‘Roid Rage

Greetings to my six readers, who are largely a separate subset of humanity from my six Penn State football readers. Both are elite groups of erudite information-seekers (or they just like my bullshit). Here in this weekly series, I’m all about me — about my progress in dealing with Type 2 diabetes and related metabolic, orthopedic, and genitourinary issues. (That intro should reduce my readership to three!). We hope to show an unbiased approach to reporting both positive and negative effects of Mounjaro, a GLP-1 receptor agonist drug, which I was prescribed in June 2024.

Today, before giving you my boring weekly numbers, I’ll tell you a little about myself and my approach to Type 2 diabetes, then deal with my intriguing testosterone results. Not for the squeamish, to be sure!

If you’re new here I’ll briefly state that I’m documenting what some hack writers would call a journey, a metaphor I disparage when it is used to describe an approach to dealing with an illness. In the words of the late Pearl Williams, a trip around the world is not a cruise.

Pseudo-journeys are not all I disdain here repeatedly, ad nauseam. Many of my blogging and vlogging compadres characterize obesity as a “chronic, relapsing disease,” a categorization with which I disagree. In fact, that characterization is a regurgitated marketing pitch perpetrated by Big Pharma through their sponsorships of medical studies and the World Health Organization. If it’s a disease, then, by God, we have a drug to fix it. Just fork over $1,200 per month for Zepbound or Wegovy for the rest of your life, and we’ll cure your obesity “disease”. Yeah, right!

Focusing on Glucose First

Nevertheless, my primary focus here is on Mounjaro therapy for Type 2 diabetes blood glucose control. I am currently injecting a 7.5 mg/0.5 mL dose weekly. I won’t bore you with stuff I’ve presented here before. If you are new here, you can read through some of my back issues to see what tools I use for tracking various parameters and how I have changed my lifestyle in this pursuit.

Although I have lost weight, deporking has always been a secondary goal. Since starting on Mounjaro, I have learned that rapid weight loss comes at the cost of lost muscle, so beyond blood glucose control I have now shifted my secondary goal to rebuilding and preserving muscle mass. In prior issues I discussed my exercise program and low-carb, high-protein diet. Regardless of prioritization, this all ties together because more muscle mass will decrease insulin resistance, which will lower blood glucose, as will fat reduction. Still, while I would like to lose another 20-30 pounds, my wish to build muscle is a paramount. I’ll lose the weight, but very slowly.

Many have opined that GLP-1 receptor agonist drugs like Mounjaro are magic pills that automatically fix diabetes and transform fatsos into fashion models. Yet this complex system of human equations is non-linear and multivariate, and there is no magic pill. No therapy comes without cost, both financial and physiological. I’ve also written about how I would like to get off Mounjaro, perhaps by the end of this year. I do not want to be a lifelong addict, especially given the short remaining lifespan of a 78 year-old. But, I am mindful of studies that have shown considerable rebound effects linked to withdrawal from GLP-1 RA drugs like Mounjaro.

Gonad, Go!

In connection with my wish to build and keep muscle, I had my testosterone tested. Last week, I told you about my discussion with Dr. DeLorean (not his real name), whose conjecture was that my total testosterone results would come back between 225 and 350, which would be slightly low to average at my advanced age. But at those levels, he did not feel that supplementation would be appropriate. In any case, I am not seeking to engage in the current vogue of testosterone replacement therapy (TRT). I ordered the testosterone tests “just because”—because I wanted to see if “low-T” would be an impediment to building muscle via resistance training.

Well, the results are in and it seems that my worst fears were unfounded. I am happy to say that Dr. DeLorean—he of little faith—was wrong again! My total testosterone is 745 ng/dL and free testosterone is 69.3 pg/mL. I am encouraged—elated even—by the confirmation of functioning ‘nads. DeLorean’s office called me this morning to tell me that he reacted similarly, saying that 745 is truly remarkable for a man my age. I told the lady on the phone, “I share his wonderment. Now, I must go out and punch somebody!”

Read on; I’ll tell you more about my muscles below in my self-aggrandizing pep talk.

Superman at 78: Building Muscle and Defying Sarcopenia

When I first started on Mounjaro back in June 2024, my primary focus was blood sugar control. What I didn’t anticipate was just how transformative this experience would be—not just in shedding sixty pounds, but in redefining my approach to aging, fitness, and muscle preservation. Now, at 78 years old, I’m not just managing type 2 diabetes; I’m actively building muscle, doing resistance training six days a week, and feeling stronger than I have in decades. And as my recent testosterone results suggest—total testosterone at 745 ng/dL (normal range 250 – 1100), free testosterone at 69.3 pg/mL (normal range 30.0 – 135.0)—I’m operating at levels that would make a much younger man jealous!

But let’s be clear: numbers are only part of the story. Strength training has become the linchpin of my success, and if there’s one message I want to emphasize to my readers, it’s this—unabated muscle loss is not inevitable as we age. Too many people resign themselves to frailty, thinking sarcopenia is just part of growing older. They give in—they concede. With the right approach—progressive resistance training, adequate protein intake, and consistent effort—you can not only preserve muscle but actively build it. I’m living proof of that. According to my cheap, Chinese smart scale, skeletal muscle has increased over seven percent since I started this non-journey.

Keepin’ It Real

Beyond shooing away sarcopenia, resistance training accompanied by a decent, high-protein diet devoid of crap food is essential to anyone on Mounjaro or other GLP-1 RA drugs. It takes hard work and mental commitment, particularly if you want to get off the needle at some point. I don’t want to be on Mounjaro for the rest of my life, but I do want to be physically active and eating properly for the rest of my life. Again, GLP-1 receptor agonists are not magic pills. Please do not regard them as a replacement for an active, healthful lifestyle!

My workout routine is no joke. I train six days a week, two hours a day, focusing on resistance exercises with dumbbells, barbells, kettlebells, and machines, ensuring a mix of free weights and joint-friendly movements. I also incorporate some cardio—not excessive, just enough to support cardiovascular health without compromising muscle gains. And I try to squeeze in a 5-7 mile hike every week or so. This approach has allowed me to keep my strength and prevent the dreaded muscle loss often linked to rapid weight loss and aging. If you’re losing weight, especially with GLP-1 receptor agonists like Mounjaro, you must be diligent about resistance training. Weight loss without strength training will strip away not just fat, but muscle—something we can’t afford as we age.

Putting It All Together

Of course, none of this happens in isolation. Nutrition plays an enormous role. I’ve dialed in my protein intake, ensuring I get at least 1.2 to 2.0 grams per kilogram of body weight. I supplement wisely—creatine monohydrate for strength, collagen protein for joint health, and Feosol Complete for iron absorption. Hydration is non-negotiable, and I prioritize sleep and recovery to let my body rebuild and adapt. At 78, I can’t afford to take shortcuts, and frankly, I don’t want to. The discipline of this lifestyle is part of what keeps me thriving.

Looking ahead, my goal is simple: continue proving that aging does not have to mean decline. I provide these updates not just to document my progress, but to inspire others—whether you’re in your 50s, 60s, 70s, or beyond—to take control of your strength and longevity. Don’t settle for frailty; severe muscle loss is not inevitable. Commit to training, proper nutrition, and an active lifestyle. Move yo’ ass from Planet Fatness to Planet Fitness! You heard it from the Turkey, if anyone asks

And if my testosterone results tell me anything, it’s that I’m doing something right! And my balls still work. That’s something, a-ight!

So, am I a seventy-eight-year-old Superman? Well, maybe not. But I feel pretty damn close—and if I can do it, so can you. Let’s keep pushing, lifting, and proving that age is just a number.

This Week’s Numbers on Mounjaro

Still on the minimum dose of 5.0 mg, my average fasting blood glucose for the week was 93 mg/dL (5.17 mmol/L), down from 98 mg/dL (5.44 mmol/L) last week. My body weight (unlike my remaining belly) remained flat at 187.2 lbs (85.1 kg). My only dietary transgression during the week was a Waffle House hamburger I choked down at my step-grandson’s sixth birthday. Next week, I’ll be moving up to the 7.5 mg dose of Mounjaro.

With HbA1c at 5.4% (36 mmol/mol) and skeletal muscle increasing as a percentage of body weight, Mounjaro therapy is taking me in the right direction. I am emphasizing the strength training because I believe it is essential at my age and I want to encourage others to feel its benefits. If I am to be a cheerleader, it will be to promote healthy lifestyle instead of pushing drugs. And if I can do it, you sure as hell can!

Au Revoir…

As always, I hope these updates have provided you with encouragement and information for your own non-journey! I’ll be back next week with more insights into dealing with Type 2 diabetes along with commentary about GLP-1 receptor agonists like Mounjaro. In the meantime, be healthy!

Blood Results Are In; Another Week, Another Doctor!

Hiya, fellow Type 2 diabetics and other curious souls. I’m back with another weekly update and commentary on my progress on Mounjaro. I cover many aspects of my health, which I hope will help others who are in the same or similar boats. At age seventy-eight, I bit the bullet, using GLP-1 RA drug Mounjaro along with major lifestyle modifications to lose sixty pounds, reduce my HbA1c from 7.6% (60 mmol/mol) to 5.4% (36 mmol/mol), and lose sixty pounds (27.3 kg) of fat since last June.

I have accomplished a lot in a short period, but I want the final push to knock off another twenty-five or thirty pounds, and get my HbA1c down to 5.2% (33 mmol/mol) consistently over two three-month periods. While I feel that Mounjaro is only a part of the story, I don’t think I could have done all this without it.

Still, I’m not a rah-rah cheerleader for Big Pharma. I’m hoping to kick the Mounjaro habit at some point when my condition has stabilized. I realize that this comes at a peril, as many who have discontinued GLP-1 RA drugs have regained weight and lost control of blood glucose. I am hoping to be the the antithesis of that cohort’s rebound propensity. Although I will not hop off the Mounjaro train anytime soon, I want to get my ass in the proper gear to be in a position to do so by the end of this calendar year.

I am at the lowest therapeutic dose of 5 mg/0.5 ml injected weekly. After my visit with Dr. DeLorean (not his real name), which I will describe later, I will increase the dose to 7.5 mg/0.5 ml. But first, I’ll bore you with the results of my blood tests, as I promised you last week.

Are You KIDNEYing Me?

My blood test results showed the usual elevation of BUN and as a result, eGFR of 59. This is just over the line into chronic kidney disease Stage 3A territory, but that’s a continuing saga, which is fortunately stable. Let’s move past my kidneys to the HbA1c and insulin results.

HbA1c Still Improving

My HbA1c improved from 5.5% (37 mmol/mol) to 5.4% (36 mmol/mol) for the period between November 19, 2024 and February 18, 2025 (three months). Note that this period included Thanksgiving, Christmas, Hanukkah, New Year’s, MLK Day, and the annual visit from snowbird friends, which all involves diet compromises. I’ve mentioned before that my personal target is 5.2% (33 mmol/mol).

My doctor asks, “Why so low?” My answer is always, “Why not?”

IR Coming HOMA

Homeostatic Model for Insulin Resistance (HOMA-IR) is a calculated number some use as an indicator of insulin resistance, which is the precursor to Type 2 diabetes and a whole host of metabolic disorders. Insulin resistance is also implicated in general inflammation and cardiovascular problems, so it is like a gun that shoots time-delayed bullets at one’s body. (Screwed-up metaphor, already, but you get the point). To calculate your HOMA-IR, you need to test fasting insulin and fasting glucose at the same time, then apply a formula.

Why Don’t Doctors Test Insulin?

The rub is that many doctors do not test insulin, just glucose. Mine does not seem to care about insulin levels, having once stated to me, “Insulin resistance is why you have diabetes. If the Mounjaro is increasing your insulin levels, it is doing its job. You must balance the negative (inflammatory) effects of insulin with the glucose control.” Yet, he also declares that prescribing exogenous insulin is a last resort for treating Type 2 diabetes. Anyway, I ordered this test myself out of scientific curiosity. Knowledge is power.

As of February 18, my fasting insulin was 11.8 µIU/L (70.8 pmol/L) and my fasting glucose was 98 mg/dL (5.44 mmol/L). My most recent prior insulin level was 18.7 µIU/L (112.2 pmol/L) back on November 19. My fasting glucose on November 19 was 96 mg/dL (5.33 mmol/L). You can find the mathematical formula elsewhere, but meanwhile, here is a link to a calculator. Using it, all those numbers boil down to a HOMA-IR score of 2.9 now as opposed to 4.4 in November, still indicating insulin resistance. Although the threshold and the meaning of the HOMA-IR score is controversial, some researchers consider a value greater than 2.0 to signify insulin resistance. I’m insulin resistant, but far less so than three months ago.

Inflammation Markers

Concurrent with these diabetes tests, I also ordered three tests for inflammation, namely hs-CRP, homocysteine, and Westergren SED rate, all of which came back in normal ranges. Reduced inflammation tracks well with reduced insulin levels, in my layman’s opinion. But I do not attribute the recent improvements primarily to Mounjaro, which I have been taking for almost nine months. Read on to learn more about my integrated approach.

Move Yo’ Ass!

What changes did I make to achieve this improvement over a mere three months? Not my diet, which has been consistent in its low-carbohydrate approach since last June when I started my Mounjaro therapy. Indeed, I have loosened up the low-carb diet due to holidays and friend visits. What I will hang my hat on here will disappoint some of you who believe GLP-1 RA drugs can fix your Type 2 diabetes without needing to significantly change the sedentary lifestyle and crappy diet that put you in that position. Yes, friends, I passionately believe that my renewed commitment to resistance training and cardio workouts along with eliminating ultra-processed crap food are jointly responsible for the improvement. Both are essential to overcome Type 2 diabetes. You already know about diet, so I’ll focus on exercise here.

Working Out to Avert Muscle Loss

My training schedule is six days per week, one-and-one-half to two hours per day. Three of those days are at a gym run by a large, local hospital organization’s sports medicine and rehabilitation division. I did my physical therapy there over the years for various injuries and surgeries, so it was familiar territory. They have equipment that would cost me big bucks to duplicate, especially for lower body training modalities. So, in my sessions there I concentrate on legs, glutes, and cardio, while at home I train upper body, back, and core.

At home are a bench, a set of 52.5 lb (24 kg) adjustable dumbbells, a kettlebell, an EZ-curl bar and straight Olympic bar, weights, a stability ball, a TRX suspension system, some resistance bands, and a yoga mat. My wife pokes fun at me for buying and using the yoga mat, something she would have earlier never linked to my condescending ass! Finally, my still quite usable forty-year-old Schwinn Airdyne stationary bike sits in the garage, which reaches over 100°F (37.8°C) in the Florida summertime. There, I can sweat off a few pounds if I’m bored or just add cardio time as needed.

Take a Hike!

Lastly, I enjoy walking and hiking, especially the latter. I like to get out on the trail once a week or so to enjoy the terrain, the heat, the snakes, and the bugs. I typically hike between five and seven miles, but the last time out a couple of weeks ago, I did nine. Twenty years ago, when I was a mere lad of fifty-eight, I could hike twelve or thirteen miles, but my old knees and back think better of that distance now. Still, getting out in the sun (or liquid sunshine) to commune with nature is rewarding even if you can hike only a mile or two!

Resistance or Cardio? Both!

My informed judgment tells me that resistance training is the more important priority versus cardio, but aside from any hiking, I do at least forty-five minutes of cardio three days a week. That leaves about eight or nine hours per week for working against resistance, be it weights, machines, resistance bands, or body weight. Is it enough? We’ll see. Every day, I look forward to my workout session with eager anticipation, so I must wonder why the hell I hadn’t set aside time for it earlier in my life. So, I’m hoping that this newfound commitment to exercise is not too little and too late.

Visit with Dr. DeLorean

That brings us to this morning’s visit with my primary doctor, who I have dubbed “Dr. DeLorean” here because among his car collection is a shiny, stainless steel bodied DeLorean vehicle. The first words out of his mouth today were, “Your A1c is better than mine! We usually want diabetics below seven, but 5.4 is excellent.” That my A1c is better than his is no small feat, as Doc is a marathon runner, yoga addict, and fitness guru. We discussed the Mounjaro dose, and my characterization of “food noise”, which supported an increase to 7.5 mg/0.5 ml. Done and ordered from my friendly PBM.

I reviewed my exercise program, my wish to preserve muscle mass, and my body weight goal with the doc. The testosterone tests have not yet arrived, so I couldn’t discuss them directly. DeLorean said he bet the results would be between 225 and 350 at my advanced age, and he added that he would not recommend supplementation at that level. His feeling is that if I am marginally low, I can live with it, and supplementation — unless huge, body-builder doses — would not contribute much to maintaining and building muscle mass.

Yet, he did agree with my goal to preserve as much muscle mass as I can and grow some more if I can. He stressed higher protein intake and possible supplementation with creatine monohydrate, both of which I am doing.

Ironically…

In the past few issues of this report, I have chronicled my functional iron deficiency. I won’t go into great detail about it here. Suffice to say that I have a deficiency characterized by normal ferritin but low free iron, iron saturation, and TIBC. I pursued the possibilities of malabsorption or low-grade gastrointestinal bleeds with my gastroenterologist (known here as the pre-eminent Irascible Dr. Scrooge), which was a dead end. So, absent signs and symptoms of anemia, we might be back to Square One.

Doc DeLorean still thinks that because my hemoglobin and hematocrit were both in range (as of November), the iron deficiency is related to my penchant for donating blood. Naturally, he asked if I had donated blood recently, to which the answer was “no”. My last donation was in November 2024.

So, the path forward will be to continue supplementation, with a switch from Original Feosol to Feosol Complete, the latter of which is heme-iron, more easily absorbed than inorganic iron salts. That was my idea. DeLorean’s stressed not to donate blood, which I will not do. We will follow up with blood tests for iron along with a CBC in March, and my follow-up visit will be in May (or sooner, if something flares up).

Who Said Anything about UTIs?

Speaking of UTIs (I know, we weren’t), I enlightened the good doc about the pathogen that caused mine: Serratia marcescens. I told him that my conjecture about why my urine had been pink during the infection was not that I had hematuria (blood in the urine), but that the pretty color resulted from the pigment produced by these bacteria. When I told him they were the same bacteria responsible for the pink plaque one sees on shower tile grout, and that it was in the soil and everywhere else, I observed the glow of intrigued recognition on his face.

“That was the stuff in the shower in my daughter’s new house that I helped her scrub off!”, he remarked. I pointed him to the Wikipedia article about it, which has a picture of a Petri dish with a bright red growth on its culture medium. He looked it up and marveled at it, saying, “I thought it was a fungus in the shower.” Then, thinking back to my UTI, he asked, “Did you rub your penis on the sink or something?” Comedian!

The Week on Mounjaro: The Numbers

Fasting glucose levels averaged 98 mg/dL (5.44 mmol/L) for the week, down from 107 mg/dL (5.94 mmol/L) last week. I’m happy to see it declining. I won’t give you average glucose this week because my Stelo biosensor is farblondzhet. I opened a service ticket with Dexcom hoping to get it replaced. My weight is 187.2 lbs (85 kg), nominally the same as last week.

Time to Skeedaddle

That wraps up another week on Mounjaro. Highlights are the dose increase, favorable blood test reports, and my ambitious exercise program. Hope you enjoyed it! Until next week…

Yes! We have no URI!

Hello, my metabolically curious peeps! I’m here with yet another boring update about my Mounjaro progress, peppered with amusing tales of my frustrations with the healthcare system and opinions on anything worth an opinion. This week, I’ll be telling the story of my gastroenterologist’s bogus no-sniffles diagnosis, along with the usual update and some news on the Mounjaro front.

I’m a diabetic old fart on Mounjaro (tirzepatide), a GLP-1 RA drug. The purpose of this weekly series is to share my experience with others who are considering Mounjaro or similar drug therapy. Although I am grateful for the positive effects of Mounjaro, I am cynical about unknown potential long-term issues, because GLP-1 RA drugs have too short a clinical history. Thus, I do not view my current prescription as a lifetime commitment to the drug, much to the dismay of Eli Lilly & Company, its manufacturer.

I occasionally use this forum to bitch at the rah-rah weight-loss crowd who promote these drugs as a panacea for obesity, to be prescribed by TeleHealth operations and taken with impunity. We are now supposed to believe that obesity is a chronic, relapsing disease, treatable mainly with major profit-producing pharmaceuticals. That, of course, is clearly bullshit perpetrated upon us by our money-grubbing friends in Big Pharma. Hell, last week, I told you about a study aimed at prescribing these injectable drugs for fat six-year-olds. Sheeit! But I digress wistfully. Let’s get back to my healthcare travails.

Shoddy Reporting in Scroogeville

I suppose I should not blame the good doctor’s rank-and-file employees for the funny screw-up I’ll tell you about here. Back when I lived in The Bahamas, we had a saying that “the fish stinks from the head on down.” So, let’s hold Dr. Scrooge responsible, even though he likely never got close to this issue. What the hell am I talking about? I’ll give you a little background information first, as some of you have not encountered the ongoing saga in earlier issues of this blog.

Iron Deficiency

I consulted The Irascible Dr. Scrooge, my long-time gastroenterologist in late January because of an observed functional iron deficiency, which my primary care doctor, known here as Dr. DeLorean, expressed no interest in chasing. Dr. Scrooge (not his real name, obviously) wanted to first test for celiac disease, then if negative, do some endoscopy to look for GI bleeds, cancer, or chronic inflammatory disease. Yet, he took a side-trip to my urinary tract when I told him that Dr. DeLorean had treated me for a urinary tract infection and I had noted that my urine was pink at one point. I told him about the UTI for completeness and full disclosure, although I thought the pink urine might not be from blood. The pathogen responsible for the infection produces a red pigment, but I said nothing about that. So, Dr. Scrooge ordered a urinalysis to look for blood in the urine.

The lab results for that screening urinalysis came back positive for leukocytes, indicating that the infection had not completely settled down. Dr. DeLorean had successfully treated it with Cipro after a false start with Macrobid, but the abnormal urinalysis inspired Dr. Scrooge or one of his extenders to order a follow-up urine culture. When the representative conveyed this to me on the phone, I thought it was weird. Scrooge was looking only for blood in the urine, not to treat a UTI. The latter would entail referring me back to my primary doctor. But who knows? Doctor’s orders (presumably), and it couldn’t hurt to see if I still had an active UTI, so I complied, giving Quest Labs a cup of my finest amber brew.

The Results Are In

Because I have an account with Quest, I get results instantly when they are published. Then, I typically hear from the ordering doctor a day or two later. Last Sunday, Quest gave me results of the culture, which were negative for any bacteria. Nothing grew, no more urinary tract infection. So, imagine my titillation when I opened my mailbox the next Thursday to find an unsigned letter from Dr. Scrooge’s practice declaring, “Your recent laboratory results did not show that you have a[n] Upper Respiratory Infection.”

It’s good to know that I don’t have a cold. Or was it unreasonable for me to expect that a urine culture would confirm that? Oy, vey! Must be allergies with all the tree pollen in the air around Central Florida. Wait, WTF??? Who said anything about a URI? Someone at Dr. Scrooge’s office must be dyslexic or something. UTI and URI differ by only one letter. And, how about this: urine starts with the three letters U-R-I. Wow! OK, enough already! You get my point. It was innocuously inconsequential in this case, but I wonder whether they proofread prescriptions with the same diligence.

Just a Typo — No Shit?!!

OK, so I called, sarcastically telling the female voice on the phone that I was happy that the results of my urine culture revealed that I didn’t have a cold or bronchitis. She got defensive, saying, “I see the typo, but obviously they meant to say no urinary tract infection.” Then, she was ready to end the call when I asked whether we’re moving ahead diagnostically about the functional iron deficiency. “After all,” I said, “the UTI was a side-trip. Now let’s get back on course.”

She did not seem to know what the hell I was talking about, so I read Dr. Scrooge’s January 27 clinical notes: “Further work up to identify possible GI causes were also discussed, such as VCS, FIT test, and Celiac antibody labs. Advised if labs are negative, patient is to complete EGD and colonoscopy followed by VCS on a separate date if [the EGD and colonoscopy are] negative.” She didn’t believe me, or she couldn’t read, because she asked me where I was reading that. I told her it was the fifth paragraph down.

Get Me Outta Here!

Then, she really wanted to get off the phone. Was this was the first time a patient read the clinical notes? Sure seemed like it. On her end, it was painfully clear that she hadn’t read them. She obviously had no answers, so she would consult with Dr. Scrooge and call me back. That was Thursday, and I have yet to hear from her or from anyone else at the practice. Nothing happens fast in today’s healthcare system in this country.

Piecing it all together, I believe Dr. Scrooge hands off cases to his staff, who drive the process from there. Shouldn’t they be basing it on his clinical notes? If they choose to take their own direction, I might as well deal with Dr. ChatGPT for my care. Still, I will continue to prod the low-level operatives and hold them to the plan. We all must be our own healthcare advocates in this strained healthcare climate.

I am certainly not anxious to be invaded in both ends by probes, and another colonoscopy prep is not a pleasant prospect, but I sure as hell want to get to the bottom of the iron deficiency. If I don’t hear from those dyslexic geniuses by Friday, [insert DJT Gaza-like implicit threat here].

Latest Mounjaro News

Here is a roundup of recent activity on the Mounjaro front, courtesy of the lazy writer’s friend, ChatGPT.

• Supply Issues Resolved: The FDA has announced that the shortage of Mounjaro (tirzepatide) has been resolved, meaning Eli Lilly’s production can now meet national demand. As a result, pharmacies and outsourcing facilities have been given deadlines (February 18 and March 19, 2025) to stop distributing compounded tirzepatide, as compounding is no longer justified due to availability canamericaplus.com.
• Kidney Benefits in Diabetes: New findings from the SURPASS trials indicate that tirzepatide significantly reduces albuminuria in adults with type 2 diabetes. This suggests potential kidney-protective effects, particularly in patients with chronic kidney disease (CKD) healio.com.
• NHS Approval in the UK: Mounjaro has been approved for use in England under the National Health Service (NHS), but access will be phased in over time, with priority given to those with the highest clinical need. The full rollout could take years, with only 220,000 patients expected to receive it initially, despite millions being eligible pharmaphorum.com.

These updates suggest that tirzepatide continues to be a highly effective treatment choice for diabetes and weight management, with extra emerging benefits for kidney health.

It Ain’t All Good News

Yet, some negative information about GLP-1 RAs also emerged this month.

• Recent studies suggest a potential link between semaglutide (Ozempic) and an increased risk of non-arteritic anterior ischemic optic neuropathy (NAION), a condition that can cause sudden vision loss due to reduced blood flow to the optic nerve. A Danish cohort study found that the use of once-weekly semaglutide more than doubled the five-year risk of NAION in individuals with type 2 diabetes. medicalxpress.com.
• The European Medicines Agency (EMA) is currently reviewing all available data on this potential risk, including clinical trial results and real-world studies. The Pharmacovigilance Risk Assessment Committee (PRAC) has initiated an investigation into whether semaglutide use is associated with an elevated risk of NAION. ema.europa.eu.
• Despite these findings, experts stress that the absolute risk remains low. A multinational study using Scandinavian health registries identified only 32 cases of NAION among over 60,000 people using semaglutide, suggesting that while the risk may be elevated, it is still relatively rare. verywellhealth.com.

For patients concerned about vision-related risks, it is advisable to discuss these findings with a healthcare provider, particularly if they have pre-existing risk factors like diabetes, hypertension, or a history of optic nerve disorders.

Updating My Progress on Mounjaro

In the past few weeks’ blogs, I have shared my observation that I might need a dose adjustment. I have been taking the lowest therapeutic dose of Mounjaro since September (5mg/0.5ml). But, since early December, I have observed an increase in average fasting blood glucose, which I have documented here. I put together a graph to give me a better picture, including (gratuitously) body weight, which continues to decrease.

The glucose situation is complicated by my discontinuation of metformin around the end of November. This certainly could be a cause for the steady increase. The body weight line on the graph paints a different picture. I continue to lose weight, but I am no longer experiencing the “fullness”, the absence of “food noise”, and the general appetite suppression that Mounjaro formerly gave me. Thus, I attribute the ongoing reduction to my amped-up workout schedule at the gym coupled with a mindful approach to a low-carbohydrate, high-protein diet.

Remember that weight loss is well down on my list of priorities for Mounjaro therapy. My first priority is glucose control, followed closely by my wish to preserve muscle mass, which is imperiled by the joint effects of rapid weight loss and sarcopenia, the loss of muscle due to aging. The weight loss is an added advantage. But at this stage, I want it to slow down due to the nasty effects of too-rapid reduction.

Offsetting Loss of Muscle Mass

The SCORES study and recent research on GLP-1 receptor agonists (GLP-1 RAs) highlight concerns about muscle mass loss during medically induced weight reduction. Findings show that muscle loss can account for 25–39% of total weight lost over 36–72 weeks, which is significantly higher than with non-pharmacological weight loss techniques. This loss is particularly worrisome because skeletal muscle plays a crucial role in metabolism, glucose regulation, and immune system function.

While GLP-1 RAs improve fat-to-fat-free mass ratios, excessive muscle loss could contribute to conditions like sarcopenic obesity and increase the risk of cardiovascular disease and frailty, particularly in older adults. Experts recommend counteracting this effect with resistance training and adequate protein intake. Some researchers are also exploring myostatin inhibitors as a potential strategy to mitigate muscle loss during weight reduction with GLP-1 drugs.

No More Drugs

I sure as hell won’t be considering myostatin inhibitors. My wish is to get off as many drugs as I can, including Mounjaro. I am trying to create a paradigm to achieve that goal with diet and exercise adjustments, which I will pursue diligently. If I need a dose adjustment or a re-prescription of metformin to keep glucose in check, I’ll do it. I will discuss this with Dr. DeLorean next Monday at my follow-up appointment.

I will have some new lab results for you next week. Aside from HbA1c, which Dr. DeLorean ordered, I have ordered hs-CRP and SED rate on my own to further pursue the iron deficiency. As well, I’m checking testosterone to see whether I really can build muscle. Finally, out of curiosity, I’m checking fasting insulin, and I threw in a comprehensive metabolic panel for an extra $20. Yes, I know, I’m playing doctor, but seriously, my scientific curiosity remains unchecked by the medical establishment’s gaslighting and obfuscation.

The Mounjaro Numbers, Already!

This will be anticlimactic, because the graph above tells the tale. Still, just for shits and grins, here we go with this week’s Mounjaro numbers. Average fasting blood glucose was 107 mg/dl (5.94 mmol/L), about the same as last week. Overall average blood glucose as reported by my Stelo CGM was 115 mg/dL (6.39 mmol/L), up 8 mg/dL (0.44 mmol/L) from last week. I attribute this to deviating from my low-carb diet during my Pennsylvania friends’ visit. Still in all, this would equate to HbA1c of 5.6% (38 mmol/mol), which is up slightly from my last test in November, but still “not too bad”.

Body weight decreased during the week, amazingly enough, reading out at 187.6 lbs (85.3 kg) this morning, a loss of 2.2 lbs (1 kg). I say “amazingly enough” because of the pig-out with friends described above. This entailed consuming significant carbs at our neighborhood Greek restaurant and a German bakery/deli in the middle of nowhere that our friends really like.

Saluting Our Presidents and Signing Off

As always, I hope you have derived something of value from my shared experiences and my information retrieval. I know that you are as happy as I am to know that my urine shows no evidence of bronchitis.

Today, we celebrate President’s Day, which merged George Washington’s Birthday (February 22) and Abraham Lincoln’s Birthday (February 12) into a single, interpolated, undistinguished, mandated Monday Federal holiday. Like Daylight Savings Time, just let the government produce GFIs (not ground-fault interrupters, but rather, Great Ideas), and they’re sure to screw it up. So, let’s celebrate our presidents today, whether it is their birthday or not. I pick one president every year. This year it is Martin Van Buren, who was born on December 5. He’s as good as any of the other forty-four.

Until next week, when I report on the lab results I mentioned and give the usual update, I bid you a Happy President’s Day. May you find the sale price mark-downs you crave on the stuff you want! We know what President’s Day is all about, don’t we?