Liquid Mobile Guide to: Medical Weight Loss Injections for Semaglutide & Tirzepatide

Table of Contents

• Weight Loss Injections Intro
• Liquid Mobile Weight Management Program
• Semaglutide
• Tirzepatide
• How to Administer Injections
• How to Store

Welcome to Medical Weight Management with Liquid Mobile!

Liquid Mobile Medical Weight Management Program
Includes initial consult, and follow-up visits via telehealth or in-person with a provider that is clinician, including nurse practitioners and physicians. Follow-up visits will align with your required refills. We recommend that you book your follow-up telehealth visit two weeks prior to requiring a refill to allow adequate time to receive the refill.

Medical Weight Management does require a commitment to losing weight, therefore there is a minimum program requirement of 2 months. Your program will be set up on a monthly billing cycle.

Recommended Labs
It is recommended that you manage your labs directly with your primary medical provider and your medical team. Labs often recommended by primary care teams include:

• A1C: High levels of blood glucose or a consistently high A1c can harm your heart, blood vessels, kidneys, feet, and eyes. As you shed extra pounds, the insulin in your body lowers your blood sugar levels more efficiently, which will cause your A1c levels to drop over time. Taking steps to get your A1c in a healthy range lowers your risk of complications such as nerve damage, eye problems, and heart disease.
• Complete Metabolic Panel: The panel also includes tests that measure kidney and liver function. These vital organs filter out proteins and waste products produced during the metabolizing process. Fluids, electrolytes, and minerals in the blood are also measured. If the body is low on fluids or electrolytes, the metabolic function slows down, leading to potential weight gain or trouble losing weight.
• DHEA Sulfate: DHEA is involved in lipid (fat) breakdown and building lean muscle. Like other hormones, we tend to produce less of it with age, with the production of DHEA peaking around age 25 – 30.
• Estradiol – Estradiol regulates body weight by decreasing appetite and increasing feelings of satiety. This could be particularly important for women whose estradiol levels are abnormal, perhaps as a result of ovarian dysfunction, or whose estradiol levels drop, as part of the normal estradiol decline during menopause.
• Progesterone: A hormone imbalance, such as low progesterone, could potentially lead to weight gain as imbalances between estrogen and progesterone are one of the emerging causes of obesity. Healthy levels of progesterone support the thyroid, which produces hormones to regulate your metabolism or how quickly food is used for energy.
• PSA – Men with obesity have been found to have lower serum levels of prostate specific antigen (PSA) than non-obese men of the same age. This has potential implications for the use of PSA for prostate cancer detection in obese men.
• Testosterone: Being an overweight man can have a harmful effect on testosterone, while higher levels of testosterone in women can hinder losing weight.
• Thyroid Panel – Losing weight can be challenging for many living with low thyroid hormone levels. Researchers have shown that a slight change in your thyroid hormone levels can lead to weight gain or even make it hard for you to lose weight.

Guest should always notify their primary care and all specialists of their Weight Management plan, related information, issues and recommendations.

What are weight loss injections?
The injections work by mimicking the hormone which suppresses your appetite. This helps to reduce and regulate your hunger to ensure you consume fewer calories. These ‘slimming’ injections are not a quick-fix or magical tool, however. Instead, they are intended to complement other crucial aspects of weight loss, including exercise and a healthy diet. Semaglutide and Tirzepatide are the two weight loss injections offered by Liquid Mobile. They are long-term safe weight loss approved by the FDA when used with diet and exercise while monitored annually by your PCP.

What are the benefits of using weight loss injections?
Semaglutide and Tirzepatide reduce your appetite and decrease your hunger by making you feel fuller for extended periods of time, helping you eat less. It also helps to reduce leptin resistance, a hormone that can affect your metabolism & weight. In addition, because these injections target fat cells and regulate blood sugar, your body can remain in “fat-burning” mode, so you don’t have to worry about losing muscle mass or results solely from water weight loss.

Other benefits include:

• Helps avoid the urges for a quick sugar fix by promoting normal glucose levels.
• Physical hunger is gone
• Better sleep
• Higher energy levels
• A healthy lifestyle can help you to feel better and improve brain health and longevity
• Weight loss helps to decrease risks associated with being overweight like coronary artery disease, stroke, high blood pressure, high cholesterol, sleep apnea, back and joint pain

Will this medication interact with my other medication?
These injections may interact with insulin and other medications for diabetes and should not be used together. This list may not describe all possible interactions. Be sure to consult your healthcare provider and provide a complete list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also, tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

What should I report before taking this medicine?
Your Liquid Mobile care team should be notified of any of the following conditions:

• Endocrine tumors (MEN 2) or if someone in your family had these tumors
• Eye disease, vision problems
• Gallbladder disease
• History of depression or mental health disease
• History of pancreatitis
• Kidney disease
• Stomach or intestine problems
• Suicidal thoughts, plans, or attempt; a previous suicide attempt by you or a family member
• Thyroid cancer or if someone in your family had thyroid cancer
• Pregnant or trying to get pregnant
• Breast-feeding

Please note this list may not include all potential contraindications or precautions related to taking Semaglutide or Tirzepatide. Please consult your primary care physician or pharmacist for a list of all contraindications and precautions.

Semaglutide: Source
What is Semaglutide?
Semaglutide promotes weight loss. It may also be used to maintain weight loss. Semaglutide is a small protein (peptide) that activates metabolic pathways in the body to increase blood sugar metabolism and reduce appetite. Changes to diet and exercise are often combined with this medication.

How does Semaglutide work?
This weight loss medication is a GLP-1 receptor agonist that mimics GLP-1, an incretin hormone our body makes when it senses food in the intestine. The small intestine releases these hormones minutes after eating and aids digestion and appetite suppression. Incretins trigger the pancreas to release the right amount of insulin when glucose levels are high, helping move sugar from the blood into other body tissues where it is used for energy. It blocks other sources of sugar. It was also found that the hormone helps with appetite suppression by decreasing the speed at which food leaves your stomach, leaving you feeling full longer. Semaglutide weight loss plus lifestyle interventions were associated with a sustained reduction in body weight.

What are the side effects of Semaglutide?
“The most common side-effect of Semaglutide is nausea and possibly other digestive issues. But we take proactive measures to ensure that the chances of this happening to you are slim. For your first month, we will start you at a lower dose of Semaglutide to allow your body to get used to it. We typically increase incrementally at month two and month three. However, everyone is different. The goal is to lose a few pounds a week with no nausea. The medication is also compounded with Vitamin B-6, which will help curb any nausea.” Side effects may include:

• Diarrhea
• Loss of appetite
• Stomach pain
• Vomiting
• Constipation

Side effects that you should report to your primary care physician as soon as possible:

• Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
• Change in vision
• Dehydration—increased thirst, dry mouth, feeling faint or lightheaded, headache, dark yellow or brown urine
• Gallbladder problems—severe stomach pain, nausea, vomiting, fever
• Heart palpitations—rapid, pounding, or irregular heartbeat
• Kidney injury—decrease in the amount of urine, swelling of the ankles, hands, or feet
• Pancreatitis—severe stomach pain that spreads to your back or gets worse after eating or when touched, fever, nausea, vomiting
• Thoughts of suicide or self-harm, worsening mood, feelings of depression
• Concerns for thyroid cancer – new mass or lump in the neck, pain or trouble swallowing, trouble breathing, hoarseness
• Concerns for pancreatitis—severe stomach pain that spreads to your back or gets worse after eating or when touched, fever, nausea, vomiting

This list may not describe all possible side effects. Call your doctor for medical advice about side effects.

Semaglutide at Liquid Mobile
We do not prescribe Semaglutide under the brand names associated with treating type 2 diabetes or weight loss you may be familiar with (Ozempic, Saxenda, Wegovy). Instead, we start all of our Guests off at a lower, compounded dose for the first month, then increase the dosage for the second and third months, respectively, as appropriate for your weight loss goals and response. Our compounded medication may include Vitamin B-6 and/or B-12 to help with potential side effects.

Does it work? Source
According to sources and in studies of people taking semaglutide, there was a 15% weight loss at 16 months. Studies show that shorter duration of treatment is associated with weight regain, so we encourage you to continue this medication long term. Individuals continuing semaglutide after 20 weeks continued to lose weight, while those switched to placebo regained weight over the subsequent 48 weeks.

Tirzepatide: Source
What is Tirzepatide?
Tirzepatide is the first medication in its class. It works by slowing digestion and helping you feel full while lowering blood sugar. Tirzepatide has an element that mimics a hormone called GIP which can reduce appetite and improve how well your body breaks down sugar and fat.

How does Tirzepatide work?
Tirzepatide works similarly to the other drugs in the GLP-1 family, but it contains an extra molecule that may give it a slight edge, GIP. The medication has a dual-action design, mimicking the action of not one but two incretin hormones involved in blood sugar control: Glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP). Incretin hormones are released whenever food is consumed. Among other things, they help promote a feeling of fullness by delaying gastric emptying and activating the brain’s satiety centers. They also boost insulin production in the pancreas and suppress glucagon production, both of which help normalize blood sugar.

What are the side effects of Tirzepatide?
Like other GPI-1 medications, the most common side effect is nausea, to minimize the risk of this occurring with Tirzepatide. We choose a specific compounded formulation. The medication may be compounded with Vitamin B-6 and/or B-12, which helps curb any nausea. We also will start you at a lower dose of Tirzepatide to reduce side effects and increase. We typically increase incrementally at month two and month three. However, everyone is different.

Other side effects include:

• Diarrhea
• Decreased appetite
• Stomach pain
• Vomiting
• Constipation
• Indigestion

Side effects that you should report to your primary care physician as soon as possible:

• Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
• Pancreatitis—severe stomach pain that spreads to your back or gets worse after eating or when touched, fever, nausea, vomiting
• Concerns for pancreatitis—severe stomach pain that spreads to your back or gets worse after eating or when touched, fever, nausea, vomiting
• Change in vision
• Dehydration—increased thirst, dry mouth, feeling faint or lightheaded, headache, dark yellow or brown urine
• Gallbladder problems—severe stomach pain, nausea, vomiting, fever
• Heart palpitations—rapid, pounding, or irregular heartbeat
• Kidney injury—decrease in the amount of urine, swelling of the ankles, hands, or feet
• Thoughts of suicide or self-harm, worsening mood, feelings of depression
• Concerns for thyroid cancer – new mass or lump in the neck, pain or trouble swallowing, trouble breathing, hoarseness

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Tirzepatide at Liquid Mobile
We do not prescribe Tirzepatide under the brand name associated with treating type 2 diabetes or weight loss you may be familiar with (Mounjaro). Instead, Tirzepatide at Liquid Mobile is used as a second-line option for our guests and will be prescribed at the discretion of your physician and nurse practitioner. Typically, Tirzepatide will be used for our guests who are not responsive to their current injection plan or have hit a plateau and struggled to continue to lose weight. If required, we start all of our patients off at a lower, compounded dose for the first month and then increase the dosage for the second and third months, respectively, and as appropriate for your weight loss goals and response. Our compounded medication may include Vitamin B-6 and/or B-12 to help with potential side effects.

Does it work? Source
A clinical trial of over 2,500 people with obesity or overweight experienced significant weight loss with weekly tirzepatide. Those treated with tirzepatide had an average weight loss of 15% to 20% of their starting body weight over 72 weeks.

How will I receive my medications?
You may receive your weekly injections in one of our local clinics, provided by a physician, nurse practitioner or registered nurse. Weekly injection clinic visits are for medication administration only and are not to be used for follow-up visits. Please book an appointment in the clinic or via telehealth for follow-ups, refills, and questions regarding your response to the current weight loss plan.

You may also elect to self-administer your injections at home. The medication will be shipped to your home.

How do I receive refills?
It is highly encouraged that you request a refill 2 weeks in advance to your medication running out. Visit www.LiquidMobileIV.com , click Telehealth, then Refill to schedule a call for a refill or call 855.954.7843. Increases in dosages will require a telehealth visit with a provider and will only be allowed after 4 weeks of being on current dosage.

How to do I store these medications?
Keep out of the reach of children and pets. Semaglutide will be dispensed by the pharmacy as a frozen product. Once you receive it, store it in the refrigerator in-between doses.

Dispose of needles in a sharps containers available at your retail pharmacy. If not assessable, place needles in a hard, closed container, such as a sealable detergent bottle.

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. You should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA’s Safe Disposal of Medicines website for more information.

What dose will I inject?
Dosages will depend on each individual, as you may titrate up about every 4 weeks at the discretion of the Liquid Mobile care team. The medication is administered once weekly, on the same day each week. Injections can be done at any time of the day, with or without meals.

Missed Doses:

• If you are using Semaglutide injection, inject the missed dose as soon as you remember it. However, if more than 5 days passed since the missed dose, skip the missed dose and continue your regular dosing schedule. Do not inject a double dose to make up for a missed one.
• If you are using Tirzepatide injections, take the missed dose as soon as you remember it. However, if more than 4 days have passed, skip the missed dose and continue your regular dosing schedule. Do not inject two doses within 3 days of each other.

How do I inject these medications?

1. Gather your supplies:

• Medication vial
• Syringe
• Alcohol wipe

2. Wash your hands and prepare injection site.

3. Clean the injection site with alcohol wipe, and let the skin dry.

4. Draw up medication

• Remove the seal on the top of the vial and wipe with alcohol
• Remove the cap off the needle
• Hold the syringe like you hold a pen or a dart, inserting the needle into the middle of the rubber stopper perpendicular, so the needle does not bend.
• Together, turn the vial and syringe upside down.
• Make sure the tip of the needle is in the liquid.
• Pull the plunger down, past the dosage prescribed. Then, push up to the prescribed dosage, as this will remove all air bubbles.
• Once you have the correct amount of liquid, pull the entire syringe out of the vial.

5. Inject into subcutaneous tissue. Subcutaneous injections will be very little pain because it is only injected directly under the skin. It can be injected into the stomach, thighs, and back of the upper arm.

• Pinch the injection site to create a firm surface. Alternate injection sites between either side of the stomach, back of the arm, or thigh.
• Inject two inches from the belly button on either side.
• Insert the needle into the skin between the index finger and thumb at 90 degrees.
• Using a slow and constant pressure, push the plunger rod until it reaches the bottom.
• Gently pull the syringe out of the skin.
• Discard of the needle in a sharps container.

Additional Suggestions
It is recommended that you work closely with your primary physician and medical team, along with a wellness consultant, fitness trainer and nutritionist, to best round out your Weight Management program and to build good weight management habits.

There is no single anti-inflammatory diet plan. Generally it emphasizes eating a wide variety of fruits and vegetables, unsaturated fats, minimally refined whole grains, tea, coffee, herbs, spices, and oily fish. The Mediterranean diet and DASH diet are popular dietary plans that already showcase many anti-inflammatory foods. Diets that have been suggested include:

• An anti-inflammatory diet plan not only highlights specific foods and food groups but limits other foods that may contribute to metaflammation such as fatty cuts of red meat, refined sugary foods and beverages, and excess alcohol.
• Mediterranean Diet: Source
• DASH Diet: Source

To learn more about getting started on your weight loss journey, visit the CDC Healthy Weight website.
Source