Managing GLP-1 Side Effects: What to Expect + How to Feel Better

Believe it or not, GLP-1 receptor agonists have actually been around since the early 1980s. They’re not as new as all the recent media hype makes them seem! Some GLP-1s are also combined with a second hormone called GIP (glucose-dependent insulinotropic polypeptide) to create dual, or combination medications like Mounjaro and Zepbound. Whether you’re taking a GLP-1 or GLP-1/GIP, or considering one, it helps to know what side effects to expect and how to manage them.

What are the common side effects of GLP-1 medications?

Nausea, vomiting, diarrhea, constipation, bloating, and indigestion are the most common side effects of GLP-1s, especially when you’re starting out or increasing your dose. They’re usually not severe, but even a short stretch of side effects can disrupt your day-to-day life.

How can you manage common side effects?

You probably hear about the side effects of GLP-1s almost as often as you hear about the medication itself. Side effects are common, but as with any medication, everyone’s body responds differently. The good news is that there are things you can do to get ahead of some GLP-1 side effects.

Start slow. Begin at the lowest dose, and work with your healthcare provider (HCP) to increase gradually over time. If side effects pick up, back off your dose and let your HCP know.

Adjust how and what you eat. This might look like:

• Eating small, frequent meals or snacks. Think three small meals and two to three snacks spread across the day you’re awake, roughly every four to five hours.
• Using a smaller plate or bowl as a built-in portion cue.
• Drinking liquids separately from meals so you have room for nutrients from food.
• Choosing lean, skinless meats, fish and low-fat dairy. Limit red and processed meats.
• Trying a low-fat meal replacement shake as an easy snack option.
• Baking, grilling, steaming, boiling or broiling your food instead of frying.
• Eating slowly, chewing well and paying attention to your meal so you don’t overeat.
• Avoiding lying down right after eating.

Expert tip: You may feel full faster than usual, so make the calories you do eat, count. Start each meal with foods packed with vitamins, minerals, and fiber (like fruits and veggies). Pay attention to what and how much you drink.

• Sip fluids throughout the day, aiming for 8 to 12 cups of water daily.
• Swap high-fat or high-sugar drinks (like soda) for water — try adding lemon, lime, cucumber, or fresh fruit to keep it interesting.
• Limit caffeine to reduce your risk of dehydration; decaffeinated drinks are a better option but shouldn’t be your main source of hydration.
• Limit low-calorie juices and flavored drinks — water is still your best bet.
• Choose low-fat dairy or dairy alternatives like unsweetened oat, almond, or soy milk.

Stay physically active. Reduced food intake raises your risk of losing muscle, which makes movement especially important while on a GLP-1 or GLP-1/GIP.

• Adults should aim for 150 minutes of moderate or 75 minutes of vigorous activity per week.
• Children and adolescents should try to get 60 minutes or more of moderate-to-vigorous activity daily.
• Add resistance training two to three times a week for 30 minutes, using weights, a resistance band or just your own body weight like squats and lunges count!
• New to exercise? Start slow and build up gradually. A 10-minute walk after meals is an easy way to get moving.

Consider a vitamin or mineral supplement. If a reduced appetite means you’re eating less variety, a daily multivitamin can help fill the gaps. Ask your healthcare provider (HCP) whether a multivitamin or mineral supplement makes sense for you.

What are the less common or rare side effects of GLP-1 medications?

• Retinopathy is eye damage including leaking blood vessels, blockages, and growths that causes changes in vision. There are many stages of retinopathy and treatments are available. Be sure to discuss this with your eye care team.
• Tachycardia has an increased heart rate. Contact your HCP immediately if you experience heart racing and pounding for more than a few minutes.
• Pancreatitis. If you have a history of pancreatitis or develop a constant, upper stomach seek advice from your HCP. 

What other safety considerations should you know about?

• Birth control: GLP-1s can slow the absorption of oral contraceptives. Talk to your HCP about alternative contraception methods.
• Fertility: GLP-1s may help restore fertility in women living in a larger body or managing polycystic ovary syndrome (PCOS).
• Surgery and anesthesia: GLP-1s slow stomach emptying, which can affect anesthesia. Talk to your HCP ahead of any planned surgery about whether and how to pause your medication.
• Dehydration and kidney health: Nausea, vomiting, and diarrhea can lead to dehydration, and in some cases, acute kidney injury.
• Hypoglycemia: Taking a GLP-1 alongside insulin or a sulfonylurea can raise your risk of low blood sugar (hypoglycemia).
• Risk of diabetic ketoacidosis: Taking a GLP-1 alongside insulin or an SGLT-2 inhibitor may raise your risk of diabetic ketoacidosis (DKA).

Here are a few ways to stay ahead of these risks:

• Work closely with your HCP and see an eye doctor regularly, since rapid drops in blood sugar can raise retinopathy risk.
• If you’re of childbearing age and not using contraception, ask your HCP about proactive contraceptive counseling, especially if you’ve had difficulty getting pregnant.
• Review your insulin or sulfonylurea dosing with your HCP to manage your risk of hypoglycemia.
• Learn the signs of hypoglycemia and how to treat it, and check in with your HCP if you notice any.

How can you track your progress?

Tracking what’s working (and what isn’t) can help you spot patterns and stay motivated. Try a free app before committing to a paid one like Fooducate, myfitnesspal, mySugr, or Lily Health App. If you already use a connected smart ring or smart watch, check to see if any helpful health-tracking features are included.

The bottom line

Side effects are a common part of starting a GLP-1 or GLP-1/GIP, but being proactive with nutrition, movement,and open communication with your HCP sets you up for success. Since nutrition plays such a big role in managing side effects, ask your HCP for a referral to a registered dietitian nutritionist to build an eating plan that works with your lifestyle. And keep in mind: these tips are general starting points, not a substitute for medical advice. Always loop in your HCP for guidance specific to your health needs. 

For more on how GLP-1s work and what to expect, explore our GLP-1 Hub.

This content was made possible by Lilly, an active partner of Beyond Type 1. Beyond Type 1 maintains editorial control over its content.