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doi: 10.1136/bmj-2024-080952

Pre-treatment: Measure morning resting heart rate for 7 days Consider baseline ECG if not done recently Review all medications for cardiac interactions Discuss with physician specifically about the glucagon receptor heart rate effect During treatment: Measure resting heart rate daily during dose escalation Continue at each dose for minimum 6 to 8 weeks before increasing If resting HR exceeds baseline by more than 10 BPM, hold dose If resting HR exceeds 90 BPM at rest consistently, consult physician before any further increases Consider microdosing approach for ultra-gradual escalation Expected timeline: Weeks 1-12: very gradual heart rate change at low doses Weeks 12-30: moderate increase as dose slowly climbs Weeks 30+: stabilization (may occur later than standard protocol due to slower escalation) Protocol 3: monitoring-enhanced approach for data-driven researchers Who this is for: Researchers who want comprehensive data, athletes tracking performance metrics, anyone who finds data reassuring

The case uses a reusable cooling gel block that helps maintaining safe medication temperatures for hours without direct ice contact that poses risk of damaging injectable medications

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OConnor, [email protected] Disclaimer All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers