Archives for July 2025

Such a Divine Comedy, Already!

A new title? Indeed. We now embark on Peptide Purgatory, a sacred holding pattern somewhere between Big Pharma’s hellish vision of eternal injections and the lean-muscled paradise of metabolic independence. Move over, Dante — there’s a new allegorist in town!

After 58 weeks treating my Type 2 diabetes with Mounjaro—or, if you prefer a more classical structure, seven cycles through the deadly sins of pharmacologic overreach—I’ve decided to stop counting. Weekly numbers were starting to feel like medieval penance: flagellate thyself with syringes, track thine macros, log thine glucose, and await absolution from the Endocrinologist-Inquisitor.

But unlike Dante’s weary soul climbing Mount Purgatorio, I do not seek cleansing by perpetual injection. I have reached the Terrace of Sloth (a.k.a. the drug pickup line at Publix), and I choose to climb out. Mounjaro has done its work—my A1c is down from 7.6% to 5.3%, and I’ve evicted 70 pounds of excess baggage—but the rest is up to me.

Big Pharma would prefer a different script, of course. They preach that obesity is a chronic, relapsing disease, with the sacrament of treatment being monthly copays and eternal syringes. This theological framing justifies lifelong pharmacotherapy while conveniently ignoring our debauched food system, sedentary lifestyles, and the collective national allergy to deadlifting anything heavier than a venti caramel macchiato while curling a chocolate frosted jelly doughnut.

In their gospel, there is no salvation outside of Novo Nordisk and Eli Lilly.

Well, I call blasphemy.

The real sin isn’t in the syringe—it’s in pretending it absolves you from doing the work. In my case, that meant ditching booze (although chronic, erosive gastritis provided the initial strong incentive), cleaning up my food, and embracing resistance training as if my post-arthroplasty hip depended on it—because it kinda does. Strength isn’t vanity. It’s survival. And at 78, I’m not chasing aesthetics; I’m chasing autonomy.

Make no mistake: I’m grateful for the GLP-1s. Mounjaro helped me reorient, recalibrate, and climb out of metabolic limbo. But it also deleted some muscle, delivered a few digestive curses, and dangled seductive lies about “easy weight loss” without consequences.

Now, I’m working toward the summit: discontinuation. I’m down to minimal meds, living leaner, lifting stronger, and eating like someone who reads ingredient labels (scary!). My goal is to be off Mounjaro by year’s end. Why? Because salvation doesn’t come in a box marked “dispense as written.” It comes from playing through pain, tracking your macros, lifting heavy, and keeping your muscle.

But before I descend into this week’s flatline progress report (hint: nothing dramatic, which is the point), let’s make a brief detour through the circles of GLP-1 delusion—where pharma angels promise salvation, but real-world data shows a less heavenly outcome.

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“Miracle Cure”, My Ass: Why the Real Work Still Matters!

You’ve seen the headlines by now. “Game-changing GLP-1s!” “Tirzepatide melts fat!” “Obesity cured!” Cue the violins, champagne, and IPOs. But two recent reports—the JAMA commentary by Lean and Batterham and the Healio real-world outcomes study—just threw some well-needed frigid water on the party. And I, your ever-contrarian Mounjaro user turned metabolic realist, have a few thoughts.

Let’s start with the JAMA piece. Lean and Batterham don’t question that GLP-1 RAs like tirzepatide can improve diabetes, weight, and cardiovascular risk. What they do question is the full-court marketing press to put half the adult population on lifelong injectable medications. Their key points: the long-term risks are still foggy, the trials aren’t designed to assess true disease modification, and the idea that everyone needs to stay on these drugs forever is—surprise!—largely pharma-driven fantasy.

Then there’s the Healio article, which delivers some much-needed real-world perspective. It followed nearly 8,000 adults who took semaglutide or tirzepatide for weight loss (not diabetes), and the results? A respectable 8.7% average weight loss at one year, but only 3.6% for those who bailed out before month three. Half quit before the year was out. The reality? If you don’t stick with it, the weight creeps back. And even if you do stick with it, most users aren’t getting the mega-doses used in the clinical trials—meaning many are seeing disappointing results.

Now, allow me to gently (or not) say: I told you so.

I’ve been on Mounjaro (tirzepatide) for over a year. But unlike the “miracle cure” crowd, I didn’t just stop at the needle. I used it as a tool—an opener—to help recalibrate blood sugar and hunger while I rebuilt the real foundation: strength, muscle, and metabolic integrity. The notion that you can simply melt away weight while lying on the sofa watching old Jane Fonda exercise videos and sipping your protein shake through a straw is seductive, yes. But also, dangerous.

Because here’s the trap no one tells the miracle crowd about: muscle loss.

If you lose 30, 40, 50 pounds without resistance training, you’re not just shrinking your waistline—you’re cannibalizing the very tissue that keeps your metabolism humming. That’s not a win. That’s a deferred collapse. When you rebound—which you will—it will be blubber, not muscle you’re adding. Add in the age-related muscle loss known as sarcopenia and you’ve got some serious, life-threatening problems.

What excites me—and what we should be focusing on—is that GLP-1s may help spare muscle when paired with resistance training and adequate protein. That’s the part I’m genuinely optimistic about. In someone actively lifting, moving, and fueling wisely, these drugs can provide a unique opportunity: reduce visceral fat, preserve or even rebuild lean mass, and unburden the pancreas and kidneys—all without a hypocaloric death spiral.

So no, I’m not dumping on the meds. I’m dumping on the fantasy. The shortcut thinking. The “no effort required” marketing that’s setting up a generation for rebound and sarcopenia. Debilitation in old age is a burden to the individual and society at large.

My protocol? Ditch the protocol. Think critically. Train hard. Track meals. Monitor glucose. Use the drug, don’t become the drug. And above all—keep your muscle.

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My Week on Mounjaro

Our star of last week’s column, Princess Poona of Hyderabad, surprisingly came through for me. Who am I to doubt EnGuide’s polite, cheerful South Asian operative?

Last Monday, I felt the heat of Dante’s Inferno as I wended my way through the fire and brimstone of automated customer service to eventually be connected with Princess Poona in her Indian call center. I was on my last dose of Mounjaro, and after being informed that the next shipment would be delayed, I needed some answers. Well, you can read that saga in last week’s report, but I’m here to tell you now that Poona’s promise to escalate my case was not just a ploy to get me off the phone. I received the shipment on Wednesday. Thanks, Poona!

Today, I’ll finish up my left knee physiotherapy with a final visit with my tennis nut therapist. I can detect no change in the chronic pain just above the kneecap after six weeks of twice-per week sessions. My self-diagnosis is quadriceps tendinopathy, which manifests itself mainly while climbing or descending stairs, or while sitting down or getting up from a seated position. Sitting inactive for a while will cause it to flare up. However, I can tolerate stationary biking or treadmill walking for 45 minutes without significant pain. I have arranged a July 25 follow-up appointment with the sports med doc to see whether she can amplify on my self-diagnosis and suggest any brilliant, non-surgical interventions.

The Mounjaro Numbers, Already!

My numbers have stabilized. Fasting glucose is 10 mg/dL higher than my long-term target, which I attribute to dietary changes. My paradigm shift from weight loss to regaining lost skeletal muscle ditched the strict low carb, low calorie approach in favor of increased protein and a calorie surplus. I have continued to lose subcutaneous fat as is evidenced by the prominence of veins in my extremities — veins that were long buried under a blanket of lard. The phlebotomists at the blood bank and Quest Labs are grateful.

• Weight: 174.6 lbs — the nominal 175 plateau.
• Fasting Glucose: 105 mg/dL — up 5.
• Stelo Overall Average: 101 mg/dL — down 5.

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Thread Count: One Less Needle, One More Rep

So there you have it: the gospel according to Big Pharma, rebutted by real-world data, Dante, and one cranky 78-year-old who lifts more than most people half his age.

The miracle-cure crowd will keep preaching pharmacological salvation. Influencers will keep selling their soul (and discount codes) for GLP-1s. And the medical-industrial complex will keep whispering that you’re broken, chronic, and helpless without their weekly miracle.

But some of us will keep grinding—tracking meals, moving iron, growing glutes, and protecting every ounce of lean mass like it’s gold bullion. Because it is.

This week? No dramatic shifts. No weight swings. Just another notch in the belt of consistency. The kind that doesn’t make headlines—but does make independence possible.

Next week: any insights gleaned by my PT evaluation, and possibly more on Poona, EnGuide, and the fine art of international peptide procurement. Bring popcorn. And creatine.

Until then:
Lift. Eat. Track. Think. Don’t let the drug do all the talking.

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For an annotated catalog of all my Mounjaro updates, please visit my Mounjaro Update Catalog page.

Welcome to the ongoing chronicle of my Type 2 diabetes treatment with the GLP-1 receptor agonist drug Mounjaro. While tracking my progress is pretty boring at this point, I like to pepper my personal stew with current news about GLP-1 RAs. I also share my experiences navigating our flawed healthcare system, a source of chronic frustration all my dear readers have experienced.

To recap my progress, at age 78 I have reduced my HbA1c to 5.3% and lost seventy pounds of blubber in just over one year on Mounjaro. Concomitantly, I’ve amped up my exercise program, particularly in strength building workouts, and I carefully watch my diet. I’ve adopted a low-carb/high protein, now with increased daily caloric intake approach to maintain my current weight. My aim is to maintain these for life, even after I ditch the Mounjaro, which I hope I can do before the end of this year.

I’ll start with this morning’s PBM frustration. My Mounjaro shipment was delayed, so I got on the phone with my supplier’s customer service in India. My experience with the polite purveyor of the corporate credo follows.

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EnGuide Me, O Thou Great Algorithm (Part II: Now With Fewer Expectations)

Back in Week 55, I voiced concern that Express Scripts’ decision to offload my Mounjaro prescription to a mysterious new entity called EnGuide might lead to chaos. “They claim this will improve things,” I wrote. “We’ll see.” Well folks, we’ve seen.

After the transfer supposedly occurred on June 15, I placed my usual refill order around June 23, right on schedule. What followed was two weeks of staring at the Express Scripts app, which assured me my order was “PROCESSING.” Not “Shipped.” Not “Delayed.” Just stuck in digital purgatory, like a soul waiting for tech support from Saint Peter’s call center.

Then came the text message—like a kiss-off from a ghosted Tinder date—saying the order was delayed and that it might arrive within seven business days of whenever they eventually ship it. You know, sometime between now and the collapse of Western civilization. Which is helpful, since I had just used my last dose.

“I am not bamboozling you, Sir.”

Naturally, I followed their suggestion to call if I had “any problems.” (Spoiler: I had one.) After battling their outsourced voice assistant—who I think was trained using transcripts from prank calls—I finally reached a real person. Let’s call her “Poona,” since I didn’t catch the actual name and EnGuide isn’t big on transparency.

Poona informed me that my order was… wait for it… delayed. Upon further questioning, she admitted they didn’t even receive the prescription from Express Scripts until June 29. That’s a full two weeks after the alleged transition. So the system that had claimed to be “processing” my order was in fact a Potemkin interface clicking along with all the sincerity of a Hallmark card printed in a war zone.

When I pressed for an explanation, Poona said the transfer had created some “technical hiccups.” That’s one way to describe catastrophic backend dysfunction. She then offered to connect me with one of their pharmacists to discuss my dosage—as if that would produce medication out of thin air. I declined, explaining that my doctor manages my dosing, and what I actually needed was a box with a tracking number on it.

We Suggest You Use a Local Pharmacy

That’s when Poona helpfully suggested I get a fill at a local pharmacy. Right. Because nothing screams efficient care like rewriting prescriptions mid-cycle to accommodate your tech fail. I reminded her that they are, in fact, my mail-order pharmacy—and that their job, shockingly, is to mail the order.

She promised to escalate my case and assured me that I’d probably get it this week. Because nothing builds trust like conditional delivery of essential medication.

I asked about my next refill, since I’ll be traveling in August and prefer not to be held hostage by supply chain roulette. She said I can reorder on July 20, but Dr. DeLorean will need to send a fresh script. I’ve put in that request, fully aware that the odds of a smooth transaction are on par with winning Powerball while being hit by a meteor.

The Bottomless Line

And then Poona gave me the real punchline: she assured me that the rough patch of this transition is now behind us and that “things will go more smoothly in the future.” Will they, Poona? Will they really? Or will my next refill involve a customer service scavenger hunt through three continents and a warehouse run by Rube Goldberg?

Place your bets.

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“Alexa, Fix My A1c”

Ladies and gentlemen, in the latest episode of Your Tax Dollars at Work, a team of researchers in South Korea has discovered that talking to a smart speaker—yes, that Alexa you’ve been yelling at for years—can actually improve blood sugar and reduce depression in older adults with Type 2 diabetes.

This is not a joke. Well, not entirely.

In a randomized clinical trial, participants over 60 were given voice-activated speakers programmed with diabetes self-care prompts. These weren’t just fancy kitchen timers or music players—no, they were equipped to spew out diabetes education modules, daily self-monitoring reminders, and affirmations like, “You’ve got this, even if your pancreas doesn’t.”

“Alexa, Fix My Brain”

Over six months, the folks who interacted with these peppy plastic sugar-coaches saw improvements in both HbA1c and mental health scores. The control group, who got standard care without the dulcet tones of their new AI friend, didn’t do quite as well.

The researchers speculate that the speaker worked as a “digital companion,” improving routine and mood. In other words, Alexa became the nagging spouse some of us never had, or maybe already have. One that doesn’t forget anniversaries, misplace the car keys, or tell you, “You don’t need to check your sugar right now—you just had a cookie!”

Now, before you rush to Best Buy to get your very own glycemic echo chamber, let’s be clear: the study was small, short-term, and limited to participants who were willing and able to learn how to use the device. So if you routinely yell “HELLO COMPUTER” like Scotty in Star Trek IV, this might not be your jam.

The Future is Now

Still, it raises some interesting possibilities. Could Alexa one day administer your insulin, reorder your Mounjaro from EnGuide (insert sarcasm here), or offer real-time shaming when you reach for the Ben & Jerry’s?

Imagine:

“Alexa, what’s my glucose level?”
“Judging by that donut you just inhaled, I’d say… high.”

“Alexa, what’s the weather?”
“Clear skies. A perfect day for a walk. Just saying.”

We’re living in strange times, folks. If someone had told me a decade ago that managing diabetes would involve injecting $1,000 hormones and chatting with a hockey puck on the kitchen counter, I’d have asked what they were smoking—and whether it was covered by Medicare.

But here we are. Stay tuned. Siri might be next.

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My Mounjaro Week by the Numbers

• Weight: 173.8 lbs — steady as she goes.
• Fasting Glucose: 100 mg/dL — down from 106.
• Stelo Overall Average: 106 mg/dL — about the same.

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Humans Optional

So this week, I was guided—misguided, perhaps—by Poona, the outsourced oracle of EnGuide, and soothed by the dulcet tones of Alexa, my imaginary pancreas whisperer. One delivered a placebo of platitudes while failing to deliver actual medicine. The other delivered imaginary empathy while pretending to be helpful.

It’s clear the future of diabetes care is here: voice-activated robots and labyrinthine mail-order supply chains. One tells you your order is delayed because your order is delayed. The other tells you to breathe deeply and visualize an HbA1c of 6.5%.

At this point, I can’t decide who’s more reassuring: Poona with her escalations and probable shipments, or Alexa with her sugar-shaming weather reports.

Either way, we’re all just one software update away from being told:
“We care deeply about your health. Now please hold.”

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For an annotated catalog of all my Mounjaro updates, please visit my Mounjaro Update Catalog page.