First Anniversary Edition!
Welcome to my weekly update, a place where you can take advantage of my firsthand experience with the Type 2 diabetes drug Mounjaro. Having been on Mounjaro therapy for a year now, I have enjoyed sharing lots of valuable information about GLP-1 receptor agonist drugs like Mounjaro (tirzepatide). Apart from Mounjaro, I also offer irreverent opinions about Big Pharma, the sad state of healthcare these days, and YouTube influencer disinformation sources.
I’m not a doctor, just a geriatric Mark Twain wannabe, so take any advice I offer with a grain of kosher salt. Do yourself a favor — do your own research. If you find this subject as intriguing as I do, you’ll be rewarded.
A Year on Mounjaro
You’ll note that I have ditched the old image of the moon rising over Mt. Kilimanjaro, which was a meaningless tribute to Facebook’s penchant for disallowing previous posts where I used an image of a Mounjaro injector. The crude and arbitrary Facebook spam detection bots condemned my posts accusing me of capitalizing on the popularity of GLP-1 drugs. The current image is suitably generic yet more relevant than the mooning mountains, so let’s see how that goes.
This 78-year-old Type 2 diabetic is in much better shape than when I initiated Mounjaro in June 2024. First at the 2.5 mg dose, I slowly amped it up to 5.0 mg and then 7.5 mg injected weekly, a dose I will likely not increase. Although the hunger suppression feature has faded, weight loss is no longer a goal. However, Mounjaro is still providing excellent glucose control. My HbA1c dropped from 7.4% to 5.3%, with fasting glucose now in the low 90s (except for a blip I write about below). I shed 70 pounds of blubber, facilitated by a low-carb dietary approach coupled with a stringent strength training program. My excellent progress on Mounjaro enabled me to de-prescribe metformin and cut my blood pressure medication in half.
I’ll remind you that this is not a damn “journey”, the trite characterization I avoid for good reason. It’s hard work, and slacking off was never an option. I try to impress that point on anyone who wishes to approach GLP-1 RA therapy.
Mounjaro is Not Magic
Given all the media coverage, the direct-to-consumer advertising by Big Pharma, and the inane YouTube, Instagram, and TikTok cheerleading channels dedicated to GLP-1 RAs, people might get the impression that these drugs are magic elixirs. I want to dispel the notion that they can sit on their asses eating doughnuts while losing hundreds of pounds and buying their way to a miracle cure for Type 2 diabetes and obesity. Without commitment to decent nutrition and punishing exercise, the only thing that will be permanently lighter will be their bank accounts. They might temporarily lose a few pounds and see some improvement in the numbers, but they’re not fixing what needs fixing—the behavior that landed them in the diabetic predicament. If they don’t intend to go all in, they might as well remain on the couch drinking beer and eating potato chips.
Adjusted Goals
Fortunately, my success story is not unique. Thousands of similar stories exist; all involve persistence and commitment. Let nothing here imply that my work is finished; I can never sit back and relax (with a donut or two). I will need to be especially careful once I discontinue Mounjaro.
Although my goals have shifted, the lifestyle changes must continue for the rest of my days. My current goal is to preserve or increase skeletal muscle mass, which would be difficult if I continue to lose weight. It is hard enough for an near octogenarian to avert sarcopenia, let alone build muscle. Therefore, I have adjusted my dietary protein and caloric intake upward, and I am increasing carbs. My secondary goal is to discontinue Mounjaro, with a target of year-end. Otherwise, I am in maintenance mode: preserved strength, continued excellent glucose control, and stable body weight.
Writing about one full year’s experience with Mounjaro has produced a treasure trove of compelling information for those embarking on GLP-1 RA therapy. I’ve covered much more than the drug and its side-effects, with subjects ranging from useful monitoring equipment to dietary revelations, from healthcare triumphs to shared laughs over the vagaries of the system and the odd characters comprising my healthcare team. If you have some spare time and a sense of curiosity about Mounjaro and its sister drugs, Ozempic, Wegovy, and Zepbound, please peruse my catalog of past updates.
Please note: This blog is not “monetized.” I write for the joy of writing, which is my only incentive.
In This Issue…
This week’s feature article materialized due to a surprise mid-week glucose spike. Because I routinely monitor my blood sugar, both through my Dexcom Stelo biosensor (a device like a continuous glucose monitor) and a traditional finger-stick Contour Next One glucometer, I can typically predict my glucose response curve. But last Tuesday’s sudden elevation defied explanation—until it didn’t. I quickly added two and two, got five, then did some digging to confirm my suspicions. Read about it below.
The Circle of Strife: Steroids, Sugar, and Serendipity (Epilogue Edition)
This week brought an uninvited guest to my otherwise well-behaved glucose profile: a 40 mg triamcinolone injection. Wait, what? Delivered to my perpetually irascible left knee (the “good” one) by the sports med doc under ultrasound guidance, its design was to break the pain cycle so I could rehab it with relatively pain-free PT. While the knee appreciated the gesture, my blood sugar most certainly did not. Within hours, my Stelo biosensor (installed earlier that evening) threw up a reading of 170 mg/dL. Suspicious of a fresh sensor’s tendency to fabricate reality, I confirmed with a finger stick: 197 mg/dL. Being reasonably well controlled until now, that’s not a spike — that’s an erupting glucose volcano!
I recalled that corticosteroids (for example, Prednisone, taken by mouth) can increase blood glucose. However, the famous Dr. DeLorean (not his real name) once told me that cortisone injected in the knee would not produce that same glucose elevating effect. As my story unfolds, you’ll see that was bullshit. I lay out the facts below.
While local in intent, injected steroids often go global in effect. Their MO includes amping up hepatic gluconeogenesis and reducing insulin sensitivity — the metabolic equivalent of cutting the brake lines while greasing the brake pads just to be sure. Cutesy metaphors aside, impelled by the alarmingly unexpected spike alert from the Stelo, I sought countermeasures.
Enter the ghost of therapies past: metformin, which I’d discontinued last November after Mounjaro had taken the glucose control reins.
Metformin to the Rescue
It turns out that not only could metformin have blunted the steroid-induced glucose surge, but a recent Australian study also links it to reduced knee pain in diabetic and obese patients. (See JAMA graphic on the right). In other words, the drug I had stopped might have eliminated the need for the injection that caused the glucose spike it could have treated. Metabolic karma! Who knew?
Conveniently, due to clerical ineptitude from the fabled Dr. DeLorean’s office, my old metformin script was never canceled. A fresh bottle had recently arrived on my doorstep courtesy of my much vilified, revenue-hungry PBM. So I took action: 500 mg that night, 500 mg the next morning, and 500 mg that evening for good measure. Encouraged by more reasonable glucose measurements, I stopped after that, as I did not want to press my luck with metformin-induced diarrhea.
Normogluteability Restoration Protocol
I dubbed this my normogluteability restoration protocol, my latest pseudo-medical neologism. (Bullshit, by any other name, would smell as sweet…). As my research predicted, by Friday morning, I was approaching my version of normal. Glucose excursions had returned to their pre-steroid baselines: my usual morning coffee bump settled around 140 mg/dL, and postprandial readings remained tame. Stelo and Contour Next One readings agreed. Time and metformin were the victors in this metabolic tug-o-war.
So, for anyone following along in these grand Mounjaro chronicles: yes, steroid injections can spike your glucose, even if they’re aimed at your knee and not your pancreas. And yes, metformin can serve as a short-term countermeasure, even after months off-duty. And finally, yes, the American healthcare system will still ship you drugs you’re not taking, occasionally serendipitously.
I sent an informative description of my research to my sports med doc via her Almighty Patient Portal (see Week 50). Although I prefaced my comments with “no reply is necessary”, I am hoping that these revelations will remind her to brief other diabetic patients about the potential glucose spike after steroid injections. Of course, her typical patients are NBA players for the local team, so she probably doesn’t see many diabetic old farts like me.
Next week: either back to smooth sailing, or another installment of “As the Beta Cells Turn.” For now, if you’re curious about the mechanism by which injected corticosteroids can affect blood glucose, read the next section. It is a detailed, technical description of the process. Afterwards, we’ll wrap up the week with a look at my slightly wild numbers.
Sidebar: How Steroid Injections Spike Blood Glucose
Corticosteroids are synthetic analogs of cortisol, a hormone naturally produced by the adrenal cortex. Their anti-inflammatory power is why they’re routinely injected into joints like knees, hips, and shoulders. However, even when administered locally, many corticosteroids enter systemic circulation — and their influence extends far beyond the target tissue. Triamcinolone acetonide, the specific steroid used in this case, is a long-acting, potent glucocorticoid that readily diffuses into the bloodstream, exerting effects throughout the body for several days.
Once in circulation, triamcinolone binds to glucocorticoid receptors in liver and muscle cells. In the liver, this binding upregulates genes involved in gluconeogenesis, the process of generating glucose from non-carbohydrate substrates like amino acids and lactate. The net result is a sharp increase in hepatic glucose output, even in the absence of food intake. In a person with diabetes or glucose intolerance, this additional hepatic glucose is poorly countered by insulin, leading to acute hyperglycemia.
Impaired Insulin Signaling
Meanwhile, in skeletal muscle and adipose tissue, corticosteroids impair insulin signaling, decreasing the efficiency of glucose uptake. This occurs through a post-receptor defect that alters the translocation of GLUT-4 glucose transporters to the cell surface. Less glucose enters muscle and fat cells, and more remains in the bloodstream. This steroid-induced insulin resistance compounds the problem initiated by increased gluconeogenesis.
Importantly, the dose and pharmacokinetics of the steroid influence the magnitude and duration of the glucose spike. Triamcinolone acetonide, especially at 40 mg, has a half-life of several days and tends to peak systemically within 24 hours of injection. While it is often described as “local,” pharmacokinetic studies show measurable systemic absorption, even when injected into a single joint. Blood glucose typically rises within hours and may remain elevated for three to seven days depending on patient-specific factors like muscle mass, insulin sensitivity, and concurrent medications.
Predictable Response
This glucose spike is especially relevant for patients who are otherwise tightly controlled on GLP-1 receptor agonists or lifestyle measures. Because these patients typically exhibit low baseline glucose variability, a steroid-induced elevation can appear disproportionately large — and disconcerting. It’s not a treatment failure; it’s a predictable pharmacologic response. The spike is temporary, but clinicians and patients should be aware of its potential to confound glucose monitoring or suggest false deterioration of diabetes control.
Finally, in high-risk individuals or those with prior poor glucose control, temporary strategies such as short-term reinitiation of metformin or tighter dietary monitoring can help blunt the hyperglycemic effect. While rare, cases of steroid-induced hyperglycemic crisis or steroid-exacerbated diabetes have been documented in the literature. For most, though, the effect is transient and self-limited, provided no additional systemic steroids are introduced.
My Week on Mounjaro
Above, I referred to my Tuesday knee evaluation. My “good” knee has been giving me pain when climbing or descending stairs, but not while walking, even for long distances. I decided to see the sports med doc about it. After viewing MRI results from last year and Tuesday’s fresh X-rays, she gave me some options, which included my ultimate choice: a steroid injection to provide short-term relief, breaking the pain cycle, plus a course of physical therapy. Another alternative is the hyaluronic acid injection which lasts longer for some people, but doesn’t work as well for others. I rejected that path for now. And, of course, I’ve been trying to avoid knee replacement surgery at all cost.
On Wednesday morning, I donated a pint of my finest B- borscht for anyone who needs the rare type. I figured that the increased glucose would give them a hyperglycemic energy boost to accelerate fixing whatever necessitated the transfusion. Pre-donation qualification by the blood bank revealed that my iron isn’t in bad shape, so it is responding to the Feosol Complete supplementation. I’m pleased to report that my hemoglobin clocked in at 14.0 g/dL.
I had a decent deadlift day on Thursday, followed by a Korean lunch. However, I felt a little off for Friday’s gym session. The exercise physiologist, who had last seen me a week before, noted that I looked like I had lost weight. As you’ll see below, I had indeed shed several pounds. My lack of energy continued on Saturday, so I skipped the home workout, but inspired by Jenny’s deadlifts, I resumed upper body work on Sunday. Nevertheless, my energy deficit, coupled with an unexplained weight loss, remains troubling. Something ain’t right!
The Mounjaro Numbers, Already!
My temporary glucose excursion resulting from the steroid injection, albeit somewhat muted by metformin, is evident in the readings below.
Body weight: 175.6 lbs (79.8 kg) — down 4.6 lbs (2.1 kg) an alarming loss with no explanation
Average fasting glucose: 110 mg/dl (6.1 mmol/L) — out of range the morning after the shot
Average overall glucose (Stelo biosensor): 123 (6.8 mmol/L) — elevated, due to temporary effects of corticosteroid.
Starting a New Year on Mounjaro
This week should be relaxing. I hope to shake whatever is sapping my energy and I hope to not lose any more weight, to avoid freaking Jenny out. (She is worried that I will soon weigh less than she does, but I digress). I’ll be seeing my favorite PT (physical torturer) for the knee rehab evaluation on Wednesday morning, the only quasi-medical appointment for the week, leading into next week’s healthcare triple-header of a hernia evaluation on Monday, a renal ultrasound on Tuesday and a YAG laser eye-zap on Wednesday. (Throw in the YAG laser follow-up appointment on Thursday and we’ve got every day covered except Friday the Thirteenth).
Reflections at the One-Year Mark
So here we are — one full year of Mounjaro therapy in the rear-view mirror, and it’s been anything but dull. I’ve been poked, prodded, scanned, injected, monitored, and data-logged like a diabetic lab rat with a Fitbit. But through it all, the numbers don’t lie: HbA1c, weight, blood pressure, glucose variability — all dramatically improved. That’s not the magic of a weekly injection. That’s the product of a disciplined, occasionally deranged, commitment to better health.
Still, this week’s detour via steroid-induced glucose chaos was a helpful reminder: diabetes doesn’t sleep, and pharmacologic surprises lurk behind every well-intentioned procedure. It also reminded me that old tools (like metformin) can still have a role to play, even when your primary therapy is humming along nicely. The moral? Stay flexible, stay curious, and keep a few metabolic tricks up your sleeve.
Looking Ahead
As I embark on Year Two, my goals are shifting — not because I’m done, but because diabetes management evolves. I’m focused now on preserving muscle, maintaining metabolic stability, and gradually weaning off Mounjaro. If that proves feasible, great. If not, it won’t be for lack of effort. Either way, I’ll keep showing up at the gym, eating like a man who reads nutrition labels for fun, and poking my fingers when the Stelo gets suspicious.
Thanks for sticking around through 52 weeks of sarcasm, science, and blood sugar psychodrama. If you’ve learned anything from my misadventures, great. If not, at least I hope you were entertained. Stay tuned for Week 53 — who knows what body part will rebel next?
For an annotated catalog of all my Mounjaro updates, please visit my Mounjaro Update Catalog page.
