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Weekly Mounjaro Update: Week 25

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The Turkey is back with you (in time for Turkey Day) to report on my weekly progress with the type two diabetes drug Mounjaro. My therapy started on the first week in June this year. Since then, my HbA1c has improved from 7.6% to 5.5%, which is excellent. However, lest I succumb to the GLP-1 drug for life groundswell that is making this class of drugs the most profitable in history, my approach is cautiously optimistic. Unlike other pop culture sources on social media, I am not a one-dimensional cheerleader for these products. What you get here are honest observations and cynical comments derived from my personal experience with all aspects of the therapy, positive, negative, and “too soon to tell.”

My annual physical exam is nigh. I have blood test results in hand. So, tomorrow, I will discuss my progress on Mounjaro with Dr. DeLorean (not his real name). Also, my final physical therapy session was last Friday. I’ll update you on all that later. First, I want to give you the GLP-1 story of the week.

Silly Rabbit! Trix Are for Kids!

(But What about Mounjaro?)

The story of the week involves parents seeking GLP-1 agonist drugs for their children to slim them down. I’ll give you a little background. The biggest selling drugs in the GLP-1 class are Mounjaro and Zepbound (both terzepatide), and Ozempic and Wegovy (both semaglutide). While originally the target consumer group was type two diabetics, the market exploded when the weight loss associated with GLP-1s became evident. The weight-loss market, comprised of both cosmetic and medically necessary reduction, is huge and ripe for exploitation. Eli Lilly & Company and Novo Nordisk, manufacturers of these drugs, would love for two-thirds of the world’s population to become addicted to their magical weight loss potions. Toward that end recently, the US FDA has approved Ozempic/Wegovy (semaglutide) for use in treating childhood obesity. The abuse potential concerned with injecting harmful drugs into children seriously bothers me.

One Mom and Daughter

I’ll point you to an article in The Wall Street Journal about a twelve-year-old girl whose Mom has been getting her GLP-1 drugs from compounding pharmacies. Her pediatrician did not feel comfortable prescribing the stuff for the kid, so the insistent mom looked for tele-health companies that are all about making money on compounded versions of the vogue drugs. Many of these companies sprang up when the last explosive class of drugs, Viagra et al., went off patent. They are merely drug pushers, with varying degrees of medical intervention.

Typically, they expect the client to do his or her own follow-up and lab testing; they cede that territory to to the client’s local doctor. Of course, people intent on getting their hands on the drug take a “damn the torpedoes” approach. Once they establish a supply channel, they might skimp on follow-up. Hell, some might not even tell their local doctor. Kids certainly have no control over the process. They must rely on parental responsibility or suffer in the absence of it. If parents seek out shady suppliers who provide their patients just enough information to satisfy their lawyers, they are putting their children squarely in harm’s way.

We know too little about the long-term effects of GLP-1 agonists, but parents are insisting on giving them to developing adolescents. Nutritional concerns abound. With their appetite suppression, how will these drugs with their associated appetite suppression affect physical growth and mental development? The answers are not clear.

Treat Your Children Well

I’m not here to tell anyone how to raise their kids, but I object to giving them GLP-1 drugs, injectable or otherwise. People want to irresponsibly give their kids crappy sugar-laden cereal, ice cream, cake, and candy, then throw drugs at them when they fatten up. Sometimes, they just want their kid to look good in her prom dress or her play clothes. A sad example came from a tele-health provider in an interview with The Wall Street Journal. She quoted a client who told her, “My daughter is size six. She’s body confident. She has friends, she’s very active, but I can’t help but think she would be better at a size 0.” Just think about that one for a while.

Where parents can step in to combat childhood obesity is feeding their kids decent food. Since the end of World War II, what kids eat has gone to hell in a hand basket. Even in my youth, we had crap like sugary cereals like Kellogg’s Sugar Frosted Flakes (“They’re g-r-r-r-reat!” —Tony the Tiger), Hostess Twinkies, Oreos, and Pop Tarts. Incessant advertising targeting children makes it hard for parents to avoid buying crap for them. And so, the childhood obesity pandemic took hold. It has degenerated from there — seventy years of crappy child nutrition. Now the CDC considers 19.7% of American children aged 2-19 to be obese.

Big Government Abetting Big Pharma and Big Fooda

I’ve written before, ad nauseam, about the food industry and Big Pharma holding each others’ hands while together they make the population sicker. Ultra processed food, high on sugars, sicken people. Big Pharma steps in with expensive magic potions to fix what the food industry damaged. And it goes on and on and on. Instead of government fixing the problems with the lobbyist influenced food pyramid and the adulteration of food, they turn a blind eye to the abuses, while green-lighting all the great new expensive drugs Big Pharma can offer. Direct-to-consumer advertising, legal only in the U.S. and New Zealand, closes the loop between the fat man on the street and Big Pharma. It is only a matter of time before the ballsy marketeers from Big Pharma implore you to ask your pediatrician whether Mounjaro is right for your six-year-old.

Harrumph!

Enough of That… Where’s My Update?

Let me start with the weekly numbers, and then I’ll fill you in on the labs and the PT. This past week included my birthday. I didn’t do anything wild, but I did deviate from my typical diet, going way over my self-imposed carb limit. So, it is no surprise that my average glucose increased to 110 mg/dL (6.11 mmol/L). However, morning fasting glucose averaged 91.7 mg/dL (5.07 mmol/L), an improvement from last week’s 100 (5.56).

My weight was flat for the week, at 195.2 lbs (88.5 kg). I am happy to take a break from losing weight, as I have dropped 50 lbs (22.7 kg) way the hell too fast.

I have noticed that my resistance to Mounjaro is increasing. Appetite suppression has waned, but I have cleaned up my diet. I might need one more dosage bump to finish the job I started. As you’ll see below, my insulin resistance is way the hell too high. I need to get that under control. Nevertheless, I hope to conclude the Mounjaro therapy during 2025. None of this “on it for life” BS. We’ll see…

Blood Test Results

If you ignore my fasting insulin level, which I’ll get to shortly, my metabolic results were pretty damn good for an old fart in his eighth decade. HbA1c was 5.5%, which is in the “normal” range, down from 5.7% in September. My eGFR, a calculated measure of kidney function, has improved to 60, which elevates me from the morass of chronic kidney disease Stage 3A to Stage 2. Because of diabetes, high blood pressure, and metabolic syndrome, my kidneys have taken a serious beating for many years. Positive results in this area never fail to elevate my spirits!

But then…

Alas, my fasting insulin rose to 18.7 uIU/mL, which suggests that I am extremely insulin resistant. What is the connection between Mounjaro therapy and this number? I will discuss it with Dr. DeLorean tomorrow, but my bet is that he won’t offer any brilliant revelations. He will tell me that a single test and one number is meaningless. After all, I, not he, ordered the test. But there is a method to my madness. I believe that insulin resistance underlies a cascade of metabolic issues. But who am I?

HOMA-IR

I had tested fasting insulin back in July. At that point, it measured 14. Holy Crap! This is a significant increase, no matter who orders the damn test. Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) is a calculated measure of insulin resistance recognized by metabolically savvy doctors, so I’ll use that score to illustrate the extent of my insulin resistance. HOMA-IR is a function of concurrent fasting insulin level and fasting glucose level. Any score above a 2 signifies insulin resistance. In my case, July’s number was 3.3 and November’s was 4.4.

However, the model is controversial. “The HOMA-IR score should not be used in patients on insulin, and studies have questioned its accuracy in those with impaired glucose tolerance, normal BMI, the elderly, and others.” Well, I am elderly and I certainly have impaired glucose tolerance.

I’m not going to panic. What can I do about it? I have already adjusted my diet and I will be increasing my exercise, now that physical therapy for my back has concluded. But if Mounjaro is causing the decrease in insulin sensitivity, my desire to get off the drug will accelerate. The alternative would be chasing dosages upward while insulin resistance also increases, in an endless upward spiral. That’s all speculation at this point. I need some hard facts, and I’m skeptical about getting them.

Physical Therapy Concludes

I think the physical therapy did me some good, especially, the core strengthening exercises, which enabled me to comfortably hike 8.6 miles (13.8 km) on Thursday. After hearing about this from me, my PT task master gave me a going-away gift by doubling the number of daily exercises I do at home. Facetiousness aside, I will do them diligently.

My back pain still bothers me, but the therapist told me in advance that there were limits to what she can do. Only surgery can assuage some of my back issues and others are not correctable by any means. Still, I think the hard work and the ongoing exercises will pay off.

The numbness and burning in my right thigh persists. I will be seeing a physiatrist (physical medicine and rehab doctor) in early December, hoping to get some relief through non-surgical means. The condition, tentatively diagnosed as meralgia paraesthetica, is annoying but not debilitating. It involves a sensory nerve, which as the name suggests affects only sensation, not control of muscles. Like lots of other annoyances that accumulate with advanced age, I can learn to live with it if the correction would be more of a pain in the ass than the pain in the ass itself!

Get Some Exercise, Fat Boy!

The physical therapist had asked me not to do my usual resistance exercise program while she was punishing me physically, so I obeyed. Now that she is out of the picture, I will get back into it, and then some. In December, I will join the exercise program at the same rehab and will resume the dumbbells and stationary bike at home.

Have a Happy Thanksgiving!

That’s all for this week. I hope to bring you some more egocentric information about my ongoing Mounjaro therapy next week after I see the doctor for my annual physical. On Thursday, I anticipate another dietary deviation at Thanksgiving dinner, but I will try to minimize its glucose impact. No sense killing myself on Thanksgiving!

I wish all of my U.S. readers a very Happy Thanksgiving, and I apologize to my Canadian readers for missing Thanksgiving last month. (Even if I’m not Canadian, I can still say I’m sorry!). See y’all next week!

Weekly Mounjaro Update: Week 24

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I’m sitting here awaiting my new refrigerator. Just got a call from Jesse the delivery guy. The unit it replaces died last Thursday of old age, and the soonest* I could get a replacement delivered was today, Monday. I’ve got to tell you, man, you don’t know how much you rely on a modern convenience until it goes away. But that will soon be rectumfied.

Mounjaro to the rescue!

WTF, you ask? I’ll tell you how Mounjaro rescued me from no-fridge hell. A couple of months ago, I purchased a dorm-sized fridge for storing Mounjaro because I was ordering twelve-weeks’ supply at a time from my PBM. I did not want to clutter up the primary food storage locker with drug boxes. So, I installed the little thing in my upstairs ham shack and electronics lab. Locating the device next door to my office provides convenient cold drink access, although it curtails the exercise I get running up and down stairs. In the context of my main refrigerator’s outage, I am fortunate that my prescient auxiliary larder purchase provided adequate cold storage to give me some weekend food variety.

I’ll keep the update brief this week, so we won’t have any opinionated editorials. But before reporting the week’s results, I cover a couple of miscellaneous personal topics.

Annual Physical Exam Blood Work

My annual physical exam is scheduled with Dr. DeLorean (not his real name) for November 26. I’ll have blood drawn for several tests in advance of that appointment. Among those scheduled are HbA1c, complete blood count, and comprehensive metabolic panel, to which I have added a self-ordered fasting insulin. I will report my progress on relevant markers next week in this space.

Physical Therapy Progress?

I have been undergoing physical therapy for lumbar spine issues. This week, we will be wrapping up that treatment with a full session on Tuesday and a progress review on Friday. I believe the therapy, coupled with daily home exercises, has done some good, although my back pain has not decreased. Looking at my MRI at our initial assessment, the therapist told me what she could and couldn’t do. There were more “couldn’ts” than “coulds”. Furthermore, a new issue cropped up just as I started PT, a nerve inflammation in my right thigh, called meralgia paraesthetica. To be fair, the PT was not directed at this issue, which could be related to the spine problems. Although I can live with its pain and tingling, I would like to find a solution.

My next step is to see a physiatrist (physical medicine and rehab doctor) on December 9. My hope is to fix as much as possible without surgery, although many of the problems with my spine suggest its need. Like anyone, I am reluctant to go under the knife, more so because I had cervical spine fusion in 2007, which did not work out too well. I will fill you in on my progress if and when anything happens one way or another.

Returning to Exercise

My physical therapist asked that I suspend weight training while she did her Cruella de Ville routine. I miss working out and want to get back into it, so I hope that I’ll get clearance at Friday’s assessment. In anticipation, I have asked the exercise physiologist at the same rehab where I get my PT if I can re-join her wellness program. She will give me an exercise capability assessment and, for a low, low monthly fee, I’ll have access to the PT training facilities. I had been a member prior to the COVID fiasco, hitting the gym three times a week mainly for resistance training. I dropped it when all the pandemic bullshit was going down.

So, my hope is that while my back is assessed six ways to Sunday, I can get my sorry ass back in shape. I hope my rapid weight loss has not caused too much depletion of muscle mass, a peril associated with Mounjaro, particularly for old farts like me. I want to preserve as much sinew as I can, trying to keep protein intake at a decent level to help with the process.

Mounjaro Update

This was a chaotic week, so my progress was not terrific. According to Stelo, a CGM that doesn’t want to call itself a CGM because, I suppose, it measures blood glucose at discrete intervals, my average glucose for the week was 103 mg/dL (5.71 mmol/L). This equates to an HbA1c of 5.2% (33 mmol/mol), which is my target. However, I am not happy with my morning glucose, which hovered around 100 mg/dL (5.56 mmol/L). I’d like that value to stay well under 100 (5.56).

I lost about 2.4 pounds (1.1 kg) during the week. That’s not healthy. As I’ve mentioned (ad nauseam), weight loss is desirable, but I’ve already lost too much, too fast (about 50 lbs (22.7 kg) in twenty-four weeks. I’m now at 195 lbs (88.6 kg, or 13 st 13). My primary goal is glucose control, and after that comes preservation of muscle mass. A distant third on the list at this juncture is weight loss.

That will do ‘er for this week. Now, it’s time to fill up that new refrigerator. I’ll be back with you next week for the next instalment in the continuing saga of As the Turkey Turns.

*With apologies to Professor Amar Mukherjee, former Chair of Computer Science at UCF, who once prohibited the use of the word “soonest” in any internal departmental correspondence to my eternal bemusement, may he rest in peace.

My Week with Mounjaro

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I’ll avoid using the picture of the Mounjaro injector to see whether that is what is triggering the draconian Facebook anti-spam algorithm. But who knows? They might delete my link to this post anyway. So, if you don’t see this on Facebook this week, I hope you’ve subscribed via the provided tool on the right. You won’t get any spam from me, just my bullshit. The creepy AI-generated cat picture I have included is meaningless, but Facebook appreciates cats, as is affirmed by the ubiquitous cat images on the social media platform. So, how could they possibly object?

For those who are new to this weekly Mounjaro update, in it I report my progress on the type two diabetes drug, on which I initiated therapy last June. Additionally, I cover topics I presume to be of interest to anyone either using or considering using this medication for diabetes. I add editorial comments about controversial topics from time to time. Hey, it’s my blog, and it’s the only soap box I have! And, by the way, a trip around the world is not a cruise, and medical treatment is not a journey.

This week on my non-journey, I’ll be looking into reports of tainted compounded versions of semaglutide and tirzepatide, the generic equivalents of Ozempic/Wegovy and Mounjaro/Zepbound, plus Novo Nordisk’s warnings about such drugs. Then, I’ll report on my health progress, always fertile territory for commentary, given that I am a metabolic horror story who has outlived his life expectancy.

Compounded Semaglutide Perils?

The drug that caused the off-label, fat loss craze that started it all, Ozempic, has inspired a profitable secondary market. Compounding pharmacies sell compounded versions of its active ingredient, semaglutide, to the weight-loss crowd. Although Novo-Nordisk, the Danish manufacturer of the branded drug has also sought and received FDA approval for sister drug Wegovy (also semaglutide) specifically for weight loss, these branded drugs are costly. When drugs are in short supply, the FDA allows compounded, generic versions to be sold. Thus, current supply shortages of semaglutide and tirzepatide (Mounjaro/Zepbound) have enabled opportunistic compounding pharmacies to produce and sell lots of generic, compounded product.

But compounding pharmacies are state regulated. Although required to report regularly to the FDA, they can take shortcuts in reporting data. State inspections vary in thoroughness and effectiveness. Unsanitary facilities sometimes are not detected. But the average consumer lacks the expertise and availability of data to vet these outfits. Does anyone know where the ingredients come from, how the drugs are produced and under what conditions, and so forth? Much of the weight-loss public’s hunger for these vogue drugs relies on faith.

Even if most facilities are sterile and take great care to avoid selling contaminated products, occasionally, a horrible tragedy occurs. Such was the New England Compounding Center case, in which dozens of people died and 750 suffered grievous bodily harm. How does one know what one is injecting into their body? Although most compounded medications are safe, it takes only one bad batch to wreak havoc. That there is even one such batch of tainted medication out there makes it akin to playing Russian Roulette.

Deaths and Hospitalizations

Approximately 10 deaths and 100 hospitalizations in the United States have been linked to use of off-brand, compounded semaglutide, according to the drug’s manufacturer Novo Nordisk. Similar issues have been reported from use of compounded tirzepatide, the active component in Eli Lilly & Company’s Mounjaro and Zepbound. Both Novo Nordisk and Eli Lilly have taken steps to curtail the distribution of compounded versions.

Naturally, the compounding pharmacy industry and their partners in retail weight-loss clinics and health spas are outraged. So are members of the weight-loss community who are addicted to these drugs and who can’t afford the high-priced branded products. One cannot blame Novo Nordisk and Eli Lilly for wanting to protect their profits. But the boosters of the compounding industry have characterized their efforts to inform and warn consumers as transparent attempts to control the market. I am not going to land on either extreme. I merely preach using caution when buying compounded products. Be as thorough as possible in researching the company that will sell you something you inject into your body.

Fullerton Wellness product contamination

As of November 1, the FDA warned patients and health care professionals not to use drugs compounded and distributed by Fullerton Wellness LLC, Ontario, Calif., dispensed to patients by medical offices and clinics. On August 14, 2024, FDA received a complaint from a patient who noticed a black particulate in a vial of semaglutide distributed by Fullerton Wellness. On September 23, 2024, FDA received information from California regulatory authorities as part of ongoing collaboration between FDA and the state noting deficiencies found at Fullerton Wellness during a state inspection. After the state inspection, Fullerton Wellness voluntarily ceased operations.

However, the tainted drugs were distributed and are still lurking out there. This certainly is an example that underscores the need to proceed cautiously.

FDA Guidelines for Consumers

Although I frequently question the FDA’s ties to Big Pharma, likening the agency to the fox guarding the henhouse, it still performs some valuable services. The FDA’s recommendations for use of compounded versions of GLP-1 drugs, including tirzepatide and semaglutide, are worthwhile reading for anyone seeking to improve their chances of avoiding adverse events when considering alternative sources. The agency has identified several areas of concern for compounded GLP-1 drugs. It is working with its state regulatory partners and will continue to communicate with compounders regarding these concerns. 

The agency states that as of August 31, 2024, FDA has received: 

  • 136 reports of adverse events with compounded tirzepatide. 
  • 346 reports of adverse events with compounded semaglutide.

Considering the burgeoning size of the market and the number of units sold, the number of adverse events is small. But if you care about what you inject into your system, this document is well worth your time. Consider it that ounce of prevention. Saving a few bucks now using questionable drugs from loosely regulated suppliers can cost you dearly in the future. Be careful!

My Progress on Mounjaro

My doctor prescribed Mounjaro at the starting 2.5 mg dose back in early June 2024. After ten weeks, my dose moved up to 5 mg, which I have injected weekly since then. Although not cheap, I am fortunate to have insurance coverage through my Part D Medicare prescription drug plan. Otherwise, I would either need to pay the retail price (about $1100/mo) or deal with tele-health compounding pharmacies. As you know, I am wary about the latter, so I would avoid that alternative.

My aim is to get my numbers in line, then “kick the habit.” I do not wish to be shooting up with Mounjaro forever. Meanwhile, I am relearning how to control carbs, with feedback from my continuous glucose monitor. (Yes, more money out the window, but diabetes ain’t cheap). The monitor enables me to gauge the effect of various foods on my blood sugar. For example, a recent lunch at our favorite Greek joint yielded an unexpected spike. I thought stuffed grape leaves would be fine, but the rice in them (plus God knows what in the lemon sauce) was too much of a glycemic load. So, as my old friend Joey’s mom used to say, “Learn to eat!” Once I do and I commit myself to good habits, I hope to wean myself from Mounjaro.

The Mounjaro Numbers, Already!

Average glucose for the week has been about 100 mg/dL (5.6 mmol/L), roughly flat. Morning fasting glucose averaged 101 (5.6), still above where I want it to be. No more dolmades for me!

Weight fluctuation was minimal during the week, winding up at 199.6 lbs (90.7 kg). Aside from the grape leaves, I can’t think of any serious dietary transgressions, so I’ll consider this a weight plateau. As you recall, weight loss is a secondary or tertiary goal of mine, so I’m not going to get all upset over not consistently “looseing weight” (sic – common egregious social media misspelling).

My physical therapy for lumbar radiculopathy continues apace. Although I have not felt much of a difference in pain levels, the core strengthening exercises and stretching are doing me good. The nagging pain, burning, and numbness from the related meralgia paraesthetica continues. Its onset was just before I started the PT. It is an inflammation of the femoral lateral cutaneous nerve, a sensory nerve associated with the lateral aspect of the thigh. Nerves take time to heal, but I decided not to leave it to chance, lest there be some correctable impingement going on there. To gain a better perspective, I made an appointment with a physiatrist (physical medicine and rehab doc) in early December. I hope more physical therapy will help with the problem, so I am not making any appointments with neurosurgeons — yet.

That’s It for Now

Summing it all up, I hope I have added enough useful information to my mundane health issues to have made this read worthwhile for you. I will return next week with another update — and maybe, a new cat picture.