal, no thyroid disease. You can proceed with GLP-1 treatment without thyroid-related concerns. Annual repeat TSH monitoring recommended during treatment (standard screening).
Follow-Up Lab Schedule: When to Repeat After Starting GLP-1
After baseline labs establish reference points, follow-up labs track GLP-1 treatment efficacy and safety. Standard monitoring schedule:
3-month labs (often 8-12 weeks into treatment): This timing captures response to GLP-1 after reaching maintenance dose. Tests typically repeated: A1C (if diabetic or prediabetic), fasting glucose, lipid panel, kidney function (creatinine/eGFR, BUN), liver enzymes. This early assessment confirms whether GLP-1 improving your metabolic markers as expected and identifies any unexpected adverse changes. Weight loss should be visible; if minimal weight loss at 3 months (0-3 pounds), provider may increase dose or assess for barriers.
6-month labs (optional, provider-dependent): Some providers order 6-month labs to track progress mid-year. Others skip to 12-month labs. Depends on provider preference and clinical situation. If significant metabolic changes at 3 months, 6-month repeat may be helpful to track trajectory.
12-month labs (1 year into treatment): Comprehensive repeat of baseline panel. Confirms sustained improvement in A1C, lipids, kidney function. Often shows marked improvement from baseline: A1C reduced 1-2 percentage points (for diabetic patients), triglycerides reduced 20-30%, LDL reduced 10-20%, weight loss 15-30 pounds. Kidney function typically stable or improved (weight loss beneficial).
Annual ongoing labs (after year 1): Once GLP-1 treatment stabilizes and you're on maintenance dose, standard annual labs replace more frequent monitoring. Annual labs include A1C (if diabetic/prediabetic history), lipids, kidney function, liver enzymes. Some providers recommend annual thyroid TSH screening given theoretical GLP-1 thyroid risk, though this is discretionary.
Additional monitoring if indicated: More frequent labs warranted if: significant weight loss causes medication adjustments (dose increases), kidney function declining (concerning for GLP-1 acceleration of disease), liver enzymes elevating (monitor for drug toxicity), diabetes diagnosis made during treatment requiring medication changes, new medical conditions developing requiring medication adjustments.
Lab Access and Options for Getting Tested
Multiple pathways exist for obtaining baseline labs, each with different convenience and cost implications:
Traditional healthcare provider (primary care, OB/GYN, other): Order labs through your current provider's office. Labs are typically sent to hospital or affiliated lab system. Blood drawn at lab location or quest/LabCorp site. Results returned to provider\'s office within 1-7 days. Cost: covered by insurance (with copays/deductibles) if provider uses in-network labs, or can be expensive ($500-1,000 out-of-pocket) if out-of-network. Advantage: insurance often covers; disadvantage: potentially slower turnaround, provider appointment delay to arrange labs.
Telehealth weight loss platforms: Many integrated platforms (Amazon Clinic, Sesame, specialized weight loss apps) partner with LabCorp or Quest. You order labs through platform, get results within 2-5 days, results share directly with telehealth provider. Cost: often included in platform visit package ($150-300 total visit + labs), or labs $50-150 if ordered separately. Advantage: convenient, transparent pricing, fast turnaround; disadvantage: must use platform\'s partner lab, may have limited test options.
Direct-to-consumer lab ordering (LabCorp, Quest): You order tests directly through LabCorp or Quest website, pay out-of-pocket, go to local collection site (drop-in, no appointment often available), results in 1-3 days. Cost: $25-60 per individual test, or packages $100-200 for comprehensive panels. Advantage: lowest out-of-pocket cost, convenience, speed; disadvantage: no provider ordering (you choose tests), insurance won't cover. This route works if you know which tests to order or have provider guidance on test codes.
At-home lab collection kits: Some telehealth platforms and direct-to-consumer companies (LetsGetChecked, imaware, etc.) offer mail-in kits. You collect blood via finger stick at home, mail to lab, results in 3-5 days. Cost: $50-150 per test. Advantage: maximum convenience (do from home); disadvantage: somewhat higher cost per test than going to lab location, possible collection errors (self-collected samples sometimes rejected).
Community health centers and urgent care: Local federally qualified health centers often provide labs at sliding scale (free to $50 depending on income). Urgent care clinics offer lab draws, though typically at higher cost ($100-200 per test). Advantage: sliding scale option for uninsured/underinsured; disadvantage: slower service, may require waiting.
Cost Guidance: What to Expect for Baseline Labs
Baseline lab costs vary dramatically. Understanding cost scenarios helps you budget and find most affordable option:
Insured patients: With insurance, baseline labs typically cost $0-300 out-of-pocket depending on deductible status and plan coverage. If deductible met, labs often covered at 80-100% and cost minimal ($0-50). If deductible not met, you pay higher amount but typically ≤$300 for full baseline panel (insurance provides some negotiated rate below full retail). Call your insurance before labs to confirm coverage and your out-of-pocket responsibility.
Uninsured patients using in-network labs (LabCorp, Quest): Basic metabolic panel $30-50, lipid panel $30-50, thyroid TSH $25-40, total ballpark $100-150 for basic panel. Comprehensive panels combining multiple tests often $150-250. This is most affordable self-pay option; use LabCorp or Quest self-order rather than hospital labs, which charge much more.
Uninsured patients using hospital/urgent care labs: Expensive—often $100-300 per individual test, $500-1,500 total for full panel. Avoid this route if direct-to-consumer labs available; you're paying substantial premium for hospital markup.
Telehealth platform labs: Often bundled into visit package $150-300 total (visit + labs combined). Cost-effective if platform includes labs in standard package. If ordering labs separately, typically $50-150 per test.
Insurance Prior Authorization: Why Labs Matter for Approval
Most insurance plans require prior authorization before approving GLP-1 medications. Many insurance companies request baseline labs as part of authorization documentation to confirm medical necessity (elevated A1C, obesity with comorbidities, etc.).
Submitting baseline labs with prior authorization request strengthens your case: A1C ≥5.7% (prediabetes/diabetes) or elevated lipids or elevated blood pressure documents metabolic disease warranting GLP-1 treatment. Labs demonstrating adequate kidney/liver function reassure insurance medication is safe. Labs establishing baseline metrics allow insurance to assess whether treatment is working (follow-up A1C reduction demonstrates efficacy, making future refills easier).
Insurance denials sometimes reverse if additional labs submitted supporting medical necessity. If your insurance denies GLP-1 coverage, ask your provider whether additional lab data supporting your diagnosis might strengthen an appeal.
What Lab Results Might Contraindicate GLP-1 Treatment
Most abnormal lab results don't prevent GLP-1 use but warrant discussion. However, specific findings might contraindicate or delay treatment:
Personal history medullary thyroid cancer or MEN2 syndrome: Absolute contraindication. If confirmed, GLP-1 medications are not appropriate; discuss alternatives with provider.
Thyroid nodules on ultrasound with suspicious features: May warrant endocrinology evaluation or biopsy before GLP-1 initiation. Benign nodules allow GLP-1; suspicious require further investigation.
eGFR <30 (severe kidney disease): Relative contraindication; may delay GLP-1 or require very close monitoring. Discuss with provider.
Severe liver disease (cirrhosis, severe hepatitis): Possible relative contraindication; discuss with provider. Mild liver disease or fatty liver typically doesn't prevent GLP-1.
Triglycerides ≥500: Significantly elevated triglycerides increase acute pancreatitis risk independent of GLP-1. Provider may recommend triglyceride-lowering intervention (lifestyle/medication) before starting GLP-1.
Most other abnormal labs are manageable with appropriate provider discussion rather than absolute contraindications. Key is transparent communication about findings and collaborative decision-making about whether GLP-1 remains appropriate for your situation.
Key Takeaway:
Baseline labs are essential before starting GLP-1 medications. They establish your baseline metabolic health, identify any contraindications, and provide reference points to assess treatment efficacy. Work with your provider to ensure comprehensive baseline testing before medication initiation, and follow-up with labs at recommended intervals to monitor treatment response.
Frequently Asked Questions
Technically yes, but strongly inadvisable. GLP-1 medications affect multiple organ systems and interact with various medical conditions. Starting without baseline labs creates serious risks: undiagnosed contraindications (personal history medullary thyroid cancer, MEN2—absolute GLP-1 contraindications—could be missed). Baseline kidney disease could worsen with GLP-1 treatment. Baseline pancreatic disease could lead to acute pancreatitis with GLP-1 exposure. Undiagnosed gallstones could present as acute cholecystitis when GLP-1 increases stone risk. Undiagnosed thyroid disease could complicate treatment. Any responsible provider should require baseline labs. Additionally, insurance often requires labs as part of prior authorization approval. Many telehealth platforms include baseline lab work as standard (often at no additional cost), so there's rarely good reason to skip it. If a provider refuses to order baseline labs or tells you they're unnecessary, consider seeking alternative provider—it's a red flag for inadequate medical oversight.
Cost barriers to baseline labs are real, but multiple solutions exist. Many telehealth GLP-1 platforms bundle labs into package pricing (e.g., $99-199 telehealth visit + labs included, making cost reasonable). Quest and LabCorp offer self-ordered lab packages at significantly reduced prices ($50-200 for basic metabolic panel) compared to hospital-ordered labs ($200-500+). Using self-ordered labs, you can get results and share with provider before scheduling visit. Some employers offer health screenings with free baseline labs; using this option before starting GLP-1 saves money. Community health centers often offer labs at sliding scale based on income, or free if income-qualified. Online discount code platforms (Groupon) sometimes offer lab packages at 40-60% discounts. If you have any health insurance (even catastrophic coverage), use it—labs are typically partially covered even with high deductibles. If completely uninsured and unable to afford labs, weigh risk-benefit: starting without labs is riskier than waiting/saving to obtain labs. Some telehealth providers will work with patients to obtain basic labs (often LabCorp at-home options) before prescription, making this feasible even with tight budgets.
Lab costs vary dramatically based on insurance, provider, and lab facility: With insurance: labs ordered by your provider through hospital/clinic are often mostly covered (insurance pays 80-100% after deductible met). Out-of-pocket cost typically $0-100 per test if deductible met, higher if deductible not met. Typical plan covers metabolic panel, lipids, thyroid, kidney function for $50-200 total out-of-pocket. Without insurance or for self-ordered labs: quest/LabCorp self-order packages: basic metabolic panel $30-50, lipid panel $30-50, thyroid TSH $25-40, comprehensive panel combining multiple tests $100-200. Telehealth platforms: often bundle labs into visit package $150-300 total, which is cost-effective compared to buying each test separately. At-home collection kits (some telehealth partners offer saliva or capillary blood collection) cost similar to self-order labs. Hospital or urgent care lab ordering (without insurance negotiation): expensive—single tests often $100-300 each, full panel $500-1,000. Recommendation: if uninsured, use LabCorp/Quest self-order rather than hospital labs; if using telehealth provider, ask about bundled lab costs upfront; if using traditional provider, confirm what insurance will cover before testing.
A1C (glycated hemoglobin) measures average blood glucose over the prior 3 months. It's calculated as percentage; normal <5.7%, prediabetes 5.7-6.4%, diabetes ≥6.5%. A1C matters for GLP-1 treatment because: GLP-1s FDA-approved for diabetes treatment (semaglutide, liraglutide approved for type 2 diabetes) reduce A1C by approximately 1.0-1.5 percentage points in people with diabetes. For weight loss in non-diabetic patients, A1C shows baseline metabolic health. Elevated baseline A1C (prediabetes or diabetes) indicates insulin resistance, making you ideal candidate for GLP-1 treatment (GLP-1s directly address insulin resistance). A1C trending up over time despite weight loss suggests metabolic dysfunction requiring medical attention or medication adjustment. A1C is used to monitor treatment efficacy: declining A1C confirms GLP-1 treatment working. Rising A1C despite GLP-1 medication suggests inadequate dose or need for additional therapy. Medications can lower A1C: if you start GLP-1 and baseline A1C was 6.5% (diabetes), it may drop to 5.8-6.0% (prediabetes or normal range), reducing diabetes disease activity. This metabolic improvement is one of GLP-1s' key benefits beyond weight loss.
Liver enzymes (ALT, AST, alkaline phosphatase, total/direct bilirubin) indicate liver function. Elevated enzymes signal liver stress: fatty liver disease (common with obesity and metabolic syndrome), viral hepatitis, alcoholic liver disease, autoimmune hepatitis, medication toxicity, other liver pathology. Why baseline liver labs matter before GLP-1: Some GLP-1s have theoretical liver toxicity risk (though rare). Baseline establishes whether liver dysfunction pre-exists medication. If liver enzymes rise after GLP-1 initiation, you can distinguish new GLP-1-related change from baseline abnormality. Elevated baseline liver enzymes may warrant imaging (ultrasound) to assess for fatty liver disease before starting medication. Severe liver disease (cirrhosis) is possible relative contraindication to GLP-1; baseline labs help identify this. Follow-up liver labs (6-12 months into treatment) assess whether GLP-1 caused any liver changes. Most patients show no liver enzyme changes or actual improvement (weight loss often improves fatty liver). If liver enzymes abnormal before GLP-1, discuss with provider: may need liver ultrasound, potentially temporary treatment (dietary modification, weight loss support) before starting GLP-1, or close monitoring after starting medication.
Kidney function assessed by: Creatinine (waste product filtered by kidneys; elevated creatinine indicates reduced kidney function). Estimated glomerular filtration rate (eGFR, calculated from creatinine, age, sex; indicates kidney function: normal >60 mL/min/1.73m², mild reduced 45-59, moderate reduced 30-44, severe <30). Blood urea nitrogen (BUN, another waste product; elevated with kidney dysfunction). Normal kidney function: creatinine 0.7-1.3 mg/dL, eGFR >60. Why baseline kidney labs matter for GLP-1: GLP-1s increase urine glucose excretion (natriuretic effect) and can promote acute kidney injury in dehydrated patients. Pre-existing kidney disease increases injury risk. Semaglutide dosing should be cautious in moderate-to-severe kidney disease; some providers reduce dose or avoid in severe disease. Baseline eGFR establishes reference point; if kidney function declines after GLP-1, you know medication contributed. Patients with eGFR <30 should discuss GLP-1 use with provider—may be contraindicated or require close monitoring. Follow-up kidney labs (3-6 months into treatment) assess whether GLP-1 caused changes. Most patients show stable or improved kidney function (weight loss improves kidney disease risk). If kidney function declining on GLP-1, dose reduction or discontinuation may be needed.
Thyroid stimulating hormone (TSH) indicates pituitary-thyroid axis function: TSH elevated suggests hypothyroidism (underactive thyroid); TSH low suggests hyperthyroidism (overactive thyroid); TSH normal (0.5-5.0 mIU/L roughly) suggests thyroid normal. Free T4 (thyroid hormone level) shows actual thyroid hormone circulating; often measured if TSH abnormal to clarify diagnosis. Why baseline thyroid labs before GLP-1: GLP-1s carry Black Box warning for theoretical thyroid cancer risk (no confirmed human cases, but animal studies showed C-cell tumors). Baseline TSH establishes thyroid health before medication. If thyroid disease pre-exists (hypothyroidism, hyperthyroidism), GLP-1 may affect disease control or side effects. Weight loss from GLP-1 improves hypothyroidism risk (obesity worsens thyroid disease). Patients with TSH abnormal before starting GLP-1 may need thyroid hormone adjustment after weight loss (reduced weight means reduced T4 requirements, preventing over-replacement). Medullary thyroid cancer history: if baseline labs show thyroid nodules, further evaluation needed before GLP-1 initiation. Personal or family history of medullary thyroid cancer or MEN2 is absolute contraindication to GLP-1. Follow-up thyroid labs (6-12 months into treatment) assess whether GLP-1 caused thyroid changes. Most patients show stable or improved thyroid function.
Lipid panel measures: total cholesterol, LDL cholesterol (low-density, "bad" cholesterol), HDL cholesterol (high-density, "good" cholesterol), triglycerides. Optimal values: total cholesterol <200, LDL <100 (lower better if heart disease risk), HDL >40 (men) or >50 (women), triglycerides <150. Lipid abnormalities (elevated LDL/total, low HDL, elevated triglycerides) indicate cardiovascular disease risk. Why baseline lipids before GLP-1: GLP-1s improve lipid profiles substantially: triglycerides typically drop 20-30%, LDL often drops 10-20%, HDL increases modestly. Weight loss amplifies lipid improvement. Baseline lipids establish reference point to track improvement. Severely elevated baseline triglycerides (≥500) increase pancreatitis risk independent of GLP-1, warranting discussion with provider. Elevated lipids may drive cardiovascular risk assessment, influencing GLP-1 benefit-risk evaluation. Follow-up lipids (3-6 months into treatment) often show marked improvement, reinforcing cardiovascular benefit of treatment. If lipids don't improve on GLP-1, provider may increase dose, adjust diet, or add statin therapy. Lipid improvement is one of GLP-1's key benefits beyond weight loss.
Follow-up lab schedule varies by provider and clinical situation, but general recommendations: At 3 months: repeat A1C (if diabetic), lipids, kidney function (creatinine/eGFR), liver enzymes. This early assessment catches any unexpected changes and confirms treatment efficacy. At 6 months: repeat metabolic panel similar to baseline. At 12 months: comprehensive repeat labs matching baseline panel. Annually thereafter: standard annual labs (A1C if diabetic or prediabetic, lipids, kidney/liver function). Special circumstances: more frequent labs warranted if: significant weight loss causes medication changes or illness, kidney function declining trends, liver enzyme abnormalities developing, diabetes diagnosis made during treatment (A1C rising), symptoms suggesting new disease. Telehealth platforms: many include follow-up labs at standard intervals (often 3, 6, 12 months) as part of ongoing care packages, making follow-up convenient. Traditional providers: you may need to request labs at appointments; proactively ask at each visit "Do I need follow-up labs?" to stay on schedule. Home collection options: at-home blood draws (companies like LetsGetChecked, imaware, offered through some telehealth platforms) allow convenient follow-up labs without clinic visits. Cost: follow-up labs often easier to obtain with insurance than initial labs (prior years met deductibles, established diagnoses improve coverage). If cost barrier, prioritize A1C and kidney function at minimum; other labs secondary.
Telehealth platforms offer several lab options: (1) Platform-included labs: many integrated telehealth/weight loss programs (Amazon Clinic, Sesame, specialized weight loss apps) partner with LabCorp or Quest, offering lab testing as part of package ($99-299 visit + labs included). You order labs through platform, collect at nearby LabCorp/Quest location or get at-home kit, results share directly with provider. Convenient, transparent pricing. (2) Platform-partnered at-home collection: some programs offer saliva or capillary blood kits (finger stick, mailed to lab). Convenient but may have higher cost ($50-100 per test vs. $25-40 self-ordered). (3) Patient-ordered labs: you self-order through LabCorp or Quest ($25-150 per test or $100-200 packages), go get blood drawn at local location, obtain results to share with provider. Provider not directly involved but reviews results at appointment. Lowest cost option if negotiating individual tests. (4) Insurance-covered labs: if you have insurance, contact your insurance to identify in-network labs. Submit lab requisition from telehealth provider; insurance often covers (partially or fully). May have copays/deductibles but usually more predictable cost. (5) Community health center labs: local federally qualified health centers offer labs at sliding scale or free if income-qualified. May take longer for results but often very affordable. Recommendation: ask telehealth provider which labs they partner with before scheduling; if platform-included labs, ask about cost upfront; if self-ordered route, use LabCorp/Quest rather than hospital labs for cost savings.
Abnormal baseline labs don't necessarily prevent GLP-1 use, but they warrant discussion and possible intervention. Examples: Elevated A1C (prediabetes/diabetes): confirms GLP-1 indication; actually drives prescription. Abnormal kidney function (eGFR 30-59): warrants cautious GLP-1 use; provider may recommend close monitoring or slower dose escalation. Severe kidney disease (eGFR <30): relative contraindication; may require avoidance or very conservative dosing. Abnormal liver function: warrants liver ultrasound to assess severity; mild elevation may allow GLP-1 continuation with monitoring; severe dysfunction (cirrhosis) may contraindicate. Elevated triglycerides ≥500: increases pancreatitis risk independent of GLP-1; provider may recommend triglyceride-lowering therapy (lifestyle/medication) before starting GLP-1, or close monitoring if starting. Thyroid nodule on labs (found during evaluation): warrants thyroid ultrasound; benign nodules allow GLP-1 continuation; suspicious nodules may delay GLP-1 pending further thyroid investigation. Personal history medullary thyroid cancer or MEN2: absolute contraindication to GLP-1; discuss alternative medications. Most abnormal labs are manageable with appropriate discussions/interventions rather than absolute contraindications. Key is having provider review labs, discuss findings, and create plan before starting medication. Never start GLP-1 without provider discussion of abnormal baseline labs.