CNCCurrency
GLP-1 Specialist
Great starting point
NOTE: Growth hormone is measured in IU (international units) and mg (milligrams):
1 mg = 3 IU
1 IU = 0.33 mg
Starting dose:
• Age below 30 years:
1.2 – 1.5 IU per day (0.4 – 0.5 mg/day) (may be higher for patients transitioning from pediatric treatment)
• Age 30-60 years:
0.6 – 0.9 IU per day (0.2 – 0.3 mg/day)
• Age over 60 years:
0.3 -0.6 IU per day (0.1-0.2 mg/day)
Patient with diabetes or who are susceptible to insulin resistance / glucose intolerance should use the lowest starting dose (0.3 -0.6 IU per day) regardless of age.
Subcutaneous injections are usually administered in the evening to mimic physiologic nocturnal GH secretion.
Dose escalation (titration):
At 1- to 2-month intervals, increase dose in increments of 0.3 -0.6 IU per day (0.1-0.2 mg/day) based on clinical response, blood IGF-1 levels, side effects, and individual considerations such as insulin resistance / glucose intolerance.
Longer time intervals and smaller dose increments may be necessary in older patients.
Goal with GH treatment:
Aim for blood IGF-I levels in the middle of the normal range appropriate for age and sex, unless side effects are significant. Consider a trial of higher GH doses to determine whether this provides further benefit as long as the serum IGF-I levels remain within the normal range and the patient does not experience side effects.
Monitoring:
While IGF-1 levels are not a good indicator of GH status, the usefulness of IGF-1 for monitoring treatment of GH disorders in adulthood is now widely accepted, especially as GH-dosing regimens for growth hormone deficiency have evolved from weight-based dosing (associated with overtreatment and side effects) to individualized dose-titration strategies, which maintain IGF1 within target limits.[7]
At 6-month intervals once maintenance doses are achieved. Monitoring should include clinical evaluation and assessment of side effects, blood IGF-1, fasting blood glucose levels, and T3, T4 and free T4, as well at lipid profile. Quality of life measurements may be done every 6 or 12 months.
Patients on concurrent thyroid, sex hormone or glucocorticoid treatment may need dose adjustments after starting GH replacement therapy.
Factors that may cause a need for higher GH doses:
• Young patients regardless of onset type
• Low blood IGF-1 levels
• Addition of oral estrogen
• Change from transdermal to oral estrogen
• To induce breakdown of stored body fat (lipolysis)
Factors that may cause a need for lower GH doses:
• Elderly patients
• High blood IGF-1 levels
• Discontinuation of oral estrogen
• Change from oral to transdermal estrogen
• Co-treatment with testosterone
• Elevation in fasting blood glucose and/or HbA1c (i.e. worsening glucose tolerance)
• Side effects
NOTE: Growth hormone is measured in IU (international units) and mg (milligrams):
1 mg = 3 IU
1 IU = 0.33 mg
Starting dose:
• Age below 30 years:
1.2 – 1.5 IU per day (0.4 – 0.5 mg/day) (may be higher for patients transitioning from pediatric treatment)
• Age 30-60 years:
0.6 – 0.9 IU per day (0.2 – 0.3 mg/day)
• Age over 60 years:
0.3 -0.6 IU per day (0.1-0.2 mg/day)
Patient with diabetes or who are susceptible to insulin resistance / glucose intolerance should use the lowest starting dose (0.3 -0.6 IU per day) regardless of age.
Subcutaneous injections are usually administered in the evening to mimic physiologic nocturnal GH secretion.
Dose escalation (titration):
At 1- to 2-month intervals, increase dose in increments of 0.3 -0.6 IU per day (0.1-0.2 mg/day) based on clinical response, blood IGF-1 levels, side effects, and individual considerations such as insulin resistance / glucose intolerance.
Longer time intervals and smaller dose increments may be necessary in older patients.
Goal with GH treatment:
Aim for blood IGF-I levels in the middle of the normal range appropriate for age and sex, unless side effects are significant. Consider a trial of higher GH doses to determine whether this provides further benefit as long as the serum IGF-I levels remain within the normal range and the patient does not experience side effects.
Monitoring:
While IGF-1 levels are not a good indicator of GH status, the usefulness of IGF-1 for monitoring treatment of GH disorders in adulthood is now widely accepted, especially as GH-dosing regimens for growth hormone deficiency have evolved from weight-based dosing (associated with overtreatment and side effects) to individualized dose-titration strategies, which maintain IGF1 within target limits.[7]
At 6-month intervals once maintenance doses are achieved. Monitoring should include clinical evaluation and assessment of side effects, blood IGF-1, fasting blood glucose levels, and T3, T4 and free T4, as well at lipid profile. Quality of life measurements may be done every 6 or 12 months.
Patients on concurrent thyroid, sex hormone or glucocorticoid treatment may need dose adjustments after starting GH replacement therapy.
Factors that may cause a need for higher GH doses:
• Young patients regardless of onset type
• Low blood IGF-1 levels
• Addition of oral estrogen
• Change from transdermal to oral estrogen
• To induce breakdown of stored body fat (lipolysis)
Factors that may cause a need for lower GH doses:
• Elderly patients
• High blood IGF-1 levels
• Discontinuation of oral estrogen
• Change from oral to transdermal estrogen
• Co-treatment with testosterone
• Elevation in fasting blood glucose and/or HbA1c (i.e. worsening glucose tolerance)
• Side effects
