Glucagon A hormone that raises blood sugar by promoting glucose release from the liver and increases energy expenditure through thermogenesis
Subcutaneous injection protocol: Starting dose: 200 to 300 mcg daily Titration: Increase by approximately 100 mcg every 1 to 2 weeks as tolerated Target dose: 400 to 500 mcg daily by weeks 5 through 12 Frequency: Once daily, subcutaneous Cycle length: 8 to 12 weeks, with optional extension to 16 weeks Timing: Consistent daily timing, typically evening for sleep applications Oral/sublingual protocol: Duration: 30 days Frequency: 1 to 4 cycles per year Best combined with: Exercise and nutrient-rich diet Injection sites should be rotated between the abdomen, thighs, and upper arms to prevent lipohypertrophy and ensure consistent absorption
Some patients respond better to compounded semaglutide (a single GLP-1 agonist) after tirzepatide tolerance sets in, because it engages different downstream pathways and has a different pharmacokinetic profile
The SURPASS-2 trial (Frias et al., NEJM , 2021) directly compared tirzepatide to semaglutide 1 mg in patients with type 2 diabetes and found tirzepatide superior across all dose levels for both weight loss and glycemic control
This gradual escalation lets your body adapt to the drug and gives your prescriber a chance to monitor for side effects before moving to the next dose