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Mounjaro: First Month Progress and Setbacks

Posted on July 1, 2024 Written by The Nittany Turkey

As of yesterday, I completed four weeks on the diabetic drug Mounjaro (generic name: tirzepatide), with some encouraging results. However, I also received some alarming blood test results that could be a setback. This blog does not sugar-coat the Mounjaro experience (pun intended), so I present the good with the bad.

For those of you who are just joining us, I am an old fart nearing the conclusion of my eighth decade on the planet. Yeah, I’m old, which most of those Mounjaro/Zepbound/tirzepatide patients you will find on social media are not. They seem to range from 20s to 60s, so we septuagenarians, with our own finicky problems and comorbidities, are rare birds, indeed. However, everyone is welcome to read and comment here, regardless of age. I promise that there will be no age prejudice, and I will not disrespect my audience by calling you “you guys”. Besides, my wife thinks my mental age is thirteen or fourteen. However, I will continue to throw stones at what I believe to be flagrant misuse of the drug, which is in short supply for us legitimate users.

Social Media Travesty of the Week

Before I get to my progress, I need to share my curmudgeonly outrage over an individual I saw on YouTube proselytizing the use of tirzepatide. He was young, healthy, and fit. I wondered, “What the hell is this guy doing taking this drug?” As the video developed, it became clear that he is some kind of personal trainer, and he puts his clients on the drug. (How and where they get it might involve shady internet doctors and compounding pharmacies). And then, the capper: he uses it himself to go from 10% body fat to 5% when he wants. The theory espoused by this long-haired gym rat is that we must mimic our primordial ancestors: fatten up in the winter and be lean and mean in the summer. But I digress. This is a completely ridiculous and dangerous pied piper who will lead many children out of Hamlin into the mountains.

Mounjaro Madness Indeed

No, I am not condemning the on-label use of Zepbound/tirzepatide for weight-loss for the morbidly obese. But as I have noted before, the preponderance of people throwing money at this drug for recreational use is disturbingly squeezing the supply for legitimate users with 40% body fat or Type Two diabetes who desperately need Zepbound or Mounjaro. This recalls young studs buying Viagra or having it passed out at orgies, which is also a “thing”, but without the supply squeezing aspects at this point, as sildenafil is ubiquitously available. In summation, the use of tirzepatide to erase one’s last 5% of body fat smacks of recreational use, no doubt by the anabolic steroid crowd.

Eli Lilly, the manufacturer of Mounjaro and Zepbound, is taking steps to curtail the distribution of counterfeit and other third-party tirzepatide. Perhaps this will either slow the frivolous distribution of the drug or it will create a robust black market.

All right. End of rant.

Progress for the Week

My glucose measurements for the past week averaged 108 mg/dL. The biggest two-hour postprandial spike was after our Thursday Colombian restaurant lunch, replete with fried plantains, white rice, bean soup, and carne asada. That spike was just up to 151 mg/dL. Meanwhile, my non-diabetic wife hovers between 80 and 98. Muy bueno, and when I grow up, I want to be just like her.

The weight loss continues. I lost five pounds during the past week. I want that to slow down, because too rapid weight loss causes all kinds of issues. For example, my skin is much less elastic at my age, for one annoying cosmetic feature. Also, and more importantly, looking back to last week’s post, we have seen that Mounjaro can dangerously accelerate dehydration. Keeping my weight loss at a sane level of one to one-and-a-half pounds per week is my goal. Weight loss is secondary to controlling the killer within me. To put it another way, not controlling diabetes is tantamount to prolonged and painful suicide.

And speaking of dehydration, this brings me to my unsatisfactory lab results.

Bad Blood

One of my old fart comorbidities, one that correlates strongly with diabetes, is chronic kidney disease (CKD). I had been at Stage 3A, but as of my blood test last Friday, I had descended into Stage 3B. My creatinine had increased significantly. Also worthy of note was the CPK (creatine phosphokinase), which was moderately elevated. The latter test relates to muscle damage and muscle loss, which is a concern for us older-than-Mathuselah dudes and dudettes who take Mounjaro, according to studies. It can affect our kidneys, which cannot filter all the toxic by-products of muscle destruction from the blood.

You might recall that I had a dehydrating hike (I covered it last week). Dehydration is certainly dangerous for kidneys, especially those that are already compromised. It is possible that the dehydration caused an acute kidney injury, and this crappy creatinine value was the result. Neither my doctor nor I blame the rapid increase on Mounjaro. However, as I confessed last week, I am an idiot. I am not invincible and immortal as I thought I was in my twenties when I did whatever I pleased with no consequences. Now I am an old man, one who needs to take care of himself because decades later I am suffering the consequences I never thought about in my youth. Setting myself up for potential acute kidney injury is about as stupid as it gets.

Addicted to Mounjaro?

Am I ignoring potential adverse effects of Mounjaro? No suspension of disbelief here by attempting to cling irrationally to a drug that has done me lots of good. Throughout this experience, I have not turned a blind eye toward the side-effects, but I understand that aspect of our psyche — part of the underlying mechanism for addiction. “Don’t take away my Mounjaro,” I heard myself saying, “even if it screws up my kidneys and I die!” Then, I became more introspective. No, if there was even a shred of evidence in the literature that Mounjaro can destroy kidneys, I would be out the door faster than a guy who pays with a counterfeit hundred-dollar bill at a Mafia-run whorehouse. (Not adjusted for inflation).

On the contrary, a perusal of the literature is encouraging on the kidney front. Researchers are concluding that Mounjaro and sister drugs forestall the progression of chronic kidney disease instead of exacerbating it. However, there is no guarantee against stupidity of the sort I exhibited bushwhacking in 97-degree weather while taking a drug noted for its dehydrating effects. And, oy vey, at the same time, I was taking hydrochlorothiazide, a diuretic, which I have discontinued since then.

Regarding the potential for muscle loss, I have amped up my protein intake and my strength exercises. Of course, this could relate to the elevation in CPK. However, I will need to watch the creatinine and adjust protein intake if it continues its upward trajectory.

Retest in a Month

My doctor feels that there is no need to panic over the creatinine number. He is aware of my dehydration and its potential to distort the numbers, so he wants to re-test in one month to see where the numbers are headed. In the meanwhile, I will keep on doing what I am doing.

That will do it for this month. I hope you are finding these weekly accounts interesting. And no, I won’t exhort you to click the like button below and subscribe to my ‘channel’ like they do on YouTube. Unlike those “influencers”, I do not do this for money; I just want to share my experiences with others who might find them meaningful. I will continue to write these weekly recaps of my trials and tribulations and I thank you readers for taking the time out of your schedule to read my humble posts.

I wish all of you in the U.S. a Happy Independence Day and all of you in Canada a Happy Canada Day!

I’ll be back next week with more progress reports, observations, and curmudgeonly comments.

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Filed Under: Health, Mounjaro Tagged With: Mounjaro, terzepatide, Zepbound

Mounjaro: Week Three

Posted on June 24, 2024 Written by The Nittany Turkey

I write a lot, and I enjoy doing it. Recreational writing ventures include a regular column in my club newsletter, the Penn State football portion of this blog, and now, this weekly feature regarding my foray into the use of the diabetic control drug (and vogue weight-loss sensation), Mounjaro. Writing about it also provides a record of my experiences for personal reflection, a weekly diary, as it were. Having completed my third weekly injection, I am here to provide observations and some opinions about the drug and its popular culture.

Recapping the past two week’s posts, I told you about my frustrations with the on-line so-called support community and with the drug’s availability. Nine out of ten vlogs and blogs center on the weight-loss aspects of the drug, even though at this point, the Unites States FDA approved Mounjaro for diabetes control but not specifically for weight-loss. (The FDA approved a relabeled version of Mounjaro called Zepbound for weight loss only). Last week, I mentioned that some YouTubers have received monetary compensation from big pharma for their efforts in promoting sister drug Ozempic and I disdained the practice of dose-splitting.

Today, I will talk about my continuing Mounjaro experience, especially one nasty side-effect that we do not talk about at the dinner table: constipation. Another one that I will touch on is dehydration. But first, the good part.

Progress after Third Week on Mounjaro

Recall that my dose of 2.5 mg is the “starter” dose of Mounjaro. For most people, the minimum therapeutic dose is 5 mg. After the first month, many move up to that dose. However, I chose to remain at 2.5 mg for the second month. I am an old fart with several significant gastrointestinal co-morbidities, along with my diabetes. I am wary about the rush-to-market testing not being thoroughly predictive enough for geriatric use. This decision to remain at 2.5 was mine, not my doctor’s.

Tomorrow, I will discuss my thoughts with my doctor. I want him to order a set of blood tests—nothing too elaborate—a SMAC-25 as a baseline for repeat and follow-up in six months, which will coincide with my next annual physical exam. I want to make damn sure that this stuff is not doing anything bad to my liver, kidneys, my muscles, and my kishkas in general.

Weight Loss, or Lack of Same

My weight loss stabilized and was flat for the week, no major surprise due to a couple of things. For one, I had been taking hydrochlorothiazide (HCTZ) as an adjunct medication for control of high blood pressure. However, since starting Mounjaro and adjusting my diet, my average morning BP is less than 120/70. Therefore, I discontinued the HCTZ with my doctor’s concurrence. HCTZ is a diuretic; in view of my dehydration, I expected to gain a little rebound water weight. Thus, it is no surprise that my weight remained unchanged since last week. I’ll note, though, that dehydration and rehydration caused a two-pound drop and increase during the week.

Glucose Control

This is the area I am most interested in, as diabetes is a killer. Many of its symptoms are occult, and we do not discover the damage this disease has wrought until it is too late. Crappy diets and metabolic syndrome exacerbate the situation. My alarm over a recent A1c report impelled me to use Mounjaro, despite the possible negative side-effects.

I am happy to report improved glucose control. My morning fasting glucose readings had been over 140 mg/dL prior to Mounjaro. During the past week, I averaged 98. Today, for example, I measured 92 before and 98 an hour and forty-five minutes after the meal. Whether or not I can attribute this completely to Mounjaro is muddled by my associated dietary changes. I will describe those next.

Dietary Changes

A well published benefit of Mounjaro is appetite suppression, given its dual effects of slower digestion and increased satiety. These “features” make it easier to change one’s diet to lose weight. So, what did I change?

I am eating smaller meals, less junk, and more fiber and protein than previously. My insulin resistance makes it problematical to consume lots of carbs, which I had been doing before the Mounjaro excursion. Sneakily, I was eating lots of cereal to provide the fiber I needed to keep the kishkas running, and of course, this caused weight gain along with glucose spikes up the ass for the past year or so. Now, I have a protein breakfast accompanied by a glass of psyllium fiber supplement to provide the fiber. I anal retentively track my meals with an app called MyFitnessPal, which ensures that I stay on track.

My protein target is ninety grams per day. It is especially important while taking Mounjaro to ensure adequate protein in the diet, because especially among us old farts, weight loss attributable to the drug often involves loss of muscle mass. Protein in the diet and resistance exercise are necessary to avert this damaging consequence. Furthermore, muscle destruction, called myolysis, can cause kidney damage, to compound the felony. So, I do what is necessary to keep the protein up and I am increasing my exercise.

Whether these changes result from the power of suggestion or the drug itself is a subject for debate. I would hope that they are permanent for me, so I can discontinue the drug at some point. Recall that I am at the starter dose of Mounjaro, which is half the recommended minimum therapeutic dose.

Some Mounjaro Side-Effects

In Economics 101, we learned the “TANSTAAFL Principle”, which posits that There Is No Such Thing as a Free Lunch. With Mounjaro, too, you will not be able to have your cake and eat it, too. (Mixing food and sugar metaphors and puns is fun for this old fart, but I digress). Aside from the price you pay at the pharmacist, trade-offs exist in return for your diabetes control and weight loss. You should prepare for them and do what is necessary to minimize them.

Below, I describe two common and notable adverse effects, which are constipation and dehydration. Some users suffer nausea or vomiting, two quite common side-effects I have not experienced. The published information for Mounjaro describes many other potential effects, some unbelievably bad. Therefore, you should diligently read the package insert and consumer materials and discuss them with your doctor to understand what you are getting into here. And do not for a moment think that you can just play with Mounjaro as a cosmetic, no-consequence drug without potentially serious side-effects. If you’re just seeking to lose a few pounds, it is not worth the risk.

Constipation

Nobody likes to talk about it, but most of us have experienced this unpleasant condition, a notable and common side-effect of Mounjaro. Man, it sucks! I keep the fiber up, but things just do not move through there like they used to. I have also used Miralax and Senekot. My guess is that they worked a little, and that without them, I would really be up the shit creek without a paddle. (So to speak).

This cannot be good over the long term, and I must wonder about the increased potential for intestinal blockages. The on-line so-called support group solutions are ridiculous, including the exhortation to eat watermelon. Completely worthless! I will discuss this subject with my doctor tomorrow to see if he has any bright ideas.

Dehydration

You MUST maintain your hydration while taking Mounjaro, or else! Kidney damage is irreversible. You drink lots of water with Mounjaro to ensure that does not happen. The idiotic weight loss community justifies the personal inconvenience of diligently pursuing increased hydration with the moronic maxims, “water burns fat” and “water flushes fat”. OK, I’ll give them their fantasies. Any port in a storm! Employ whatever reasoning you choose, but just do it! DO NOT obsessively celebrating “loosing” on the scale by regarding dehydration as legitimate weight loss. Hydrate diligently and intelligently. Your kidneys will thank you.

Ants: “Your a idiot!”

As I mentioned, I was taking hydrochlorothiazide for blood pressure control. This, in combination with the Mounjaro, cause excessive dehydration. I can typically tell when my hydration is low by how prominent my veins are in my arms and legs, and during the past couple of weeks on Mounjaro, it has been low. Couple this with my decision to do a strenuous hike last Tuesday in “feels-like” temperatures of high 90s Fahrenheit, and you have a recipe for disaster. I had to lay down during the hike to rest for a while, as my heart was pounding due to hypovolemia and the heat. A few harvester ant stings added insult to injury. Perhaps they were driving home an oblique hymenopteran message: “dumbass!”.

I brought along two-and-a half liters of water for that hike, which was only three-and-a-half miles, but it involved some heavy bushwhacking. I drank all that water. Furthermore, in the days before the hike I drank lots of fluids. Still, I became seriously dehydrated and felt crappy for days. My doctor confirmed that dehydration can occur with sudden onset while taking Mounjaro. One reason for this is that the satiety effect suppresses thirst as well as hunger, so people forget to drink water. So, please heed my warning!

Summing Week Three on Mounjaro

This concludes my weekly observations. I am hoping that my observations regarding side-effects like constipation and dehydration, as well as my modest short-term successes on a low dose of Mounjaro, will help guide you in making your personal decision to collaborate with your physician in determining whether “Mounjaro is right for you”.

I want to add that while social media has its place, it does not replace your legitimate doctor. (I add the qualification “legitimate” because weight-loss boutiques and less than scrupulous teledocs are now prescribing terzepatide to anyone, just for the asking). Too many people who get most of their information on social media are too lazy to do the real research necessary to make their own decisions. Social media posts run the gamut from highly informative to complete misinformation, with some “influencers” dangerously verging on practicing medicine without a license. To avoid legal trouble, most will provide a disclaimer. Take it seriously! You must not rely on “influencers” to make your health decisions, which should be a collaboration between you and your physician(s). Watch the influencers’ posts for amusement, take note of any interesting tidbits, and then talk to your doctor.

That’s it for now. I will return next week with more observations and paths forward.

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Filed Under: Health, Mounjaro

Mounjaro Madness

Posted on June 17, 2024 Written by The Nittany Turkey

Last week, I wrote about my first week on the vogue drug Mounjaro, manufactured by Eli Lilly & Company. I described my negative experience seeking a decent diabetic support group that was not completely obsessed with weight loss. This blog seeks the truth, not pop wisdom. Realizing that alienating the obsessive weight loss community will cause my readership to evaporate, I continue to avoid the subject of “how much, how fast?”. If you’re in that camp and you’re looking for a feel-good blog that will provide validation for your $1,200/mo., this ain’t it. Stop reading now!

My second week on the Mounjaro starter dose of 2.5 mg just ended. I have had no side-effects worthy of note. My average blood glucose is decreasing, although my dietary adjustments account for some of that, as well as the 7.6-pound weight loss I have experienced. I suspect that most of the latter is water weight loss, as the Mounjaro seems to produce a diuretic effect.

So, there isn’t much to report regarding weekly progress, but then again, I’m on the starter dose. I understand, subject to error in my interpretation, that 5 mg is the minimum therapeutic dose for Mounjaro, and I expect to get there at some point. The same documentation says increase to 5 mg after the first month, but I’ll stick with 2.5 for at least the second month. I’m old, I have co-morbidities up the yingyang, and I’m not anxious to start with the adverse effects. Hell, if I can accomplish what I want to accomplish on the 2.5, I’ll stay at 2.5!

Not a Miracle Drug

I want to dispel the notion that Mounjaro is a “miracle drug”, which will automagically bring your A1c and weight back to spec. That is bullshit. Mounjaro might help, but it will still require arduous work on your part. When I see people on Facebook or YouTube talking about how they can now have their pineapple margaritas with a clear conscience, it annoys the hell out of me.

If a responsible doctor who is integrally involved in your long-term health management prescribes Mounjaro, you must be prepared to do your part. You will need to ensure that your diet is adjusted. If you do not, serious side-effects will ensue, aside from defeating the purpose of taking the damn injection in the first place. For example, if you do not keep up with daily protein and exercise requirements, the weight you lose will be more muscle than fat.

Another undesirable side-effect is kidney damage relating to dehydration. You must diligently ensure that you are well hydrated. This is not an option, borne of the folk wisdom of the gratuitous weight-loss crowd that “water flushes the fat.” It is necessary for your survival. Have I made my point?

If these are things you don’t want to read because you’re only interested in losing weight at all cost, you’re in the wrong place. However, the the drugs in this class (GLP-1/GIP-1 uptake agonists) have proven to be valuable adjuncts to lifestyle modifications in controlling Type 2 diabetes. My major advice is to discuss everything with your doctor and resist falling into “influencer” traps.

Dose-Splitting

I’ll shift gears to take another look at the latest on-line lunacy, dose-splitting. Perhaps spurred on by supply shortages or by a desire to economize on those $1,200 monthly payments not covered by insurance, people are sharing information about how to stretch doses. For example, they buy 15 mg Mounjaro pens and make three 5 mg doses from them. Are these people nuts? Who is guiding them? I have seen no fewer than five YouTube videos providing amateur, hearsay instructions to willing “influencees”. The blind leading the blind.

This is fully analogous to idiots wanting to save money on an electrician, thinking that watching a YouTube “How to Install Your Electric Vehicle Charger” will give them the knowledge necessary to perform the task. In the YouTube world, where the Dunning-Kruger Effect abounds, idiots counsel idiots, and good information must be weeded out. However, if you’re too stupid to know what good information is, you’re certainly too damn stupid to do the wiring for a 60-amp, 240-volt continuous load branch circuit. Go ahead, burn your house down! But I digress.

Just Nuts and Bolts, Right?

Much like the mantra of “it’s only wires and screws” intoned by the incompetent amateur electrician, you see similar ignorance from the amateur pharmacist weenies. You’ll do the equivalent of burning your house down if you play follow-the-leader with YouTube bullshit about “How to Be a Compounding Pharmacist Without a Degree.” However, it won’t be your house. It will be you!

This is something you are injecting into your body. Any contamination is a potentially large medical problem. Recall the 60 Minutes story about the compounding pharmacy in Michigan whose back pain injections killed people due to mold contamination while packaging the drug. If it can happen to the big boys with their expensive lab facilities, what about the kitchen table home pharmacy?

I saw one “influenceress” providing detailed dose-splitting instructions. She was going on about sterilizing a crappy-looking, battered table on which she was doing her compounding, while a dog walked around her, impatiently waiting to be fed. He had a bemused look on his canine face. “What the hell is she doing now?”

Paid “Influencers”

I love the term “influencer” because watching those clowns on YouTube, Instagram, TikTok, etc., I feel influenced to throw up. (No, it’s not the Mounjaro doing that, although nausea and vomiting are documented side-effects. I’ll need to wait for my dose to be increased to experience those fun features.). No, I’m just disgusted thinking that lazy minions’ decision processes are influenced by these unqualified commercial mini-enterprises. There is no regulation of the misinformation passed around as fact, and therein lies the problem.

YouTube has no problem allowing the crap I mentioned in the previous section, which could prove to be a large, general health risk. Neither do they care about the erroneous do-it-yourself amateur electrician videos. Yet they’ll take down political misinformation, as if that was life-threatening. Something’s gotta give with these unfettered “influencers.”

Annoyingly, I watched a woman who claims to be a flight attendant on Mounjaro doing her commentary while feverishly applying make-up. Who the hell wants to watch that? Does it give her street cred with the gratuitous, cosmetic weight-loss crowd? Seriously, you must be a combination of bored, lazy, and ignorant to watch that crap for any longer than it takes to click the “back” button.

Unbiased?

Well, it turns out that big pharma has not left the “influencer” stone unturned. I read an article in the Wall Street Journal recently that described payments of between $10,000 and $50,000 to so-called influencers to promote Ozempic, a sister drug. So, the “unbiased” personal testimony you harken to when you play “follow the influencer” might not be so unbiased after all. (I doubt that the manufacturers will consciously fund the geniuses who promote dose-splitting, though).

Frigging “influencers” also derive commercial revenue based on the YouTube algorithms. The more subscribers they get, the more videos they produce, the more “likes”, etc. all count toward their compensation. Only idiots believe that what they see on YouTube is straight-from-the-heart, altruistic, brotherly/sisterly advice from those who have been there. It is a commercial venture, and Mounjaro, Ozempic, Wegovy, Zepbound, and their cousins are big money keywords.

And don’t get me going on the annoying unscripted, rambling dialog, where the audience is addressed as “you guys” and videos begin with “Let’s get started!”. Harrumph!

Mounjaro Customer Cohort

The other evening, I received a call from my pharmacy. The young, female voice asked me whether I wanted to be a part of the manufacturer’s customer feedback program: “You’re taking a drug called Mounjaro. The company who makes it has a program for customers, which would involve one fifteen-minute phone conversation every month or so. Are you interested in participating?” I agreed to participate.

I am certainly curious as to what Eli Lilly has in mind with this Mounjaro customer feedback program. Will it be one-sided? Will they push me and my doc to increase doses or try to influnce us in other ways? I note on Lilly’s website that they offer the services of their own tele-health doctors, so I’m wondering whether that will factor in somehow. If you have participated in this program and can amplify on this information, please leave a comment. Enquiring minds want to know.

I will report any interaction with Eli Lilly and its Mounjaro customer feedback program here as my relationship with them progresses. Interestingly, though, before the phone call ended, I told the pharmacist’s mate that my participation in the program was contingent upon overcoming the supply issues associated with Mounjaro. She said, “Your refill is on or after June 23. I can reserve one for you so you’ll be sure to get it.” Perhaps participation in this program will pay off.

I’ll be back here next week with more comments about Mounjaro and the Mounjaro community. In the meanwhile, I continue to seek good information.

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