💜 GLP-1 Guide

🧮 Dose → syringe units

📋 Official table — 10 mg/mL

Transcribed from your Lavender Sky Rx summary. At this concentration: mg × 10 = units.

🔍 Triple-check ritual

Do this the same way every week. It takes ten seconds and it's the difference between a dose and a hospital visit.

1. Read the vial label out loud — drug name and concentration. "Tirzepatide, ten milligrams per milliliter."
2. Say the conversion out loud — "Two milligrams. Times ten. Twenty units."
3. Read the syringe before you inject — front edge of the stopper on the 20 line. If it's on 2, you under-dosed by 10×. If it's on 200, you can't — but if you filled past 100, stop.

📅 Titration planner

Tick each week off as you take it — saved in this browser.

📖 The rules behind the plan

• 2 mg once weekly for the first 2 weeks. Your approved starting dose.
• After 2 weeks you may go to 3 mg. You can stay at 3 mg indefinitely if you're losing weight consistently.
• Then +1–2 mg every 3–4 weeks, only as needed, to a maximum of 15 mg/week.
• Adequate appetite suppression → don't increase. The goal is the lowest dose that works, not the highest you tolerate.
• Any side effects or sensitivity → hold. Do not increase.
• If you've had a sensitivity at any point, increase by no more than 1 mg at a time from then on.

⏰ Missed a week?

The FDA-approved label for branded tirzepatide gives a clear rule. Confirm it applies to your compounded product, but this is the standard:

🗓️ Timing

• Same day each week, any time of day. Pick a day you'll actually remember.
• With or without food — doesn't matter.
• You can shift your injection day if needed, as long as it's been at least 3 days since the last dose.
• Set a recurring phone alarm. A missed week is the most common self-inflicted setback.
• Many people inject in the evening so the first-day nausea happens while asleep. Worth trying if day one is rough.

🧼 Why this section exists

You're doing at home what a nurse does in a clinic: puncturing a sterile vial and putting its contents under your skin. Every germ that gets in comes from your hands, the vial top, your skin, or a reused needle. The technique below is the standard CDC/WHO aseptic sequence, adapted for self-injection.

🖐️ Hand hygiene

1. Soap and warm running water. Scrub 20 seconds — palms, backs, between fingers, thumbs, under nails.
2. Rinse and dry with a clean towel or paper towel.
3. Alcohol-based hand sanitizer (60%+) works when hands aren't visibly soiled — rub until fully dry.
4. Do this immediately before setting up, not ten minutes and three doorknobs earlier.

🧴 Preparing a clean workspace

• Hard, flat, non-porous surface — a wiped-down counter or table. Not a bed, not a couch, not carpet.
• Wipe the surface with alcohol or a disinfectant wipe and let it dry.
• Good light. You need to read tiny graduations.
• Lay out everything before you start: vial, syringe (still sealed), two alcohol pads, gauze, sharps container open and within reach.
• Pets and kids out of the room. No eating, no drinking at the workspace.

💧 The alcohol rule — swab, then wait

Alcohol doesn't kill on contact. It kills as it evaporates, and the job isn't finished until the surface is dry. This is the most commonly skipped step in home injection.

• Never fan, blow on, or wipe the alcohol dry. Blowing on it re-contaminates the surface with your breath; wiping just moves the germs around.
• Wet alcohol dragged into the puncture is what makes an injection sting. If yours sting, this is almost always why.
• Use a separate pad for the vial and the skin. Don't double-dip.

🚫 One needle, one syringe, only one time

The CDC's "One & Only" rule. Every item below is a real, documented route to infection:

✅ Pre-injection checklist

Run this every single week. Tick to save.

📍 Where tirzepatide goes

Three approved subcutaneous regions — the same three on the FDA label for branded tirzepatide: abdomen, thigh, and back of the upper arm. You're aiming for the fat layer between skin and muscle, not the muscle.

🔄 Rotation — and why it's not optional

Injecting the same spot repeatedly causes lipohypertrophy: a firm, rubbery thickening of the fat under the skin. It's harmless to look at and quietly ruins your therapy — the tissue absorbs medication erratically, so some weeks you get your full dose and some weeks you don't. Reported in up to two-thirds of people who don't rotate properly.

Worse, lipohypertrophic tissue is less sensitive, so it feels like the best place to inject. People gravitate toward their favourite spot precisely because it's already damaged.

Two rotation systems — pick one and stick to it

Checking for lipohypertrophy

• Once a month, run your fingertips flat over each injection region with light pressure.
• You're feeling for anything firmer, rubbery, thickened, or raised compared to the tissue around it — often easier to feel than to see.
• Found one? Stop injecting there and give it months to recover. Tell Brandi — absorption from a healthy site may be higher, which can change how the dose hits you.

📐 How deep, and at what angle

Subcutaneous means the fat layer — below the skin, above the muscle. Hit muscle and absorption speeds up unpredictably and it hurts; stay too shallow and it leaks back out.

💉 The full procedure

1. Wash hands, prep the workspace. See the Hygiene tab.
2. Take the vial out of the fridge and let it sit 15–20 minutes. Room-temperature liquid stings dramatically less. Don't warm it in your hands, in water, or in a microwave. Don't shake it.
3. Inspect the liquid. Should be clear and free of particles. Cloudy, discolored, or floating matter → don't use it, message the portal.
4. Check the label — right drug, right concentration, within BUD.
5. Swab the vial's rubber top with a fresh alcohol pad and let it air dry.
6. Open the syringe. Don't let the needle touch anything — not the counter, not your fingers, not your clothing. If it does, discard it and start with a new one.
7. Pull air into the syringe equal to your dose (20 units for 2 mg).
8. Vial upright on the table. Push the needle straight through the center of the rubber stopper and inject the air in. This equalizes pressure so the liquid draws smoothly instead of fighting a vacuum.
9. Invert — vial upside down, needle tip staying below the liquid line — and pull back past your dose, to roughly 25 units.
10. Clear the bubbles. Keep it inverted, tap the barrel so bubbles rise to the needle end, then push the plunger up to your exact number — 20. The bubbles go back into the vial and you land on the dose. Air in a subcutaneous shot isn't dangerous, but it displaces medication you paid for.
11. Withdraw the needle and read the syringe at eye level. Front edge of the stopper on the 20 line. Say it out loud.
12. Pick your site from the rotation schedule. Not last week's site.
13. Swab the skin ~30 seconds, then let it air dry ~30 seconds. Do not blow on it.
14. Pinch about an inch of skin and fat between thumb and forefinger, lifting it away from the muscle.
15. Insert in one smooth, confident motion at 90° or 45°. Hesitating hurts more than committing.
16. Hold the pinch. Push the plunger down slowly and steadily until it stops. Slow injection = less stinging and less leakage.
17. Count to 5 with the needle still in. This lets the tissue accept the volume instead of pushing it back out the track.
18. Withdraw at the exact same angle you entered, then release the pinch.
19. Light pressure with gauze. Do not rub or massage — rubbing changes absorption and increases bruising. A drop of blood or a small bruise is normal.
20. Syringe straight into the sharps container. Do not recap. Do not set it down first.
21. Vial back in the fridge, cap on.
22. Log it — date, dose in mg, units drawn, site used, anything you noticed.

🩹 If something goes sideways

🧊 Storage

• Store in the main body of the fridge — not the door (temperature swings every time it opens) and not touching the back wall (freezing risk).
• Never freeze it. A frozen vial is dead, even after thawing. Discard it — peptides denature and you cannot tell by looking.
• Keep it in its original carton, away from light.
• Write the BUD on the vial the day it arrives. Marker on the label. Don't rely on memory across three months.
• A cheap fridge thermometer is worth it if you're not sure your fridge holds range.

✈️ Travel

• Carry-on, always. Cargo holds freeze and checked bags get lost. This is not a "probably fine" situation.
• Insulated bag with a gel pack, with a cloth or towel between pack and vial so it can't freeze against it.
• TSA permits medically necessary liquids and syringes. Keep the pharmacy label on the vial, declare it at screening, and pack syringes in their original packaging.
• Bring the pharmacy label or a copy of your prescription documentation. Not required everywhere, but it ends conversations quickly.
• Hotel mini-fridges are unreliable — some run warm, some freeze. Test with a drink before trusting it overnight.
• Pack one spare syringe and extra alcohol pads. Travel-size hard-sided container for used sharps if you'll inject on the road.
• Branded tirzepatide pens tolerate up to 21 days under 86°F. Do not assume that applies to your compounded vial — confirm before you rely on it.

🗑️ Sharps disposal

• Used syringe goes into an FDA-cleared sharps container immediately — puncture-resistant plastic, leak-resistant sides and bottom, tight-fitting puncture-resistant lid.
• No container yet? A heavy-duty plastic household container works as a stopgap — laundry detergent bottle or similar. It must be leak-resistant, stay upright, and have a tight, puncture-resistant lid. Label it clearly.
• Never put loose needles in household trash or recycling. Never flush them.
• Keep the container upright, out of reach of children and pets, away from the workspace edge.
• Replace at ¾ full — don't fill to the top, don't press down on the contents.
• Disposal rules are set locally. Pharmacies, hospitals, health departments, and mail-back programs all take them — check your county's rules.

📦 Reorder rhythm

1. Follow-up with Brandi sets your next dose and quantity.
2. Invoice arrives by email or in the portal's invoices tab — verify before paying.
3. Pay → Confirmation Email within ~24 hrs → order placed with the pharmacy.
4. Then it ships.

🍗 Your targets

These are Brandi's numbers from your welcome message. The sections below are the reasoning, so you know which ones are load-bearing.

💪 The muscle problem — the one that actually matters

This is the part most people skip and later regret. Across GLP-1 trials, roughly 20–40% of total weight lost is lean mass, not fat. That's not unique to the drug — it happens with rapid weight loss generally — but the drug makes rapid loss easy, so the risk is real.

Muscle is your metabolic floor. Lose it and your maintenance calories drop, which makes regain easier and the next attempt harder. This is the mechanism behind "the weight came back worse."

Protein

• Brandi's target: 20–30 g per meal. The broader evidence-based range for someone losing weight is 1.2–2.0 g per kg of body weight per day.
• Sources: lean meats, eggs, Greek yogurt, cottage cheese, fish, tofu, beans, whey.
• Protein first on the plate. On a GLP-1 you will get full before you finish — so the protein needs to be gone before that happens.
• Appetite suppression makes hitting protein genuinely hard. A shake is a legitimate tool, not a failure.

Resistance training

• 2–3 days per week minimum, per Brandi. More is better if you can recover from it.
• Compound movements: squat/leg press, hinge/deadlift, push (press), pull (row), carry.
• Progressive overload — add weight or reps over time. Same weights forever ≈ no stimulus.
• Don't drop the weights when you feel weaker. You will feel weaker on fewer calories. Keep showing up; the signal to keep muscle is the point.
• Cardio is for cardiovascular and metabolic health. It does not protect muscle. Do both.

🍽️ Eating on a GLP-1

• Eat slowly, stop at comfortably full — not stuffed. Gastric emptying is slowed, so the fullness signal arrives late and hits hard. Overshooting is the #1 cause of a miserable evening.
• Smaller, more frequent, balanced meals beat three big plates — less nausea, less reflux.
• Limit ultra-processed food, fried food, and sugary drinks. They worsen GI side effects and blunt the weight loss.
• Order: protein → fiber → the rest.
• Fiber (25–30 g/day) from vegetables, fruit, and whole grains. This is your main defense against GLP-1 constipation and it steadies blood sugar.
• Ramp fiber up gradually with water. Sudden large increases cause bloating and cramping.
• Alcohol tends to hit harder and sits worse. Go carefully the first few weeks.
• If reflux shows up at night, front-load food earlier in the day and don't lie down within 2–3 hours of eating.

💧 Hydration is a safety issue, not a tip

64+ oz/day. This one has teeth: the FDA now requires a kidney injury warning across GLP-1 drugs. Postmarketing reports include acute kidney injury — some requiring dialysis — and the majority occurred in people who got dehydrated from nausea, vomiting, or diarrhea.

• Sip throughout the day. Chugging a large volume on a slowed stomach feels terrible.
• Suppressed appetite suppresses thirst cues too. Don't wait to feel thirsty.
• If you're vomiting or have diarrhea you can't get ahead of, that's a message-the-portal situation, not a tough-it-out situation. Electrolytes help; they don't substitute for medical advice.

🩹 Side effects — first moves

⛔ Absolute contraindications

Tirzepatide carries a boxed warning — the FDA's most serious — for thyroid C-cell tumors. It causes them in rodents at clinically relevant doses; whether it does in humans is unknown. It is contraindicated in:

• Personal or family history of medullary thyroid carcinoma (MTC) — family history alone rules it out, regardless of your own thyroid status
• Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)
• Known serious hypersensitivity to tirzepatide or any ingredient

🚑 Stop and get emergency care

• Severe, persistent abdominal pain — especially radiating to your back, with or without vomiting. This is the pancreatitis presentation.
• Allergic reaction — trouble breathing, swelling of face/lips/tongue/throat, widespread hives, fainting.
• Gallbladder attack — fever, upper-right abdominal pain, yellowing of skin or eyes, clay-colored stool.
• Severe dehydration you can't reverse — can't keep fluids down, little or no urine, dizziness on standing, confusion.
• Signs of very low blood sugar if you also take insulin or a sulfonylurea — shakiness, sweating, confusion, blurred vision.

📨 Message the portal (not urgent, but don't sit on it)

• Nausea, constipation, or reflux you can't manage with the food rules
• Vomiting or diarrhea that won't settle
• Injection site that stays red, hot, swollen, or painful past a couple of days
• You suspect you drew or injected the wrong amount
• You missed a week and aren't sure how to restart
• Vision changes
• You feel a firm or rubbery lump at an old injection site
• Any new diagnosis, surgery, pregnancy plan, or new medication

⚠️ Interactions and situations to flag

🏷️ On compounded vs. branded

Your product is compounded tirzepatide from Hallandale, not FDA-approved Mounjaro or Zepbound. Compounded drugs are not FDA-reviewed for safety, effectiveness, or manufacturing quality. Much of the clinical detail on this page — the 4-day missed-dose rule, injection sites, contraindications, interactions — comes from the FDA-approved tirzepatide label, which is the closest authoritative reference for the same molecule.

Where compounded product genuinely differs is in concentration, preservative, vial format, and storage rules. Those are exactly the areas where guessing causes harm, and exactly why the portal's Dosing/Units page and Brandi's answers override anything here.

📮 Who to contact

Provider: Brandi Willard, FNP-C — Nurse Practitioner, Lavender Sky Health

✅ Order flow

1. New patient form reviewed & approved → done, at 2 mg/week
2. Invoice notification by email or portal → verify accuracy
3. Pay
4. Confirmation Email within ~24 hrs — shipping, follow-ups, support, self-injection guide
5. Order placed with the pharmacy
6. Ships → check Dosing/Units in the portal before the first shot

📌 Why they cap your quantity

Lavender Sky's stated policy: ethical prescribing means a full patient evaluation, a dose appropriate to you, and a quantity matched to that dose — then following your progress, self-titration, and side effects to determine what comes next. They're explicit that they're not a bulk supplier and won't dispense large amounts against possible future unavailability. Tier requests above demonstrated usage get declined. Monitored and enforced for safety and care-standard compliance.

🔗 Sources

This page combines your Lavender Sky welcome message and Tirzepatide (Hallandale) Rx Summary with published guidance from the FDA, CDC, and WHO. The portal is the source of truth — if anything here disagrees with it, the portal wins.

• FDA — Concerns with Unapproved GLP-1 Drugs Used for Weight Loss
• FDA MedWatch — Dosing Errors with Compounded Injectable Semaglutide
• Mounjaro (tirzepatide) FDA Prescribing Information
• DailyMed — Mounjaro label
• CDC — Safe Injection Practices
• CDC — Preventing Unsafe Injection Practices / One & Only Campaign
• WHO — Best Practices for Injections and Related Procedures
• FDA — Safely Using Sharps at Home, Work and Travel
• JAPhA — Tirzepatide and GLP-1 impact on oral hormonal contraception
• Medscape — Resistance training + protein and GLP-1 muscle loss
• FDA kidney injury warning across GLP-1 drugs
• Lilly Medical — GLP-1 therapy and surgery/anesthesia