Archives for 2024

Welcome to another weekly Mounjaro update, where I describe my personal progress on the drug and blow wind about related issues.

Yesterday morning’s COVID test was negative! So, I’m hoping to conclude that episode. From the time I tested positive on Wednesday until now it is a little more than the expected ten days. Although I still feel fatigued and crusty, I hope to bounce back soon. Being an old fart, recovery time is always longer. However, I spent half an hour on the stationary bike yesterday to test my exercise tolerance with no issues.

Another situation that arose over the vacation was lower back pain and sciatica, which still afflict me. The doc threw some Alleve at it, but it isn’t working. As the back pain causes loss of sleep, I assume that it is contributing to my high blood pressure, which despite weight loss, has been unacceptably high since my return.

This week’s issue will provide additional information about the new, non-prescription, wearable glucose monitors. I am using Stelo by Dexcom, and during the week I discovered that Abbott Labs has a competing product. After that, I provide a soul-searching narrative about my latest irresponsible, self-deluding weight gain, which made me even sicker, precipitating my Mounjaro therapy. Of course, I need to toss in an editorial about how obesity is not a disease for which the only reasonable treatment is with pharmaceuticals. Finally, I will provide an update of my progress on Mounjaro.

It’ll be a long one, but it’s free! You can’t beat that with a stick!

Stelo Update

Last week, I talked about the Stelo biosensor, a continuous glucose monitor-like product from Dexcom that is available over the counter directly from the manufacturer. I couldn’t believe that Dexcom’s major competitor in the diabetes market, Abbott Labs, would allow Dexcom to scoop that market segment. They haven’t, as they are marketing a competitively priced product of similar capabilities, called Lingo. I have not yet explored its capabilities, as I am satisfied with the Stelo, but I have provided links if you wish to make your own comparison. One major issue for me is that Abbott in its dubious wisdom has created an app for the iPhone, but not for Android, which is the platform I use. (Besides, Abbott markets their product as a Lingo “journey” — and you know how I feel about characterizing things as “journeys”.)

Medicare does not cover the cost of continuous glucose monitors for type two diabetics unless they are on insulin or have suffered hypoglycemic episodes. Other insurance companies might have different policies. Furthermore, those covered CGMs require a prescription. The non-prescription Stelo and Lingo devices open fresh territory not only for diabetics, but also for people interested in their metabolic health with no pathology. Everybody can benefit from them for under $100 per month.

Better Than I Thought!

In my prior report, I mentioned that data could not be exported from my Stelo, and the blood glucose history was deficient. That was before I discovered the “Clarity” app from Dexcom, which provides robust reporting and the capability to export a CSV file — exactly what I wanted! Data is stored in the cloud, but I don’t know for how long it is kept.

I have tracked the Stelo against my Contour glucometer. I find that the Stelo reads high by 8-10 mg/dL. However, what I am interested in with the Stelo is gauging the relative effects of what I ingest on my blood sugar. How rapidly the glucose rises and falls is more significant than the absolute values, along with staying in a tight overall range.

One thought on the disparity in readings concerns timing. Because the glucometer measures glucose in the blood, whereas the Stelo measures glucose in the serous fluid, glucose might take more or less time to get to one or the other. Over time, the two methods might well be in closer agreement.

Had I started wearing the Stelo or a similar glucose monitoring device two years ago, I could have avoided the gruesome story you’ll read below.

My Yo-Yo Weight Story, Chapter XXXVIII

I’ve ridden the diet roller coaster for an entire lifetime, almost eight decades. Recently, in 2020, I lost about seventy pounds, and like most chronic yo-yo dieters, I vowed to never pork up again. What made me think I would not break that ridiculous self-promise yet again?

Many of you personally identify with this yo-yo syndrome. In my case, I think I can identify the “why”, but that doesn’t mean it won’t ever happen again with a completely different “why”. The overarching cause is nervous eating, sneaking in carbs, etc., which I cover up with self-delusion. Comfort food does not provide comfort. It causes inflammation and pain. I characterize it instead as an oral fixation, at least in my case.

Between September 2020 and January 2024, I gained forty-eight pounds. The accelerated part of that curve was a thirty-pound pork-up between August 2022 and January 2024. Not coincidentally, in August 2022, I had a bout with diverticulitis and gastritis. After getting those awful ailments under control, my GI doc, who I’ll call Dr. Scrooge, exhorted me to increase my fiber intake. Mind you, I’m not blaming Scrooge here, for it was my implementation of his fiber mandate that was faulty. Instead of healthy vegetables, I took the easy, ultra processed cereal route, as you will see below.

Because of the gastritis, I gave up all forms of alcohol, an abstinence I have maintained straight through. However, I undoubtedly compensated by replacing one ingested form of comfort with another.

Getting My Fiber

My approach to the fiber mandate was shoveling mounds of ultra processed, high-fiber breakfast cereal down my gullet. I discovered that General Mills Fiber One Original is artificially sweetened, so I thought it was a promising idea. Couldn’t hurt, right? (After a while, I came to despise the cloying sucralose sweetening, but hell, I was getting my fiber, wasn’t I?). Whereas a two-thirds cup serving of Fiber One Original provides eighteen grams of fiber, it also nails you with thirty-three grams of carbohydrates. But two-thirds of a cup doesn’t fill a bowl, and more cereal means more fiber, right? Thus, it couldn’t hurt to eat a few bowls per day — more fiber! Yeah, and more carbs, too.

All this with the foreknowledge that I’m a carb-sensitive diabetic. I was oblivious to the danger, because it felt momentarily good to eat the Fiber One crap, which my wife described as “gerbil food.”

Hiding from the Glucometer

I hid from the glucometer and the scale, but A1c tests told me that my average serum glucose was 170 or 180 mg/dL. My blood pressure was elevated, my diabetic neuropathy was keeping me awake at night, and I was miserable. All that misery only made me want more comfort “fiber”.

Look at the ingredients in the “very healthful” Fiber One Original: Whole Grain Wheat, Corn Bran, Modified Wheat Starch, Color Added, Guar Gum, Cellulose Gum, Salt, Baking Soda, Sucralose. 

When General Mills shut down its Fiber One production lines to upgrade them last summer, a shortage ensued. I couldn’t find Fiber One on the shelves anywhere! So, I replaced Fiber One with Cheerios — the original yellow box, not the honey-nut kind. Then, the power of sugar/carb addiction really took hold vigorously. And as I mentioned, I sometimes had two or three bowls per day of the wonderful, inflammation causing grain products, with their sneaky doses of sodium, sugar, preservatives, and guar gum, whatever the hell THAT is! It was easy, load up a bowl, add milk, and bingo! Oral gratification in a box! (Cheerios have no guar gum, but they do add tripotassium phosphate to preserve freshness).

Hyperbolic Pork-Up

The result was that hyperbolic pork-up I mentioned, which I rationalized to my primary care doc, Dr. DeLorean (not his real name), by stating that I was getting my fiber. Dr. Scrooge, my GI doc, who acts like ol’ Ebenezer, but Scrooge is not his real name, either, exhorted me to increase my fiber intake. Yeah, I was rationalizing, kidding myself, but I was not kidding Dr. DeLorean. He upped my blood pressure meds, adding hydrochlorothiazide, and told me that he and I both knew that I could get the diabetes and weight back under control because I had done so before. He knew that I knew that the carbs were the key. Yes, I knew better. But no, I didn’t act better.

Alas, I didn’t heed Dr. DeLorean’s advice. I had been worrying about some incidentally discovered GI issues, which Dr. Scrooge diagnosed in January this year. After fretting over them for a while, shoving down increasingly more comfort food, I found myself entering a destructive thought pattern — hell, if that many things that could kill me, who cares about the diabetes and the weight? Might as well go down stuffing my face and my lifelong obsession with crap food!

Thanks! I needed that!

Fortunately, my pity party did not last. I convinced myself that my self-destructive approach was leading me down into Dante’s inferno, but I was not yet ready to abandon hope. With a crappy lab report in hand, and weight at an uncomfortable peak, I performed a difficult contortionist’s act of putting a foot up my own ass, impelling me to action. And so it was that at the ensuing follow-up visit, Dr. DeLorean and I agreed on Mounjaro for my type 2 diabetes.

This was a serious commitment, as I do not like to throw drugs at health issues that I could treat with self-control and hard work. How many chronic conditions can we treat that way, without resorting to injecting foreign substances into our bodies? This is a silly spiral we’re in, justifying drugs to treat our self-imposed health issues. Yet, there I was, going down the road I and “South Park” had ridiculed.

Obesity is Not a Disease (No Matter What Big Pharma Says)

And that’s my story. I do not feel as if obesity is a disease that requires expensive drugs, although those drugs can be helpful for those who need a crutch. I do feel that the food industry in this country is ridiculously out of control, pandering nutritionally vacuous, ultra processed bags of addictive, health-destroying substances and pushing them onto our plates. Breakfast cereal is a particular scourge. Marketing aimed at our kids, replete with brightly colored cartoon character pimps, hooks them early. The fattening of America is a real thing, caused by the food industry with complicity by the government and the encouragement of Big Pharma. Addict yourself to crap, pork up, and we’ll cure your “disease.”

A Voice of Reason

Dr. Suneel Dhand, one of the rational health commentators on YouTube, recently posited that if doctors in the 1970s had the same “Mr. Fix-It”, procedural attitude as doctors today, instead of telling people to quit smoking, they would have told them to continue, but here’s a once-a-week injection that will fix it for you. Precisely. Conquering smoking addiction was difficult for many people, but those of us (myself included) who knew what was best for us bit the bullet and quit.

Fifty years later, our screwed-up society, which puts personal responsibility at the bottom of the list of priorities and externalized excuses at the top, says we’re so sorry you are “volumetrically challenged” (or some such euphemism), because it is not your fault. But through the miracle of modern pharmacotechnology, we can fix you up! We can develop and subsidize a drug that will help you, you poor, helpless soul!

Victims?

We must not stigmatize fat people, because they are victims, they say. We must treat their unfortunate disease, they say — with high-profit-margin drugs, of course. Denial of responsibility and quick fixes are the American Way in the Twenty-First Century. And if you’re calling it “bullshit”, you’re absolutely right!

Those self-interested advocates promoting obesity as a disease typically cherry-pick studies without following the funding or seeking contrary information. One such YouTube advocate cited “recent” research that poor diet causes insulin resistance which causes basal metabolism to decrease, so therefore, obesity is a disease? Huh? Medical science has long known that yo-yo dieting has that effect. A very few people have a genetic issue that causes obesity, but for most of us, we just eat too much toxic, ultra processed food. Victims? Yes, victims of problems we create for ourselves, although our toxic food environment severely constrains our choices.

Another Specious Argument

Another outcry is that obesity requires pharmaceutical treatment because obesity is the harbinger of many other chronic conditions. This is incontrovertibly true. Well, except for the part suggesting that only pharmacotherapy can treat it. At precisely what point did a reasonable approach to eating, coupled with exercise, improved lifestyle, and psychological counseling fly out the window? Does Big Pharma have us all brainwashed to the extent that we automatically turn to their overpriced drugs? The more expensive, the better? A few months on some of them would pay for a personal trainer, a dietitian, and a counselor.

But one injection per week doesn’t involve much hardship. Even with the high price tag of GLP-1s, they’re an easy sell to a willing market. Finally, a solution that works! Oy vey.

Addicted to Crap?

No, obesity is not a disease, in the same sense that heroin or fentanyl addiction is not a disease. Both recreational drugs and recreational eating of ultra processed foods are scourges on our society, caused by greed and the resulting exploitation of human weakness. Moreover, drug pushers, of both the street-corner and the corporate varieties, encourage us. “I can’t help myself. They put crap in front of me, so I ate it!” The gratuitous weight-loss crowd indulges in the logical fallacy of justifying lack of self-control with externalized victimhood. They cry for institutionalized compensation and correction for the problems they themselves created.

If Less is More, Then More is Better

Now I am hearing rumbling about Eli Lilly testing Zepbound, their weight-loss approved tirzepatide product, at even higher doses than the current maximum of 15 mg. The tirzepitide-addicted weight-loss weenies have rapidly progressed to the current maximum dose, which one “influencer” dubbed “The King”. At present, they have nowhere to turn, at least with respect to on-label use. So, the proposed 20 and 25 mg doses will be like Christmas for those junkies whenever they come to the market. Then, they’ll max out at 25 mg until the next bump-up by Lilly. Will these be “The Emperor” and “The Galactic God”?

And Big Fooda will keep pushing crap to bring more and more fatties into the fold. Yep. We’re an addictive society — addicted to crappy food and addicted to what we perceive as miracle cures, at least until we and our complicit governmental regulators figure out that we’re screwing ourselves up even more.

Want to get a more scientific perspective on the scourge of ultra processed foods and the drugs that we need to fix their effects? Read “Metabolical”, by Dr. Robert Lustig.

My Progress

Doc Follow-Up

I visited Dr. DeLorean last Wedneday for a regular follow-up with a Covid twist. I had done preliminary blood work to check on my Mounjaro progress. As I had predicted based on my copious glucometer readings, the A1c was 5.8. DeLorean congratulated me and noted that I was only one-tenth of a point above his A1c. (He considers himself a paragon of health, a Yoga/running fanatic). I told him to take some Metformin, because he needed to get it down below 5.2.

We discussed Mounjaro dosage, deciding to leave it at 5 mg. The logic there is that we’re dealing with glucose control, not weight loss. I had noted that I hadn’t felt any appetite suppression since about my second week on 2.5 mg, back in June. However, as my doc affirmed, we embarked on this therapy to control glucose, it’s working, and weight loss was always a secondary objective. As DeLorean said, “I’m happy with your blood sugar, and I’ll take the weight loss if it comes.”

Oh well! “The King” will not grant us an audience anytime soon. (That’s how the “influencer” with the backwards baseball cap on YouTube characterized the 15 mg dose of Mounjaro).

No, I Don’t Want to Be on Mounjaro Forever

That is cool, because I don’t want to be on Mounjaro forever, regardless of Eli Lilly’s desire for that to happen. I want to wean myself off it and take charge of my own glucose. Given my history, this is a tough nut to crack, but I want to be taking as few drugs as possible if hard, motivated work can solve my problems. This decision could well be in the hands of my Part D PDP. For 2025, they have removed “Tier 6” from the plan completely, and Mounjaro was in Tier 6. I must wait for October 15, when they release the 2025 formulary, to discover whether they moved Mounjaro to another tier or will not cover it at all. This change probably relates to overprescription and overuse of the drug, coupled with the elimination of the Medicare Part D “Doughnut Hole”.

Glucose

As I mentioned, my lab tested A1c was 5.8, which equates to average blood glucose of 120 mg/dL over a three-month period. During the past week, my average was 114, using the readings from the Stelo.

Blood Pressure

This is a problem, and it might relate to either the aftermath of Covid-19 or my back issues. I have been seeing 140/80 consistently in the morning. I do not want to increase medication, as the issue must be secondary to some other pathology. Interestingly, before embarking on my vacation, I had reduced the medication and was averaging below 120/75. I screwed something up. Rather than throwing pills at it, I want to find the root cause.

Weight

My weight increased by 1.8 pounds during the week, but the baseline 206.6 pounds from a week ago represented precipitous drop during my Covid-19 infection. My appetite has now returned, so I would expect for weight to remain flat. The ten-pound weight loss during Covid was scary, so this is one time in my weight cycle that further weight loss is undesirable, at least for now.

Wrapping It Up

I hope my narcissistic rambling was useful to you in some way. Although Mounjaro is not right for everyone, as the direct-to-consumer advertising mantra goes, it has effectively controlled my glucose thus far. Sharing my experience might provide some ideas for those of you who have similar metabolic issues.

I mentioned two currently available non-prescription wearable glucose sensors. I was happy to see these products because my insurance does not cover the cost of the prescription version, and I could not justify the expense of self-pay. Many people were in the same boat. These sensors will play into an expanding market consisting of people concerned about their metabolic health.

My weight gain/weight loss story should trigger some of you with comparable stories, I hope in a constructive way. It is easy to fall into the trap of rationalization and blame-casting, while sweeping personal responsibility under the proverbial rug.

Finally, I always have an opinion. I present my side of the “obesity is a disease” postulates, which is contrary to much of the politically correct denial of personal responsibility extant today. I know that my position is extremely unpopular, as it puts people in charge of their own lives, a vanishing concept these days. However, the multi-trillion-dollar U. S. health care industry is broken. I cannot fix it, but I can tell you what I think is wrong with it.

Thanks for reading!