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…

This old fart has been on the type 2 diabetes drug Mounjaro for half a year, with dramatic results even on the lowest therapeutic dose (5 mg weekly). My latest HbA1c result was 5.5% (37 mmol/mol), I’ve lost 57 lbs (25.9 kg), and anecdotally, I believe my inflammation is reduced.

Last week, I completed my annual physical exam, which involved a lengthy review of my myriad ailments with Dr. DeLorean (not his real name), and the usual prodding and probing. After my requisite editorial opinion piece, I will report on the salient features of our discussion. Finally, I will report on Mounjaro influenced results of the week, and look at where I am going from here with diet and exercise, including some exit plan ideas.

Biden Administration Wants Medicare to Cover Fat Drugs

Long standing legislation prohibits Medicare and Medicaid from paying for weight loss drugs. However, now that interested parties, namely Big Pharma and their sycophants in the medical community, have classified obesity as a chronic disease, their co-conspirators in government wish to spend taxpayer money on this crap at an estimated cost of $25+ billion. Please do not be so naive as to think that government has any money of its own. This expenditure will hit our wallet. All of us. Simply stated, it is a transfer payment from the taxpayers to Big Pharma, who will use the logical fallacy that obesity is only treatable through their drugs as a justification for this plunder.

On the governmental side of the equation, what is the political impact? The lame duck Biden Administration is flipping a big, populist bird at the incoming Trump Administration, hoping to either embarrass them into preserving the policy or use the repeal as public attack material to gain an edge in the mid-term elections, spending taxpayer money to do it. Fat people vote; seniors vote. Folks, it is all about money and power, not about public health. That’s my opinion and I am sticking with it.

The Real Fix Is Not Throwing Drugs at Obesity

If the Federal government wants to do something about obesity, it should start by blowing up the crony laden USDA, FDA, NIH, and CDC. Although I regard RFK, Jr as a crazy person, perhaps he’ll be crazy enough to accomplish that objective with the listed three-letter agencies. Also, I have high hopes for sane and rational Dr. Marty Makary heading up the FDA. In any case, the damn food pyramid essentially created by lobbyists, needs to be fixed and the government must devote significant energy toward regulation of ultra-processed food. It is the crap we eat and our sedentary lifestyle that is making us fat, not some mystery disease that only drugs can fix. Let government deal with that aspect, instead of lining coffers of Big Pharma with costly purported miracle cures!

Do I practice what I preach?

Am I a hypocrite? After all, I’ve lost 55 lbs and Mounjaro is responsible for much of that. I have type two diabetes, which, thanks to Mounjaro, is well under control. That was my primary goal, not weight loss. Furthermore, my plan is to get off Mounjaro at some point my doctor and I agree upon, after I have completely committed to permanent lifestyle adjustments, which I touch on below. I’m sorry to disappoint Big Pharma, but if their plans are for me to be on this stuff for the rest of my life, I’m hopping off that train as soon as possible. Alas, that profit-driven desire from the Big Pharma boardroom is the impetus for pushing Medicare to cover the GLP-1 drugs, because doing so will open new, geriatric doors for exploitation.

In my opinion, although proponents push the use of weight loss drugs as a preventive measure to forestall chronic metabolic disorders, the blanket authorization by government will be an expensive mistake that promotes abuse. Its estimated cost, as I mentioned, is $25+ billion, which like most government estimates is way the hell too low. The suggested threshold for approval is a minimum Body Mass Index (BMI) of 30. But I would expect that coverage will extend to people desiring cosmetic weight loss who do not necessarily meet that blanket criterion, exacerbating the waste of taxpayer money.

As I have stated many times in past updates, a basic principle of economics is There Ain’t No Such Thing As A Free Lunch (The TANSTAAFL Principle). Medicare Part D premiums will surely rise if this program is implemented. And fat people will rapidly realize that their co-pays will be huge, while Big Pharma and their government partners smile derisively at the hoodwinked public.

Another Problem: Waste, Fraud, and Abuse

Medicare abuse is rampant, and no one seems to be doing anything about it. In fact, I have been involved in at least two incidents where Medicare paid for crap I or my doctors never ordered. In one case, I was receiving dozens of Covid tests for several months from two different sources to the extent that I had an unmanageable stockpile of them. The Explanation of Benefits (EOBs) told me that those unscrupulous scammers were making thousands on the fraud. In another, even more ridiculous one, I received an EOB saying some outfit in Brooklyn had supplied me hundreds of urinary catheters and was, again, paid thousands of dollars. I reported both. The process is tortuous, and my firm belief is that benumbed government workers throw such claims in the Federal Workers trash can, because otherwise, they would need to do some work.

So, no, I do not endorse this obvious political maneuver. Too much of that one-hand-washes-the-other crap in Washington is too much, already. Let us work together to improve our food system, which after all is what made us fat, and let us encourage people from eight to eighty to increase their activity. Take that $25 billion and buy every overweight man, woman, and child in the United States some unbiased nutritional counseling and an exercise plan. Fix school lunches so they’re not pushing pure crap at our kids, establishing fattening up habits for the rest of their lives. Remember that a concerted effort in eliminating cancer and COPD deaths from smoking produced astonishing results. Much as we conquered our smoking habit, we can vanquish our crappy eating habits!

Thank you for reading another editorial rant from The Nittany Turkey!

Back to My Progress on Mounjaro

Dr. DeLorean expressed approval over my reduction in A1c, which at 5.5% (37 mmol/mol) is now below the pre-diabetes range in an area the medical industry considers “normal”. I told him my target was 5.2% (33 mmol/mol). He asked me why I wanted it that low. My response was that I had seen that number before, earlier in my life, so I set my sights on returning to it. Very unscientific, but I’m using it as a motivator.

Getting My Fat Butt in Gear

I got the doc to sign off on an exercise authorization for the local sports med and rehab gym. Today and tomorrow, I’ll be meeting with my personal trainer there to create a workout plan to augment the back and core strengthening exercises and dumbbell workouts I have been doing at home. My wife now classifies me as a gym rat. I’m not, but I do not mind working hard to achieve my objective.

I hiked roughly 8.5 miles (5.3 km) on two occasions in the past two weeks. The second hike turned into a swamp tromp, wading through fetid water, getting stuck in mud, dealing with aggressive attacks by thorny vegetation, and crossing a barbed-wire fence line four times. (I did not plan that bushwhack, but I’m relentless and stubborn when I set my sights on something, which was reaching a particular point on a trail that Hurricanes Helene and Milton had recently obliterated). At age 78, I believe the core strengthening exercises have increased my hiking endurance, which I intend to further test in the coming weeks. The current cool weather is a motivator. Alas, it never lasts long here in Central Florida. Soon enough, I’ll be out there dehydrating myself again on 95°F/35°C days with matching humidity.

Getting Off

Dr. DeLorean felt that it was too early to get me off Mounjaro, but felt that when the time came, I may start lengthening the interval between injections. He and I are well aware of rebound effects when withdrawing from GLP-1 drugs. It is my hope that when the time comes to get off this stuff, my diet and exercise patterns will have become permanent features in my daily existence.

I had been taking metformin concomitantly with the Mounjaro. Continuing the discussion about when I can get off the Mounjaro, doc said I can dump the metformin now. I am always happy to decrease the number of drugs I am taking, and the results you will see below reflect my metformin freedom since Tuesday.

My Mounjaro Numbers for the Week

Recall that Thanksgiving happened during the week. My Dexcom Stelo CGM tells the story. The instantaneous value shown at 9:07 PM on Thanksgiving evening during the Dolphins game, 121 mg/dL, needs to be adjusted downward by about 16 mg/dL to 105 mg/dL ( 5.82 mmol/L) to accommodate the bias against my measured blood glucose using a finger-stick blood glucometer. Stelo does not do that automatically, like the non-dumbed-down Dexcom G7. The Stelo measures glucose in interstitial fluid, not blood, so there is a difference in time and level. Anyway, what we’re interested in is the shape of the spike, not the absolute glucose value.

Thanksgiving dinner was nominally at 2:00 PM, although perfectionist turkey carver Aliya prolonged the anticipatory salivating agony. When the dinner bell finally rang, I avoided bread, stuffing, mashed potatoes, and gravy — and especially, sugar-laden cranberry sauce — concentrating on the delicious turkey Aliya had roasted beautifully. Additionally, I doled out some quintessential green bean casserole and a portion of the Greek Salad I made for the occasion. My major carbohydrate indulgence was a slice of pumpkin pie, which I suspect was responsible for the spike you see in the screenshot.

The Day After

Interestingly enough, my morning glucose on Friday morning was an outlier, still at 96 mg/dL (5.33 mmol/L); the average fasting morning glucose measured by my Contour Next One glucometer was 85 mg/dL (4.71 mmol/L). The Stelo tells me that my average glucose for the week was 115 mg/dL, so applying the bias I mentioned in the lead paragraph gives us 99 mg/dl (5.49 mmol/L). Not too shabby!

Weight loss for the week was 2.8 lbs (1.3 kg). Although I am still too fat, I want to flatten out the curve so I am not losing too much weight too quickly. If you have followed my progress at all, you’ll know that I have dropped precipitously from 245 lbs to 192 (111.1 to 87.0 kg) in six months, which can have some negative health consequences like treatment induced neuropathy of diabetes (TIND), which I described in the July 22 edition of this update.

That Should Do It for Another Week

So, as you now know, I made it through Thanksgiving, which is significant for a diabetic, old Turkey. I have progressed nicely with blood glucose, and I am working on strength, agility, and endurance along with cleaning up dietary habits, especially avoiding ultra-processed crap. As well, I continue to hope for a renaissance in the governmental agencies that allowed us to get fat, who now want to take the easy path of selling out to Big Pharma with the taxpayers’ wallets.

See you next week!