Archives for September 2024

Greetings, fellow Type Twos! I am back once again to describe my weekly progress on Mounjaro, and to provide some collateral information and observations for anyone interested in monitoring and improving their metabolic health. I should note that I do not offer medical advice, and I am not a doctor (thank God). Neither am I a paragon of metabolic health, offering leadership by example. Taking advice of any kind from me is a fool’s errand. Nevertheless, I might throw out an idea or two that might inspire you to do some research on your own. Opinions, I’ve got, already!

As you might have read in last week’s Post-Vacation Update, I returned from my “JOURNEY” (a real one, not the metaphorical kind the YouTube weenies take on their GLP-1 medication of choice) replete with cold symptoms, a fever, and a positive test for Covid-19. For a couple of days after testing positive on Wednesday, my symptoms worsened, but now I have settled into a flu-like state, in which I feel like I am in the Twilight Zone and lack energy. However, writing doesn’t require much energy. Also, it provides relaxation for me, so welcome to my weekly rant.

In this week’s column (if I might use that archaic newspaper-oriented terminology), I will describe the effect of Covid-19 on my weight. I will tell you about a new continuous glucose monitor (CGM) I am testing, one that has been approved for non-prescription use. Finally, I will wrap up with the week’s progress, albeit distorted by my unintended viral visitors.

Covid Weight Loss

I gave my doctor some advice. I told him that his cosmetic weight loss patients would love him if he treated them with Covid-19. The disease gives them the effortless avoirdupois reduction solution folks of that ilk crave. While this was obviously a facetious suggestion, I based it on my current experience since contracting the virus. In last week’s update, I had reported a two-pound weight loss while on vacation. I now believe that drop was due to Covid.

My weight had been holding steady until the last couple of days on the road. Now back at home, between September 11 and today, September 16, I have lost 9.2 pounds. If I count the other two pounds during the vacation, that is over eleven pounds lost over a week’s time. Again, I attribute the dramatic drop to Covid, not Mounjaro.

This is certainly not a sustainable formula for weight loss, and I strongly recommend against attending Covid parties with that aim in mind. Shedding pounds in this manner is stressful to the body. I try to stay hydrated, but I pee a lot, too. I must conscientiously avoid dehydration. Because my kidney function is impaired due to age and metabolic syndrome, dehydration is a dreadful thing, especially in conjunction with the Mounjaro and other medicines I am taking.

If I experience an uncomplicated recovery from Covid, my hope is that I regain some of my ill-gotten losses. How’s that for a twist?

Throw in Sciatica, too!

When it rains, it pours. During our vacation, I tweaked my lower back, which has long been a ticking time bomb. A CT scan a couple of years ago characterized “moderate to severe multilevel degenerative disc disease within the lumbar spine predominantly involving the mid and lower lumbar spine”. In conjunction with taking Mounjaro, I had ramped up my exercise program, which seemed to result in less back pain. However, on vacation, awkwardly tossing around a fifty-pound suitcase, I messed something up.

So, now I need to deal with the back, too. The lower back pain radiates to the right-side butt and down the right leg. I cannot stand in one place for long. I eschewed an ER visit on the trip so I could get home quicker. Of course, that meant dealing with pain while driving for three days. Undoubtedly, the seated position while driving did not help the situation.

My self-treatment options are limited to Extra-Strength Tylenol, which doesn’t work. I need to get the damn thing evaluated and seek some treatment for it, because it is destroying my sleep. My hope is that I can avoid opiates and surgery, as I would prefer corticosteroids, muscle relaxers, and physical therapy. A visit to a local ER might be needed to get the ball rolling. I was tempted to go there last night while tossing and turning and not achieving any relief from the pain. We’ll see…

Stelo Glucose Biosensor

I discovered that the FDA had approved a new product from Dexcom, a wearable device like a continuous glucose monitor that does not require a prescription, is self-paid, and is available to anyone. Previously, I had eschewed CGMs, such as the Dexcom G7, because our Medicare regulators would not cover their cost for a Type 2 diabetic unless 1) on insulin, or 2) had documented hypoglycemic episodes. Even if my doctor were to prescribe a CGM, the out-of-pocket cost would have been over $300/month. Everybody has his price, and for that kind of money, I’ll endure finger pricks a few times per day. However, this new product offered by Dexcom for less than $100 per month piqued my interest.

Dexcom, makers of the flagship G7 CGM, saw the need for people in my category who want to track their glucose variations, so they developed this dumbed-down product, called Stelo. It is available directly from the company for under $100 for a month’s supply, or $90 for a monthly subscription. Each monitor is good for fifteen days, during which it communicates with the Stelo app on my phone with a graphical update every fifteen minutes. The Stelo cannot be integrated with an insulin pump, so the granularity of its measurements is coarser than that of the G7. It is just intended as an informational device. Dexcom labels Stelo as a “glucose biosensor”, not as a continuous glucose monitor.

Get It Quickly!

Interestingly, although I ordered Stelo directly from Dexcom through their website, the product was delivered the next day by Amazon. Amazon now makes deals with third-party companies wishing to avail themselves of Amazon’s rapid and diffuse distribution network. I suppose this form of distribution applies in selected areas where Amazon has a strong presence. That’s everywhere, right?

The Stelo cannot export information (yet) to share with a doctor or with readers of my column. In fact, I wanted to send an SMS to my wife with a screenshot of the glucose graph, but I could not do a screenshot. The message was that screenshots were prohibited due to security restrictions. WTF? I hereby request that Dexcom at least give us the capability to download information so we can analyze it in Excel if nothing else. Furthermore, show-and-tell with the doctor would be a good thing. I am assuming that the FDA approval might have been contingent on restricting the use of data to personal amusement, but I sure hope there’s a way around this restriction.

[UPDATE: There IS a way around it, in the form of the “Clarity” app from Dexcom. I’ll tell you more in next week’s update.]

(This is an entertainment device, not to be confused with a serious medical device, and you may not base your medical decisions on its readings under penalty of being acknowledged as being as stupid as the FDA and Dexcom’s lawyers want you to be). Oy vey!

Playing with My Biosensor

I have been wearing the Stelo “biosensor” for two days and have experimented with glucose-spiking ingestion, like eating several types of meals, as well as taking one Mounjaro injection. It is interesting to observe the glucose rapidly increasing, then falling off slowly after a carb-laden meal, a graphical depiction of insulin resistance. The readings are biased about 10-12 points higher than my Contour Next glucometer, which has tracked very closely with lab blood testing in the past. But the real benefit I will derive is in viewing the ups and downs. Absolute numbers are not as important, so long as they stay in range. And I will continue to use my glucometer at least once per day.

I cannot yet say whether I will be sticking with the Stelo once the novelty wears off. I signed up for the $90/month subscription, which is cancelable anytime. We’ll see whether Dexcom keeps that promise when the time comes. In the meantime, I will provide further observations and conclusions as time goes on and I find undiscovered features or deficits.

Asking whether I am wearing a glucose monitor or a glucose biosensor is like asking whether that thing in the sky is a hawk or a bird.

Weekly Mounjaro Results Recap

Undaunted by Covid, I will now present the skewed results for the week in the usual manner. As I mentioned, shockingly, my weight loss since last Wednesday is 9.2 pounds. Glucose average for the period was 104. However, my blood pressure has been running high, about 140/80. I attribute that to the illness and the back pain I have been experiencing for the past ten days.

I’ll be back next week, hoping to be in a better frame of physical and mental health.

If you wondered where the weekly updates went, Jen and I have been on vacation for a few weeks, so I want to share my on-vacation performance with any interested readers. This post will focus on managing Mounjaro administration while on the road and dealing with dietary issues that are the bugaboo of diabetic vacationers. Additionally, I will mention a friend’s huge weight loss and diabetes improvement using Mounjaro.

Recapping where I was prior to vacation, my current Mounjaro dose is 5 mg I had been on 2.5 mg for eight weeks, and 5 mg for two weeks. I had reported average blood glucose of 100 mg/dL. My weight had stabilized with about a 30-pound overall loss, and my blood pressure was in the normal range after a drop in losartan dosage from 100 to 50 mg. My morning fasting glucose was averaging 91, and just before leaving, I noted an 83. Excellent progress! So, naturally, I was concerned about not maintaining that substantial progress on vacation.

Vacation Food Challenges

My wife and I decided on the OMAD strategy, meaning one meal a day. Of course, she, being a thyroid disaster, needed to modify that regimen to include some small snacks during the day. We were either on the road or doing activities, so the temptation to sit around and eat was minimal. The problem is, eating either restaurant or catered food every evening still presents a challenge for a diabetic trying to avoid carbs and the ultra-processed crap that got him there in the first place. (No, obesity, metabolic syndrome, and type 2 diabetes are not communicable diseases, as Big Pharma and their follow-the-money co-conspirators three-letter federal agencies would have you believe. They are chronic conditions resulting from the crap pushed at us by Big Fooda. But I digress).

We ate at restaurants frequently. We also enjoyed home cooking with friends in Pennsylvania for the several nights we stayed there. Then, at the three-day event we attended in New Hampshire we had two catered lunches and a dinner, all fortunately implemented to a higher and more healthful standard than all the prior such events I had attended. On those three days, I had two meals. At restaurants, I chose proteins and limited carbs to vegetables and occasionally, pasta. However, on our last night on the road, Jenny and I split a medium-sized pizza, my only quasi-decadent indulgence.

I felt no hunger during the day. Activities and the Mounjaro, keep the hunger bug at bay, although I must tell you that the hunger suppression on Mounjaro has abated after the first eight weeks, even though I increased the dose after that. I will discuss this with my doctor next week.

How I Dealt with Refrigeration of Mounjaro

I bought a little insulin cooler that operates on built-in rechargeable batteries, which enabled us to be on the road for nine or ten hours and keep the Mounjaro cool. I needed it to store only two pens, but it can accommodate three. What I found in my home testing was that humid air would condense inside the storage chamber, so I put the Mounjaro in a ziplock bag.

Here is a word of advice for those who buy this unit: fully charge the batteries each night, preferably using the plug-in charger that comes with it. I tried using the USB cord, but it took forever, either plugged into my laptop or an old multi-port charger I take along on road trips. (Later, I got a high-capacity multi-port charger, which worked fine). The battery will last a day on a full charge.

How cold will it keep the Mounjaro? At home, my test showed that it could achieve 2-3 degrees Celsius, which would be close to ideal. However, sitting in a hot car all day, the temperature would rise to 12-13, which is not bad, but not ideal for long-term storage. Note that Mounjaro can be stored at room temperature (up to 30 degrees Celsius) for up to twenty days, so no harm done. Just keep that battery charged, because a hot car can destroy your precious cargo!

An Unexpected Incidental Mounjaro Story

On our way to New Hampshire, we spent an evening and a night’s lodging with a friend in Connecticut who I hadn’t seen for a couple of years. Pulling into the driveway of his house, some guy came out of the garage to greet us. Jenny and I wondered who the hell it was, as we had never seen this guy before, but quickly, we realized that it was Fred. He had shed 115 pounds and looked like a different person.

I asked him to tell his story, which involved Mounjaro. He had gone to the doctor in January, found that he was seriously diabetic, and wound up on Mounjaro. He was quite sure he was going to die soon if he didn’t get his diabetes under control. On Mounjaro, his maximum dose was 10 mg, and his most serious complication was constipation. It takes a lot more than Mounjaro to lose that amount of weight, so hats off to Fred for his accomplishment and best wishes for him to keep his diabetes under control.

So, Give Me the Results, Already!

As one might expect, the compromises of vacation living and eating created a hitch in my progress with blood glucose. I tested only once a day on vacation, fasting, when I woke up. The average morning glucose for the past week was 111, and for the past two weeks (encompassing the entire vacation) was 108. I would give this my family’s maximum rating of “not too bad.”

As for my weight, well, what am I supposed to do on vacation, eat donuts and gain weight, like the gratuitous weight-loss bloggers say you should because you shouldn’t deny yourself the crap you crave? Like they think the best part of an enjoyable vacation is eating? OMG, eat whatever you want because you’re taking a wonder drug that lets you do whatever the hell you want? No, fatsos, this is not a paradigm for managing your metabolic syndrome. That mode of thinking is what got you there in the first place and it is why you will inevitably fail at any crash diet, drug induced or otherwise. Indulging your cravings will only make them stronger.

All that having been said — and said from experience, because I have been there and done that many times — I lost two pounds while on vacation. And no, I didn’t miss the donuts, which were laid out on the table each morning at the three-day event. My biggest indulgence was the macaroni salad, and a sparing proportion at that. And thus, I am pleased that the trip did not cause me to alter my thinking by going into “I’m on vacation, so who gives a shit?” mode.

Wrapping It Up

Back home now, I hope to resume my weekly updates. I will see my doctor next Wednesday, a real, live in-person visit with a real, live primary care physician. In other words, not a screen session with some TikTok doc hired to sell tirzepatide for the thinly disguised fat farm “telehealth clinic” that employs him. At that visit, I’ll discuss Mounjaro dosage. As I had noted, paradoxically, when I switched to 5 mg from 2.5, not only did the appetite suppression abate, but also the side-effects decreased, namely constipation. Does this mean the drug is performing because my “system” has accommodated it? Would it be appropriate to go to 7.5 mg?

Thanks for reading my Mounjaro updates. Please, if I can answer any questions, let me know. And for those of you who have asked me why I do not make YouTube videos, I’ll tell you why: 1) it is too much work, 2) I am too old and ugly to put my face on video, and 3) I am too politically incorrect for YouTube. I don’t care about “monetization”, just sharing experiences with interested diabetics. Finally, the gratuitous weight-loss crowd who are just fat without complications would run me out of town for refuting their fundamental assertion that obesity is a disease to be treated by drugs sold by profit-oriented compounding pharmacies and their telehealth clinic collaborators.

UPDATE: I tested positive for COVID-19 upon my return, so I’ll be chilling out for a while. I’ll let you know how I am doing in next Monday’s update.