Bet Your Bottom Dollar

Although the title for this series of blog posts relates to my experience with Mounjaro pharmacotherapy, I cover the broader subject of my comprehensive approach to type two diabetes management. I’ll tell you what I have been doing to improve my situation after a recap of how I got here and at what cost.

One day this past spring, I woke up and told myself that I was doing things all wrong. Ignoring the well known fact that I’m carbohydrate sensitive and insulin resistant, my diet was crappy and I settled into a sedentary lifestyle. I was out of control. I knew what I was doing to myself, but I kept on doing it.

Out of Control

At age 77, I was looking at fasting glucose measurements of 150-160 mg/dL (8.3 – 8.9 mmol/L) each morning and my HbA1c was at 7.6% (60 mmol/mol). I needed major changes to avert a life-ending train wreck. Although my philosophy has always been to avoid drugs as much as possible, I researched GLP-1 and SGLT-1 drugs, which are all the modern rage, thanks to Big Pharma’s profuse marketing campaigns. I read several papers in medical journals, which convinced me to narrow down my choice to Mounjaro. With the concurrence of my doctor, I initiated Mounjaro therapy in June 2024.

My results have been excellent. The drug is a crutch, alright, but I would prefer to consider it a jump start. My diet/exercise battery was dead, so I needed something that would get my metabolic engine running again. Eventually, I want to disconnect the jumper cables and run this thing on my own. Mounjaro has enabled me to make significant progress on glucose control while I remodel my diet and ramp up my exercise program. I exercise daily and eat a low-carb diet, the combination of which has enabled me to shed over fifty pounds (>23 kg) along the way.

At What Cost?

None of this is cheap. Although Mounjaro is covered by my Medicare Part D drug coverage, my insurer places it in a cost-sharing tier, so if I remain on Mounjaro during the entire year 2025, it’s going to cost me $2,000. Other lifestyle adjustments are less expensive. Despite my bad back, I joined the wellness program at a local rehab and signed up for some personal training with the exercise physiologist. I do three days per week at the gym. I have purchased a decent collection of exercise and resistance training equipment for home use as well, for the non-gym days. Finally, eating real food is more expensive and time consuming than eating crap. Instead of getting all my calories for a day from a submarine sandwich and a bag of potato chips, I now cook all my meals from scratch.

If Mounjaro and all the lifestyle adjustments do what I want it them to do for me, they are well worth the money. I’m getting close to my HbA1c target 0f 5.2% (33 mmol/mol). If I can maintain that level for a decent period (six months to a year) I will need to get together with Dr. DeLorean (not his real name) to figure out an exit plan from Mounjaro that will avert the oft-reported “rebound effect”. Meanwhile, I hope I can stay in the diet and exercise groove, which I want to continue until I take the proverbial eternal celestial dirt nap.

Do I Truly Need Mounjaro?

Could I have accomplished this objective without Mounjaro? Perhaps, because I have lost weight and got my HbA1c down to 5.3% (34 mmol/mol) in the past. Unfortunately, I did not stick with the program. I could blame Covid-19 lockdowns, but I live in Florida. Besides, I had nothing better to do during the Covid time than to lose weight. I lost seventy pounds (32 kg) in 2020 and 2021, then slowly gained much of it back from 2022 to 2024. Yo-yo cycles have long defined my life. I figured that this would be my last chance so, to use a well-worn poker metaphor, I went all in.

While Big Pharma has convinced the ever-expanding weight-loss community that GLP-1 drugs such as Zepbound and Wegovy are magical, pharmacological cures for their invented “disease” of obesity, their object is to create lifelong reliance on their highly profitable products. The marketeers of Eli Lilly & Company and Novo Nordisk A/S, aided by doctors, medical journals, and medical societies they have “sponsored”, have convinced the children of Hamlin to follow them into the mountains, knowing that magic sells. Most fat people wouldn’t be fat unless they were defective in their approach to diet and exercise, so Big Pharma’s marketing plays into their inability to shed pounds the old-fashioned way. I want to do better, and I want to ultimately escape their iron grasp, replacing perceived magic with hard work.

Budweiser or Miller High Life?

It is time for me to wrap up this stream of consciousness with a personal anecdote. In the vacuous social media weight-loss milieu, an acronym, “NSV”, describes observed intangible benefits of one’s progress toward the deporking goals. NSV stands for “Non-Scale Victory”. Tonight, I experienced an NSV. My wife noted that due to my diet and exercise programs I am developing defined abdominal muscles. She said, “Soon, you’ll have a six-pack!” My response was, “Developing a six-pack? Hell, I’ve got the whole keg!” I have always been hard on myself. Although I have made good progress, I’m not seeing what she’s seeing!

My Week on Mounjaro

The past week was quite stable. Morning glucose was 92.4 mg/dL (5.13 mmol/L) and overall average glucose was 100 mg/dL (5.56 mmol/L). I had a spike to about 160 mg/dL (8.89 mmol/L) after lunch on Thursday, when I diverged from the plan to eat some bread.

I have noted that not eating after Eight PM tends to keep my morning “fasting” glucose lower, so I’ll be more diligent in observing that self-imposed policy going forward. No midnight snacks for this fatso!

My weight remained flat for the week, like the belly Jenny thinks I have. This is a reasonable weight to maintain for a while. In prior columns, I have mentioned the deleterious effects of losing too much weight too fast, and I’ve already done that. I would like to lose about thirty more pounds, but not at the expense of my further compromising dwindling, senior muscle mass. Weight loss has always been a secondary or tertiary goal, which I am not pushing. I certainly do not wish to chase ever-increasing doses of Mounjaro to accomplish it.

Are We Having Fun Yet?

That’s all for this week. This coming week I’ll have the EMG and nerve conduction study to determine the cause of my left thigh numbness and pain. Despite the pain, I’ll hit the gym for an hour-and-a-half Monday, Wednesday, and Friday, and I’ll do my daily home resistance training and stretching. I tend to get obsessed with these things, you know.

Over Half a Year on this Expensive Crap

So, yeah, I’m being irreverent again. I’m calling the magic potion that has helped so many people and saved so many lives “expensive crap.” However, I am trying to maintain my perspective. This is a foreign substance I’m injecting into my subcutaneous fat weekly, one which has no business being there. My aim is to accomplish my objectives, then taper off the stuff and hope that I am not locked into an addiction cycle I cannot break. That is why I do not regard Mounjaro as my almighty savior. Instead, it is a high-priced prostitute, pimped by Big Pharma, to whom I am paying big bucks, knowing that my momentary good feelings come at the risk of some serious long-term consequences. Let’s hope nothing falls off!

While I am still making progress, I will persevere with Mounjaro. What I fear the most is when the time comes to taper off, a rebound effect will reverse my gains. I hope I can avert that disaster by making permanent changes to my dietary and exercise regimens in the meantime. I will have lost a bunch of weight, and with rapid weight loss comes depletion of muscle mass, which in turn lowers metabolic rate. The reduced metabolism causes one to gain weight while eating less, and fear of gaining weight is what drives many people to become addicted to GLP-1 drugs such as Mounjaro, Ozempic, Wegovy, and Zepbound.

In Big Pharma’s Grasp?

Being realistic, I do not have many years left on this planet. I would prefer not to spend my remaining days as slave to pharmaceutical products. When I think of the many people who would do anything to get their next fix of one of the GLP-1s, it makes me sick. Losing weight they have been unable to lose in the past is a powerful addiction enabler, and fear of the process reversing itself keeps them addicted. But for me, my desire is to take as few drugs as possible. Mounjaro is one of four drugs I’m taking since Dr. DeLorean (not his real name) took me off metformin. Next, I would like to get off Lipitor, but I’m not sure that I can. I’ve been taking statins for about the past quarter century.

This week, I’m a little late in getting this update out to you because of several commitments on Monday. One such commitment is my long-awaited visit with a physiatrist (physical therapy and rehab doctor), which I’ll report on below. The impetus for seeing him, as you may recall, stemmed from my back issues, which flared up during my August/September vacation. I have been performing physical therapy for strengthening core and stretching back-related muscles, which has produced decent results, but I have a lingering issue with numbness and burning in my right thigh, which suggests either meralgia paresthetica or nerve root compression stemming from my lumbar spine issues.

My goal with the back problems does not involve a complete cure. I just want to be able to comfortably hike for 7-10 miles at least once per week. A subgoal is avoiding surgery. In the past three weeks, I have hiked 8+ miles twice and then 6+ miles last week. The first two hikes were comfortably within my back’s capabilities. However, I had a setback on the most recent hike, as Jenny can lay witness. The last three-quarters of a mile was painful. I was walking uphill on soft sugar sand when my back stopped cooperating. So, it was a slow, hard, uncomfortable trek from that point. I should not expect miracles, based on how bad my MRI looked, but I will not shy away from hiking. As a capstone on Thursday’s back episode, I was able to complete Friday’s and today’s gym workout pain-free.

Physiatrist Visit

I got my ten minutes with the physiatrist, who I’ll call Dr. Rabbit (not his real name). After viewing my back MRI, he reviewed a couple of problem areas with me, focusing on the potential cause of my right thigh numbness and burning. He asked enough questions and did enough manipulation to narrow down the issue with the lateral cutaneous femoral nerve to two possibilities: nerve root impingement, or pressure where the inguinal ligament crosses the nerve (meralgia paresthetica). To resolve between those two, he scheduled an EMG (electromyography) and nerve conduction tests for me next week. I’ll certainly let you in on the results. In the meanwhile, I’ll expect to see many more internet ads regarding back pain and leg numbness.

The Week on Mounjaro

My blood sugar is under good control despite being off metformin for a couple of weeks. Average morning glucose was 92 mg/dL (5.11 mmol/L). Overall average glucose was about 101 mg/dL (5.61 mmol/L). My weight was up one pound (450 g) this week, which means I am stabilizing. After my 52 lb (23.6 kg) loss in five months, I deserve a break! But weight loss was never the primary goal of the Mounjaro therapy, so I am happy with this plateau and wouldn’t be upset if I could stay right here.

That’s it for another week. I’ll be back next week right here with more egocentric clinical rambling and acerbic opinions. I hope my personal horn-blowing will provide some benefits to others considering Mounjaro therapy for type two diabetes. Until then…