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Week 52 Mounjaro Update: Steroid Shot Sparks Spooky Sugar Spike

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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.

Week 51 Mounjaro Update: Wake Up and Smell the Coffee!

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I’m a day late and a dollar or two short this week due to the long holiday weekend. Fortunately, I’m thinking my six readers (well, only four last week) had better things to do on Monday, anyway, so my missing Mounjaro update didn’t cause any separation anxiety. In any case, fear not! The prodigal Turkey returns with another episode of “As the Glucagon Turns” (subtitled “Taking the World in Big GuLPs”).

When I started this series, I just wanted to write about my progress, my trials, and my tribulations on the GLP-1 receptor agonist drug Mounjaro. I have been treating my Type 2 diabetes with Mounjaro for nigh onto a year. As my four regular readers know, I am a 78-year-old male who identifies as male and my pronoun is “who”. If anything, this will classify me as an owl, but anyway, I’ll now recap my accomplishments for new readers.

A Year’s Progress

On Mounjaro, I’ve lowered my HbA1c from 7.6% to 5.3%, eliminating metformin and lowering the dose of losartan (my ARB-inhibitor blood pressure medication). I’ve lost 65 pounds of blubber, cinching in my corpulent waistline from a tight 42″ to a true 36″ (and a cheat 34″). Along with taking the drug via a weekly injection of a 7.5 mg/0.5 ml dose, I have worked hard on resistance training and eating a decent diet. I want to establish revamped behaviors that will serve me from now until I take the eternal celestial dirt nap.

Apart from reporting on my progress and throwing in some information about some of my tools and techniques, I cover subjects relating to Mounjaro, health care, diabetes, and weight loss. My love-hate relationship with Big Pharma and the compromised state of the flawed healthcare system in this country frequently trigger me to vent my spleen through the keyboard. As well, my rants are anathema to YouTube influencers, who serve as mindless cheerleaders and shills for Big Pharma, pushing their products in return for compensation while feigning objectivity for the gullible masses.

This week, before getting to the part where I chronicle my week and present my progress, I’ll write about how coffee spikes my blood sugar in the morning and what that might mean. You might recall that in Week 43, I wrote about some interesting claims that coffee could increase muscle growth. Who knows what the research community will divulge next about the popular pick-me-up?

Rise and Shine: Coffee Awaits

Ever since integrating a Dexcom Stelo into my daily routine, mornings have become a bit more enlightening—or perhaps alarming—particularly regarding my cherished ritual: coffee. Each morning, shortly after my customary cup, a noticeable spike in my blood glucose appears. My curiosity piqued, I delved into the literature to understand this phenomenon better.

Contrary to popular assumptions, it’s not uncommon for coffee—specifically caffeinated coffee—to cause a transient rise in glucose levels. Indeed, the key culprit is caffeine, which acts by stimulating adrenaline release. Adrenaline, in turn, triggers the liver to increase glycogenolysis, thereby releasing glucose into the bloodstream. While this mechanism is fairly well-documented, it generally causes only a mild, temporary increase in blood sugar. However, the extent of this reaction varies among individuals, influenced by factors like insulin sensitivity, overall metabolic health, and perhaps even habitual caffeine intake.

Reduced Insulin Resistance?

The question becomes more intriguing when considering coffee’s broader metabolic impacts. Notably, several studies have highlighted a paradoxical yet beneficial effect: consistent coffee consumption might actually reduce insulin resistance over time. Researchers have suggested multiple mechanisms for this beneficial effect, including the presence of bioactive compounds such as chlorogenic acids and other polyphenols, which have antioxidant properties and may enhance insulin sensitivity.

Chlorogenic acids in coffee may reduce glucose absorption in the intestine and alter gastrointestinal hormone release, thus contributing to improved glucose metabolism. Additionally, coffee’s antioxidant-rich profile is believed to combat inflammation and oxidative stress—two significant contributors to insulin resistance and diabetes progression.

Can Coffee Forestall Diabetes?

Moreover, epidemiological studies consistently indicate that habitual coffee drinkers, especially those consuming 3–4 cups per day, have a lower incidence of type 2 diabetes compared to non-coffee drinkers. A meta-analysis published in “Diabetes Care” found that each additional daily cup of coffee was associated with a 7% reduced risk of developing type 2 diabetes, a significant protective effect.

This complex interplay between coffee’s acute effects on glucose and its chronic benefits on insulin sensitivity underscores the nuanced nature of nutrition science. It seems that the transient morning spike in my glucose readings might be a minor trade-off for coffee’s longer-term metabolic advantages.

In practical terms, awareness of this acute effect can help us make informed decisions—perhaps moderating the timing and quantity of coffee intake or combining it with other dietary elements known to blunt glucose spikes, like fiber or protein-rich foods.

Ultimately, while that immediate post-coffee spike might momentarily trouble my Dexcom readings, the broader evidence supports coffee as a beneficial ally in the ongoing struggle to maintain insulin sensitivity and manage type 2 diabetes effectively.

My Week on Mounjaro

Tuesday and Wednesday were to be doctor visits, but I slept through my Wednesday YAG laser zapping appointment. Tuesday was a follow-up with short-timer Dr. DeLorean. Being a concierge doc, he focused on how good I looked and called me “one of my biggest success stories”, reiterating that an HbA1c of 5.3% represents phenomenal glucose control for a diabetic. “That’s better than mine! We normally try to shoot for less than 7%.” But I quickly moved beyond the grandiose accolades, because I had some serious blood chemistry concerns and a possible inguinal hernia.

Last week, I wrote about a sudden rise in potassium level, which we need to monitor. I also mentioned that after several months of supplementation, iron is coming back to the low end of “normal”. We’ll retest both next month to see where they’re going. As for the hernia, DeLorean forgot to examine it, but referred me to a general surgeon anyway. His office called me while I was driving home. I asked if he wanted me to come back to examine me. They said, “No, from your description, he’s pretty confident that’s what you’re dealing with.” That’s pretty much the way that practice works — if they can’t prescribe a drug for it, farm it out to a specialist to do the dirty work.

Wake Up!

I had to postpone the YAG laser, which was to have been Wednesday. I had been “under the weather” all week and I overslept—right through the 7:30 AM appointment time. In fact, the phone ringing at 8:15 asking “where the hell are you?” from the ophthalmologist’s office served as my wake-up call. So that’s postponed to June 11, the same week as my appointment with the general surgeon to evaluate the hernia.

Today, I get to see a sports med doc about my left knee. It hurts when I am resting, but not when I walk, so who knows? I had an MRI about a year-and-a-half ago that showed it was still in pretty good shape, much better than the other knee.

Isn’t it cool how we spend all our time trying to forestall the deterioration of our bodies as we cross the divide between middle age and OLD? On to this week’s numbers.

Mounjaro Numbers for the Week

Body Weight: 180.8 lbs (82.2 kg) — unchanged
Fasting glucose: 95 mg/dl (5.3 mmol/L) — unchanged
Average glucose (Stelo biosensor): 108 (6 mmol/L) — damn Stelo died on me on Sunday! I requested a new one.

Conclusion: Grounds for Optimism

So, where does that leave me at the end of Week 51? Still at 180.8 pounds, still holding fasting glucose steady at 95, and still poking a needle into my gut every week like it’s just another Tuesday—which, often enough, it is.

This week’s exploration into the metabolic minefield triggered by my innocent morning brew reminds me of an essential truth in diabetes management: context matters. A glucose spike from coffee might seem counterproductive in the short term, but it’s a blip on the broader metabolic radar if the long-term trend points toward improved insulin sensitivity and reduced disease risk. That’s the delicate balancing act we play: minute-by-minute vigilance blended with month-by-month patience.

And patience, dear reader, is a virtue you’ll need in spades if you’re trying to navigate America’s healthcare labyrinth with anything more nuanced than a sinus infection. Case in point: I’ve got one foot in the exam room and the other on the voicemail of a scheduling assistant, just trying to stitch together coherent follow-ups for potassium levels, laser zaps, hernia pokes, and knees with minds of their own.

Not Too Bad

But you know what? At 78, I consider it a small miracle to be able to lift weights six days a week, hike nine miles without serious complaint, and gleefully eviscerate the medical-industrial complex from my keyboard. The GLP-1 ride has delivered far more than I expected when I started out, and with my numbers stabilizing, I now focus less on weight loss and more on what I can do with this leaner, meaner carcass.

Next week marks the official one-year point. I’ll take stock, sip some celebratory (black) coffee, and see if the Dexcom screams or shrugs.

Stay tuned—this turkey isn’t done roasting yet.

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

Week 50 Mounjaro Update: Patient Portal Purgatory

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Welcome back to another edition of Mounjaro updates, industry news, alliteration, and my patently impertinent opinions. Each week, I reveal my experiences with GLP-1 receptor agonist therapy for Type 2 diabetes. At age 78, I’ve been at it for almost a year now, with significantly tangible results, namely lowering my HbA1c from 7.4% to 5.3%, de-prescribing metformin, reducing losartan, my blood pressure medication, from 100 mg per day to 25 mg per day, and shedding 65 pounds of body weight. But I digress.

My personal objectives have evolved from weight loss and glucose reduction to maintenance in both those areas. Muscle loss always accompanies rapid weight loss, so I have amped up my resistance training program while increasing the protein and carbs in my dietary intake. Sarcopenia conspires with the weight loss to cause even more muscle atrophy in older adults, inspiring me to redouble my efforts.

My secondary objective is to discontinue Mounjaro before year-end. The fewer drugs I take, the better. Furthermore, Mounjaro ain’t cheap! Despite being covered by insurance, it costs me about $250 per month. I can think of a wide range of better things to buy with that money. However, quitting is a two-edged sword. The peril is a rebound in glucose and body weight, and the key to avoiding both is to continue the stringent lifestyle changes that got me this far.

Oversharing

I try not to bore you completely with my medical details. You’ve got problems of your own, so you don’t need to spend great gobs of time pondering mine. However, my hope remains that you will gather a modicum of useful information from what I write here. Please remember that I’m not a doctor, so I’m not offering medical advice—just recounting personal experiences and delivering irreverent opinions about the sad state of healthcare in the 21st Century. Surely, you will relate to some of it.

Later, on the mundane personal health front, I’ll share my happily boring weekly numbers and my latest lab results, which include a new low in HbA1c. I’ll recap my one-month honey experiment, which might have impacted those labs. But first, it is time to go off on those healthcare software abominations known as patient portals.

(RD, this one’s for you!)

This Week’s Non-Mounjaro Rant—Patient Portal Purgatory

In this week’s issue, we take a cynical look at the ubiquitous medical software backwater called “patient portals.” You’ve encountered them and you share my frustration with them, no doubt. They’re poorly written, they’re clunky, and they have seen little improvement through the decades. Could it be that the industry doesn’t care about effective communication with patients? Ya think?

I’ve been wasting lots of time on multiple patient portals compiling information for my forthcoming doctor change. When I brought up the subject with my wife, she commiserated with me by sharing her own patient portal tales of woe. She hates getting emails telling her she has a message in her patient portal, which is a pain in the ass to navigate. “The word ‘portal’ suggests a connection to The Twilight Zone,” said Jenny. “I can’t get it out of my head.” I’d say she was onto something—an apt characterization of an other-worldly software usability experience.

Who Wrote That Crap?

A friend who has been involved in engineering projects most of his life recently commiserated on the sad state of patient portal software. He is currently dealing with serious health issues requiring coordination of information among multiple providers. However, the poorly designed, antiquated, user unfriendly interfaces of patient portals make them more of an impediment than a useful tool. “You and I have led projects where such garbage interfaces and shoddy work would have been summarily rejected and would have gotten us fired. Are patient portals designed by committees of kids on skateboards, or what? Who is leading them?” My lamely dismissive response was, “The God of Apathy.”

I sure as hell wish the healthcare industry would actually care, but their aim has long been offering token compliance appeasements instead of useful tools. As long as the insurance companies and the federal government are their funding sources, patients will be relegated to their perceived role as necessary evils who happen to carry the key to the insurance reimbursement castle.

Understandably, patients are dissatisfied with the status quo, which suuuuuuuuuuuuuuuucks. Will patient portals ever fulfill their promise or will they top out disappointingly at “not too bad”? Read on and learn how they arrived at their current nadir of usability, then read our proposed solution. As always, your thoughts and comments are welcome!

The Patient Portal Problem: Healthcare’s Missed Digital Revolution

Introduction

Imagine, if you will, a world born from the luminous haze of the dot-com dawn—a world where the phrase “patient portal” was uttered in a health IT conference room with the hopeful naiveté of a new millennium. The name endured, calcifying into bureaucratic scripture, while time marched on. Now, thirty years later, what was once hailed as digital progress stands ossified—a relic of static screens and unmet promises, preserved in the amber glow of compliance. In this other world, you’re a card-carrying patient with no name and no face, just a date of birth and a password. You have now entered the Patient Portal Zone… [fade to black]

How the Portal Got Its Groove (and Lost It Immediately)

The ostensible original vision? Empower patients! Improve outcomes! Communicate with ease! Those goals would be attainable in a normal, customer-driven industry, but that ain’t healthcare! What we got instead was a clunky login screen, two-factor authentication that works 50% of the time, and a messaging system that might as well be a wax-sealed letter delivered on horseback.

In the early 2000s, the idea of a centralized digital interface for patients was radical. So naturally, healthcare vendors borrowed the word “portal” from the corporate world, where it meant a homepage stuffed with useless links. The branding stuck—because “screwed-up nightmare” was already taken.

Once Meaningful Use regulations, crafted during the Obama administration, began incentivizing the mere existence of patient portals, vendors rushed to ship half-baked, checkbox-satisfying garbage. The result? Software designed by committee, deployed by fiat, and maintained by people who hadn’t logged in since Bush v. Gore.

Glossary of Patient Portal Bullshit

  • Patient Portal: A secure digital environment designed to prevent patients from easily accessing their data while feigning transparency.
  • Secure Message: An email-like function where your doctor’s assistant might reply in 7–10 business days with, “Please call the office.”
  • Visit Summary: A PDF download of your last appointment, formatted like it was generated by a dot matrix printer in 1987.
  • Lab Results: Clinical test values released at 3:27 a.m. with no context, leading you to either WebMD-induced terror or apathy.
  • Appointment Scheduling: A tool that lets you see all the available appointments you can’t actually book without calling.

Why We’re Still Stuck in 1999

  • Healthcare’s Lack of Competition: Patients can’t shop around easily, so providers don’t have to care. Welcome to health don’t-care. If our patient portal is as crappy as the practice’s down the street, it’s “good enough.” A decade ago Healthcare IT News published a report stating that providers often regard portals merely as compliance tools rather than opportunities for meaningful patient engagement. Little has changed since then. The patient experience is worse than ever.
  • Vendor Lock-In: Major portal vendors Epic and Cerner have contracts so long they require parchment scrolls written in cuneiform along with sworn blood oaths. These companies have no incentive for improvement with clients locked into ten-year deals and firmly entrenched Stockholm Syndrome.
  • HIPAA as a Scapegoat: Let’s be clear, mateys—HIPAA isn’t stopping innovation. Banks, brokers, and dating apps all involve web sites that work under strict privacy laws and still manage not to suck. Nevertheless, HIPAA has become a convenient scapegoat for lack of progress on portable electronic records and conveyance of useful patient information in the medical industry.
  • Insurer-First Revenue Models: As long as the claims go through and the pre-auths get denied on time, patient satisfaction can be safely ignored. This relegates patients to their true function: witless, soulless transporters of the all-important insurance card.

The Portal Experience: A Dramatic Reenactment

You receive a cryptic email: “You have a new message from your provider.”

You log in, reset your password, get a 2FA text, fail, try again, and finally enter a digital anteroom with no clear navigation. Poking around through several hits and misses, you strike paydirt: the proudly announced, promised message.

It reads: “Your labs are back.”

You click an obscure button labeled “Labs,” and find a PDF titled “Document-20240507-73612-Final-Final.pdf.”

ALT: 87. AST: 98. BUN: LOL. No context, no interpretation, no joy.

The Fix: If Anyone Actually Cared

  • Design for Users: Start by not treating patients like adversaries with low digital literacy. Try usability testing that includes actual humans.
  • Open APIs and Integration: Let wearables, apps, and smart devices integrate seamlessly. Your CPAP knows more about you than your portal does.
  • Provide Real Messaging Tools: Look, if you can’t respond faster than the Pony Express, maybe don’t call it “messaging.” Send us real, informative emails and text messages through secure channels we regularly use, not perfunctorily vacuous announcements promising more vacuous messages, but only after the right sequence of incantations.
  • Stop Hiding Behind HIPAA: Build secure systems like every other serious digital industry. Patients want access—not a 1982 game of Adventure with no connection to the world beyond. Plugh!

Conclusion: This XYZZY Portal Needs a Bulldozer

Patient portals were supposed to be the digital front doors to modern healthcare. Instead, they’re those rotating glass traps that make you miss the elevator. Token gestures toward engagement aren’t enough. It’s time to raze the cobwebbed ruins and build something functional, frictionless, and maybe—just maybe—actually patient-friendly.

Until then, the portal is probably useful for renewing your prescriptions, given enough lead time. Otherwise, enjoy your secure message. And don’t forget to call the office. Until your next disastrous visit, you are now leaving The Patient Portal Zone.

AI: The Quick Ticket Out

While we’re dealing with old TV shows, how about a quick trip to Fantasy Island, where all dreams are possible and I can share my vision of a useful patient portal of the future. The price of the ticket to the magical island involves a paradigm shift: the healthcare industry must fully embrace artificial intelligence (AI) to enhance the patient experience while reorienting itself toward serving real human patients instead of its sacred bottom line. Clearly, this can only happen on Fantasy Island, but please share my pipe dream of a useful patient portal of the future.

My Dear Friends… Welcome to Fantasy Island

Using currently available AI technology, the industry could easily accomplish the transformation by effecting the following improvements:

  • Enhanced Patient Communication: Current portals typically rely on basic messaging features that leave patients waiting days for responses. Integrating AI-driven chatbots and virtual assistants would offer immediate, 24/7 interaction, dramatically improving response times and patient satisfaction while freeing the human medical staff from the encumbrance of answering routine questions. No more, “Our office is closed for lunch from 12 to 2 and we’re off on Friday. If this is a medical emergency, dial 911. Otherwise, leave a message and we’ll call you back as soon as possible.”
  • Improved Lab Results Interpretation: AI could provide instant, personalized explanations of lab results, contextualizing information based on patient history and current health conditions, making complex medical data understandable and actionable. No more uninterpreted, cryptic PDFs.
  • Dynamic Visit Notes: Rather than static, often jargon-filled notes, AI-powered tools could translate provider notes into clear summaries, highlighting important follow-up actions, medication instructions, and key insights tailored specifically for each patient. No more inscrutable dot matrix printouts.
  • Efficient Appointment Scheduling: AI can revolutionize appointment systems by optimizing scheduling through predictive analytics. AI-driven portals could anticipate patient needs, proactively suggesting timely follow-ups and eliminating wait times caused by traditional back-and-forth communication. No more, “These appointment times are available. Please call us during office hours to book your appointment.”
  • Personalized Health Recommendations: AI integration could continuously analyze patient health data from multiple sources, including wearable devices and prior records, providing personalized health recommendations and preventive care advice directly through the patient portal. This could reveal medical issues long before symptoms would impel you to make an appointment three weeks out.
  • Administrative Streamlining: By automating routine administrative tasks such as filling forms, updating medical histories, and managing prescription renewals, AI could significantly reduce both patient frustration and provider workload, freeing up more resources for actual patient care. (I’ve watched my doctor increase staff while patient service declines—they’re all asses and elbows, and he doesn’t even take insurance! What the hell are all those people doing?)

Beyond Tokenism

Forward-thinking innovators have an enormous opportunity to redefine healthcare communication. However, achieving this vision requires industry leaders to embrace innovation, invest in user-centric technology, and prioritize meaningful patient engagement.

To realize their potential, patient portals must advance beyond mere tokenism. The healthcare industry must adopt a competitive, consumer-focused mindset, recognizing patients as engaged participants rather than passive insurance carriers.

I remain cynical about our possibilities of ever getting on de plane to Fantasy Island.

The Great Honey Experiment

In my Week 45 Update, I revealed my intent to act as a human guinea pig to test an assertion made by one of those diet/nutritional pseudo-experts on YouTube. Supposedly, slurping down a daily tablespoon of raw, unfiltered honey would not create a blood glucose nightmare, even for a diabetic. At the same time, it was going to lower my blood lipids—particularly triglycerides—by altering my gut microbiota. Wouldn’t it be wonderful if it were true? Eat more honey, fix your triglycerides, normalize your blood sugar, and be sweeter than ever! Yep, I was a doubter.

My obviously non-scientific tablespoon-a-day experiment can neither confirm nor deny the claims, but what I can say is that my HbA1c, which represents about three months of glucose impact, did not reflect the increased carbs and sugar intake. It dropped from 5.4% in February to 5.3%. I can also say that my serum triglyceride number was 108 mg/dL, which is the lowest in recent history. On the other hand, despite my frequent, strenuous workouts, “good” cholesterol (HDL), was down to 46 mg/dL. It was 53 mg/dL in February.

So, what gives? I don’t know. My only conclusion is that an occasional tablespoon of honey won’t kill me—but at this point I’m so sick of that sweet stuff that it won’t ever get the chance!

Other Blood Test Revelations

Aside from the honey angle, my blood test revealed an increasing potassium component, which at 5.7 mmol/L is too high. This mild hyperkalemia could represent muscle breakdown from my strenuous workouts with the added issue of my compromised kidneys. My calculated eGFR was 55, putting me squarely in chronic kidney disease stage 3A. This will bear watching, and I promise not to eat any more bananas.

The good news is that my functional iron deficiency first discovered back in October is a bit less concerning now. After not responding very well to elemental iron (Original Feosol), I switched to carbonyl iron supplementation (Feosol Complete). Since I switched, iron binding capacity and saturation levels have slowly rebounded. None of the numbers were out of range, despite donating a pint of my vintage B-negative on March 30. However, they remain at the low end of their respective scales, which means we’ll need to keep an eye on them.

Now, on to my week.

My Week on Mounjaro

It was another sideways week, which is fine with me. Thurday’s lunch involved a Hawaiian steak and a few bites of Jenny’s key lime pie at Hillstone. Nevertheless, on Friday my weight dipped below 180 pounds. This prompted Jenny to ask me when was the last time I saw numbers in the 170s on the scale. “High school,” I replied. “But I had a lot more muscle back then.” I’m not trying to lose any more weight anytime soon, instead concentrating on getting some of that muscle tissue back. Toward that end, my workouts are doing their job—I set a couple of new one-rep maxes this past week.

The Mounjaro Numbers, Already!

Body Weight: 180.4 lbs (82.5 kg) — down a pound
Fasting glucose: 95 mg/dl (5.3 mmol/L) — down slightly
Average glucose (Stelo biosensor): 106 (5.9 mmol/L) — not bad, not bad.

Concluding Thoughts — Still on Mounjaro (for now)

So here we are at the 50-week mark—three protein-shake-fueled seasons of body recomposition, glucose micromanagement, and screaming into the digital void of patient portals. If there’s a theme this week, it’s this: nothing gets better on its own. Not your muscle mass, not your metabolic health, not your iron deficiency, and sure as hell not the software trying to impersonate your healthcare system. As I close in on one year of Mounjaro, my trajectory remains forward—maybe slower and more nuanced, but still forward. The portal may be broken, but my resolve isn’t.

Over the next two weeks I’ll be busy with doctors while hoping to steer clear of their damn patient portals. First, on Tuesday, I’ll have what will likely be my final follow-up with Dr. DeLorean before shifting to the new primary care doc, Dr. Macallan. I will discuss the hyperkalemia and what I believe to be a developing inguinal hernia, which will need repairs. Next week, I have an appointment with a sports med doctor regarding my knee pain, and later, an appointment with the eye doctor for YAG laser zapping to fix cloudiness in my right eye. Three-and-a-half years after cataract surgery, this is a common sequel. Yea, verily, the remainder of May will require my Tesla’s full attention, so it can seamlessly teleport me from doctor to doctor.

A Good Use for the Patient Portal

Toward the end of the month, I will also need to write a nice letter giving notice to Dr. DeLorean of my intent to discontinue his services. The ten-year relationship impels me to magnanimously avoid summarily dismissing his ass with a characteristically snarky letter. However, I am seriously contemplating sending my even-tempered, professionally acceptable letter to him through his bloody annoying, user unfriendly patient portal. Guaranteed non-response!

See you next week, when maybe, just maybe, we’ll hear back from that secure message we sent in February. [Cue Twilight Zone theme music.]

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