GLP-1 agonists & endocrinology: transforming diabetes & metabolic health with Dr. Chhaya Makhija

GLP-1 agonists have been making waves in the world of diabetes and weight management, but many people still don’t realize who pioneered their use in clinical care—endocrinologists. As Dr. Chhaya Makhija, a triple-board-certified endocrinologist, explains, hormones regulate nearly every system in our body, making endocrine care essential for achieving long-term metabolic health.

Let’s dive into what GLP-1 agonists are, how they work, and why seeing an endocrinologist is key to unlocking their full potential.

What are GLP-1 agonists?

GLP-1 (Glucagon-Like Peptide-1) is a naturally occurring hormone in the body, produced in the gut. Its main role is to help regulate blood sugar levels by:
✔ Increasing insulin production when blood sugar is high
✔ Suppressing glucagon release, preventing sugar spikes
✔ Slowing digestion, keeping you full longer
✔ Interacting with brain receptors, reducing cravings

Endocrinologists were among the first specialists to prescribe GLP-1 agonists when they were approved nearly two decades ago. These medications—such as exenatide (brand names were Byetta & Bydureon), dulaglutide (brand name Trulicity), liraglutide now available as generic (Daily injection) and semaglutide (Ozempic approved for DM-2) and Wegovy (Approved for Obesity). The GLP-1 receptor agonist and glucose-dependent insulinotropic polypeptide - dual agonist is tirzepatide (Mounjaro approved for type 2 Diabetes) and Zepbound (approved for obesity)—are now widely used to manage type 2 diabetes and obesity. The oral formulation for semaglutide is also FDA approved and is a daily tablet for Type 2 Diabetes. 

Dr. Chhaya Makhija presenting healthcare communication, on a laptop screen, to a patient.

How do I work with my patients and GLP-1 therapy?

GLP-1 is a hormone and has a short half-life, and in simple terms, it means that it is released in our gut but gets destroyed rapidly by an enzyme. A GLP-1 agonist works on the same GLP-1 receptors and prolongs the effect of GLP-1 hormone which brings about its various metabolic effects. Let’s dive into a deeper level of expertise in tailoring treatments.

1. Precision in metabolic, weight and diabetes management

GLP-1 medications aren’t a one-size-fits-all solution. Dosing and monitoring are crucial, and that’s where as an endocrinologist I assess:
✔ Your metabolic history – insulin resistance, PCOS, prediabetes and diabetes risks, weight changes over time, family history, ethnicity, sleep apnea and current complications.
✔ Lifestyle factors – meal patterns, stress, sleep, activity levels, cravings, challenges with weight loss and what have you tried in the past to help with diabetes or weight care. 

✔ Your Gut health - GERD (reflux, acidity, gastritis), bowel movements, prior gut surgeries, your fiber intake, your water intake, etc. 

✔Your Body composition - I get a baseline body composition analysis for most of my patients undergoing lifestyle interventions, with or without GLP-1 RA and track it every 6-8 weeks. It’s not just the weight and BMI but Important parameters like the Visceral fat, Muscle mass, muscle mass and fat mass distribution, body fat mass are assessed and your treatment plan is personalized to work on health goals. 

✔ Considerations and Patient-Physician shared decision making –Reviewing contraindications like family or personal history of medullary thyroid carcinoma, pancreatitis, gallstones etc are essential ,and then what is my patient’s goal, what are their concerns and do they meet the medical criteria for these medications. 

As an endocrinologist: "I specialize in fine-tuning hormones to optimize metabolism, diabetes and your health. GLP-1 is a tool that must be used correctly to be truly effective."

2. The link between hormones & GLP-1 use in my patient care

🔹 Thyroid health: Undiagnosed hypothyroidism or subclinical hypothyroidism or unaddressed hyperthyroidism can affect GLP-1 agonist therapy response, hence it is crucial to review thyroid blood test, treatment, and adjust management.
🔹Gut health: A healthy microbiome supports optimal GLP-1 function, discussing nutrient foods, fiber intake, diversity of vegetables, protein intake (lean meats or vegetarian options, individualized based on patient preference and health), an essential part of the treatment.

🔹Menopause health: If a woman is suffering from menopausal symptoms, then discussing options of hormone replacement therapy and appropriate screening for that age is necessary as GLP-1 agonist therapy will not be a replacement for hormone replacement therapy. Depending on the individual’s symptoms and health, both these aspects should be discussed about their benefits. 

🔹Diabetes care: Lifestyle interventions and then with or without GLP-1 agonist have helped several of my patients to wean off insulin, improve their diabetes control, normalize hemoglobin A1C as well as reduce medications like their blood pressure medications or cholesterol medications. 

To get the best results, slow and steady, and optimizing lifestyle interventions helps to achieve longer gains in health and less risk of losing muscle mass. 

This holistic approach ensures better, long-term results rather than just a temporary fix.

"GLP-1 medications are powerful, but they work best when combined with nutrition, movement, strength training, stress management, and other important hormonal care."

The Unified Endocrine & Diabetes Care approach

At Unified Endocrine & Diabetes Care, Dr. Makhija and her team provide comprehensive, personalized care for patients considering GLP-1 therapy. Their approach includes:

💡 In-depth medical evaluations – to determine if GLP-1 is the right fit for your body
🥑 Nutritional coaching – balancing blood sugar naturally through diet
🏋️ Lifestyle optimization – movement strategies tailored to insulin resistance, weight loss and diabetes

📊 Ongoing monitoring – adjusting doses for the best possible outcome

Whether you’re new to GLP-1 medications or want a specialist to oversee your metabolic health, working with an endocrinologist ensures a science-backed, tailored approach.

Take the first step toward better health

If you’re struggling with diabetes, weight gain, or metabolic imbalances, let’s work together to find the best solution for your body.

📍 Now accepting patients in Fresno & the Bay Area | Telemedicine available

📞 Call (559)-272-9192 | (650)-410-0078 to schedule your consultation.

💡 Your health isn’t just about numbers—it’s about feeling your best every day!

At Unified Endocrine & Diabetes Care, we are committed to providing expert endocrine and metabolic health services to patients throughout Fresno, and the San Francisco Bay Area. Whether you're managing osteoporosis, hormonal imbalances, diabetes, or metabolic disorders, our specialized care is accessible to communities across Contra Costa County, Alameda County, and Santa Clara County. 

Our practice serves patients in Walnut Creek (25 miles from San Francisco, 30 miles from Silicon Valley), Lafayette (20 miles from San Francisco, 35 miles from Silicon Valley), Orinda (17 miles from San Francisco), Berkeley (12 miles from San Francisco), Oakland (10 miles from San Francisco), Pleasanton (35 miles from San Francisco, 20 miles from Silicon Valley), San Ramon (30 miles from San Francisco, 15 miles from Silicon Valley), and Palo Alto (35 miles from San Francisco, 5 miles from Silicon Valley). 

Through in-person visits and telemedicine, we make expert osteoporosis management, hormone therapy, and diabetes care more accessible to those in Danville, Fremont, Hayward, Sunnyvale, and beyond. 

Our goal is to provide comprehensive, evidence-based treatment for patients across the East Bay, South Bay, and surrounding regions, helping them improve their quality of life with cutting-edge diagnostic tools, personalized treatment plans, and advanced metabolic care.