Lab monitoring calendar for GLP-1 therapy: what is repeated, when, and which triggers move the date

A calendar implies a schedule, and the first thing to say is that the GLP-1 labels do not contain one. What they contain is a trigger and a set of warnings. The schedule below is built by laying those over the intervals that already apply to the conditions people on these drugs commonly have. Where a line comes from a label it says so; where it comes from the ADA or KDIGO it says so; where it is common practice with no source behind it, it says that too.

The calendar

1. Before the first dose

   Baseline

   A1c, fasting glucose, lipid panel, comprehensive metabolic panel, CBC. Add TSH, B12, ferritin or a pregnancy test when the pre-therapy checklist gives you a reason. The labels mandate none of it; the ADA lists it for people with diabetes. The history questions (thyroid cancer in the family, pancreatitis, gallstones, insulin or sulfonylurea use, contraception) matter more than any tube.

2. Weeks 1 to 12: starting and escalating

   Trigger-driven, not scheduled

   This is the window the labels name for the dehydration warning: monitor renal function in patients reporting reactions that could lead to volume depletion, especially during initiation and escalation. No routine draw; a metabolic panel if vomiting, diarrhea or poor intake lasts more than a day or you feel faint. People on insulin or a sulfonylurea check glucose at home per their prescriber's plan. People on levothyroxine may have a TSH rechecked toward the end of this window.

3. Month 3

   First scheduled repeat, if you have diabetes

   The ADA calls for an A1c about every 3 months when therapy has changed. Starting a GLP-1 is a change. A CBC alongside keeps the A1c interpretable. For people without diabetes there is no 3-month lab in any guidance; a visit, yes, a tube, no.

4. Months 3 to 12: established dose

   Condition schedules take over

   Diabetes: A1c every 3 months until at goal, then twice a year. Kidney disease: eGFR and urine albumin at the frequency your KDIGO category sets. Statin users: lipids and liver enzymes 4 to 12 weeks after any dose change. MASH: your liver clinician's plan. Everyone: the same dehydration trigger, and the pancreatitis and gallbladder symptom warnings, which never switch off.

5. Month 12 and yearly after

   Annual review

   A1c, lipid panel, comprehensive metabolic panel, CBC; eGFR plus urine albumin-to-creatinine ratio if you have type 2 diabetes (ADA, at least yearly); B12 if you take metformin (ADA, periodic); TSH if you take levothyroxine or have had significant weight loss on it. This is also when to compare against the baseline and decide what the next year's list should be.

6. Any time

   Symptom triggers

   Persistent or severe abdominal pain, possibly radiating to the back: lipase, same day (label pancreatitis warning). Right upper abdominal pain, fever or jaundice: liver enzymes, lipase, ultrasound (label gallbladder instruction). Neck lump, trouble swallowing, persistent hoarseness: examination, not a routine calcitonin (label thyroid warning). Missed period: pregnancy test now.

7. Planning a pregnancy or stopping

   Washout and handover

   Semaglutide: discontinue at least 2 months before a planned pregnancy (Wegovy and Ozempic labels). Tirzepatide: discontinue when pregnancy is recognized; the oral contraceptive backup rule applies while on it. On stopping for any reason, no label sets post-treatment labs; the condition schedules (ADA for diabetes, KDIGO for kidney disease) continue unchanged.

Reading the calendar honestly

Two patterns are visible in it. First, for a person with no diabetes, no kidney or liver disease and no thyroid condition, the whole calendar collapses to: baseline, a trigger plan, annual review. Anything more frequent is a preference, and it is fair to ask what a result would change. Second, for a person with type 2 diabetes the calendar is busier, and almost none of the extra draws are because of the GLP-1; they are the ADA schedule that applied before the prescription and will apply after it.

The one thing that is specifically about the drug is the trigger. The starting and escalation weeks are when gastrointestinal reactions peak (the Tirzepatide Hub and Semaglutide Hub give the label rates by dose), and the labels' instruction to check renal function when fluid is being lost is the closest thing to a monitoring rule they contain. Know your baseline creatinine, know the symptoms, know who to call.

What to agree with your prescriber

• Which items on the calendar apply to you, and which do not.
• The trigger plan: what symptoms, what test, how to reach the practice, and which medicines to pause during a fluid-losing illness.
• Which laboratory to use for repeats, so the reference intervals match.
• How you will get copies of results.

Keep the record

The tracker below stores dated results for the tests on this site, draws a trend line per test spaced by date, shows the common range and its source alongside, and exports a CSV. It runs entirely in your browser: nothing is sent anywhere, and there is no account. It does not flag values as high or low. The range on your report and the clinician who ordered it do that.