I’m a day late and a dollar or two short this week due to the long holiday weekend. Fortunately, I’m thinking my six readers (well, only four last week) had better things to do on Monday, anyway, so my missing Mounjaro update didn’t cause any separation anxiety. In any case, fear not! The prodigal Turkey returns with another episode of “As the Glucagon Turns” (subtitled “Taking the World in Big GuLPs”).

When I started this series, I just wanted to write about my progress, my trials, and my tribulations on the GLP-1 receptor agonist drug Mounjaro. I have been treating my Type 2 diabetes with Mounjaro for nigh onto a year. As my four regular readers know, I am a 78-year-old male who identifies as male and my pronoun is “who”. If anything, this will classify me as an owl, but anyway, I’ll now recap my accomplishments for new readers.

A Year’s Progress

On Mounjaro, I’ve lowered my HbA1c from 7.6% to 5.3%, eliminating metformin and lowering the dose of losartan (my ARB-inhibitor blood pressure medication). I’ve lost 65 pounds of blubber, cinching in my corpulent waistline from a tight 42″ to a true 36″ (and a cheat 34″). Along with taking the drug via a weekly injection of a 7.5 mg/0.5 ml dose, I have worked hard on resistance training and eating a decent diet. I want to establish revamped behaviors that will serve me from now until I take the eternal celestial dirt nap.

Apart from reporting on my progress and throwing in some information about some of my tools and techniques, I cover subjects relating to Mounjaro, health care, diabetes, and weight loss. My love-hate relationship with Big Pharma and the compromised state of the flawed healthcare system in this country frequently trigger me to vent my spleen through the keyboard. As well, my rants are anathema to YouTube influencers, who serve as mindless cheerleaders and shills for Big Pharma, pushing their products in return for compensation while feigning objectivity for the gullible masses.

This week, before getting to the part where I chronicle my week and present my progress, I’ll write about how coffee spikes my blood sugar in the morning and what that might mean. You might recall that in Week 43, I wrote about some interesting claims that coffee could increase muscle growth. Who knows what the research community will divulge next about the popular pick-me-up?

---

Rise and Shine: Coffee Awaits

Ever since integrating a Dexcom Stelo into my daily routine, mornings have become a bit more enlightening—or perhaps alarming—particularly regarding my cherished ritual: coffee. Each morning, shortly after my customary cup, a noticeable spike in my blood glucose appears. My curiosity piqued, I delved into the literature to understand this phenomenon better.

Contrary to popular assumptions, it’s not uncommon for coffee—specifically caffeinated coffee—to cause a transient rise in glucose levels. Indeed, the key culprit is caffeine, which acts by stimulating adrenaline release. Adrenaline, in turn, triggers the liver to increase glycogenolysis, thereby releasing glucose into the bloodstream. While this mechanism is fairly well-documented, it generally causes only a mild, temporary increase in blood sugar. However, the extent of this reaction varies among individuals, influenced by factors like insulin sensitivity, overall metabolic health, and perhaps even habitual caffeine intake.

Reduced Insulin Resistance?

The question becomes more intriguing when considering coffee’s broader metabolic impacts. Notably, several studies have highlighted a paradoxical yet beneficial effect: consistent coffee consumption might actually reduce insulin resistance over time. Researchers have suggested multiple mechanisms for this beneficial effect, including the presence of bioactive compounds such as chlorogenic acids and other polyphenols, which have antioxidant properties and may enhance insulin sensitivity.

Chlorogenic acids in coffee may reduce glucose absorption in the intestine and alter gastrointestinal hormone release, thus contributing to improved glucose metabolism. Additionally, coffee’s antioxidant-rich profile is believed to combat inflammation and oxidative stress—two significant contributors to insulin resistance and diabetes progression.

Can Coffee Forestall Diabetes?

Moreover, epidemiological studies consistently indicate that habitual coffee drinkers, especially those consuming 3–4 cups per day, have a lower incidence of type 2 diabetes compared to non-coffee drinkers. A meta-analysis published in “Diabetes Care” found that each additional daily cup of coffee was associated with a 7% reduced risk of developing type 2 diabetes, a significant protective effect.

This complex interplay between coffee’s acute effects on glucose and its chronic benefits on insulin sensitivity underscores the nuanced nature of nutrition science. It seems that the transient morning spike in my glucose readings might be a minor trade-off for coffee’s longer-term metabolic advantages.

In practical terms, awareness of this acute effect can help us make informed decisions—perhaps moderating the timing and quantity of coffee intake or combining it with other dietary elements known to blunt glucose spikes, like fiber or protein-rich foods.

Ultimately, while that immediate post-coffee spike might momentarily trouble my Dexcom readings, the broader evidence supports coffee as a beneficial ally in the ongoing struggle to maintain insulin sensitivity and manage type 2 diabetes effectively.

---

My Week on Mounjaro

Tuesday and Wednesday were to be doctor visits, but I slept through my Wednesday YAG laser zapping appointment. Tuesday was a follow-up with short-timer Dr. DeLorean. Being a concierge doc, he focused on how good I looked and called me “one of my biggest success stories”, reiterating that an HbA1c of 5.3% represents phenomenal glucose control for a diabetic. “That’s better than mine! We normally try to shoot for less than 7%.” But I quickly moved beyond the grandiose accolades, because I had some serious blood chemistry concerns and a possible inguinal hernia.

Last week, I wrote about a sudden rise in potassium level, which we need to monitor. I also mentioned that after several months of supplementation, iron is coming back to the low end of “normal”. We’ll retest both next month to see where they’re going. As for the hernia, DeLorean forgot to examine it, but referred me to a general surgeon anyway. His office called me while I was driving home. I asked if he wanted me to come back to examine me. They said, “No, from your description, he’s pretty confident that’s what you’re dealing with.” That’s pretty much the way that practice works — if they can’t prescribe a drug for it, farm it out to a specialist to do the dirty work.

Wake Up!

I had to postpone the YAG laser, which was to have been Wednesday. I had been “under the weather” all week and I overslept—right through the 7:30 AM appointment time. In fact, the phone ringing at 8:15 asking “where the hell are you?” from the ophthalmologist’s office served as my wake-up call. So that’s postponed to June 11, the same week as my appointment with the general surgeon to evaluate the hernia.

Today, I get to see a sports med doc about my left knee. It hurts when I am resting, but not when I walk, so who knows? I had an MRI about a year-and-a-half ago that showed it was still in pretty good shape, much better than the other knee.

Isn’t it cool how we spend all our time trying to forestall the deterioration of our bodies as we cross the divide between middle age and OLD? On to this week’s numbers.

Mounjaro Numbers for the Week

Body Weight: 180.8 lbs (82.2 kg) — unchanged
Fasting glucose: 95 mg/dl (5.3 mmol/L) — unchanged
Average glucose (Stelo biosensor): 108 (6 mmol/L) — damn Stelo died on me on Sunday! I requested a new one.

---

Conclusion: Grounds for Optimism

So, where does that leave me at the end of Week 51? Still at 180.8 pounds, still holding fasting glucose steady at 95, and still poking a needle into my gut every week like it’s just another Tuesday—which, often enough, it is.

This week’s exploration into the metabolic minefield triggered by my innocent morning brew reminds me of an essential truth in diabetes management: context matters. A glucose spike from coffee might seem counterproductive in the short term, but it’s a blip on the broader metabolic radar if the long-term trend points toward improved insulin sensitivity and reduced disease risk. That’s the delicate balancing act we play: minute-by-minute vigilance blended with month-by-month patience.

And patience, dear reader, is a virtue you’ll need in spades if you’re trying to navigate America’s healthcare labyrinth with anything more nuanced than a sinus infection. Case in point: I’ve got one foot in the exam room and the other on the voicemail of a scheduling assistant, just trying to stitch together coherent follow-ups for potassium levels, laser zaps, hernia pokes, and knees with minds of their own.

Not Too Bad

But you know what? At 78, I consider it a small miracle to be able to lift weights six days a week, hike nine miles without serious complaint, and gleefully eviscerate the medical-industrial complex from my keyboard. The GLP-1 ride has delivered far more than I expected when I started out, and with my numbers stabilizing, I now focus less on weight loss and more on what I can do with this leaner, meaner carcass.

Next week marks the official one-year point. I’ll take stock, sip some celebratory (black) coffee, and see if the Dexcom screams or shrugs.

Stay tuned—this turkey isn’t done roasting yet.

---

For an annotated catalog of all my Mounjaro updates, please visit my Mounjaro Update Catalog page.

Welcome back to another edition of Mounjaro updates, industry news, alliteration, and my patently impertinent opinions. Each week, I reveal my experiences with GLP-1 receptor agonist therapy for Type 2 diabetes. At age 78, I’ve been at it for almost a year now, with significantly tangible results, namely lowering my HbA1c from 7.4% to 5.3%, de-prescribing metformin, reducing losartan, my blood pressure medication, from 100 mg per day to 25 mg per day, and shedding 65 pounds of body weight. But I digress.

My personal objectives have evolved from weight loss and glucose reduction to maintenance in both those areas. Muscle loss always accompanies rapid weight loss, so I have amped up my resistance training program while increasing the protein and carbs in my dietary intake. Sarcopenia conspires with the weight loss to cause even more muscle atrophy in older adults, inspiring me to redouble my efforts.

My secondary objective is to discontinue Mounjaro before year-end. The fewer drugs I take, the better. Furthermore, Mounjaro ain’t cheap! Despite being covered by insurance, it costs me about $250 per month. I can think of a wide range of better things to buy with that money. However, quitting is a two-edged sword. The peril is a rebound in glucose and body weight, and the key to avoiding both is to continue the stringent lifestyle changes that got me this far.

Oversharing

I try not to bore you completely with my medical details. You’ve got problems of your own, so you don’t need to spend great gobs of time pondering mine. However, my hope remains that you will gather a modicum of useful information from what I write here. Please remember that I’m not a doctor, so I’m not offering medical advice—just recounting personal experiences and delivering irreverent opinions about the sad state of healthcare in the 21st Century. Surely, you will relate to some of it.

Later, on the mundane personal health front, I’ll share my happily boring weekly numbers and my latest lab results, which include a new low in HbA1c. I’ll recap my one-month honey experiment, which might have impacted those labs. But first, it is time to go off on those healthcare software abominations known as patient portals.

(RD, this one’s for you!)

This Week’s Non-Mounjaro Rant—Patient Portal Purgatory

In this week’s issue, we take a cynical look at the ubiquitous medical software backwater called “patient portals.” You’ve encountered them and you share my frustration with them, no doubt. They’re poorly written, they’re clunky, and they have seen little improvement through the decades. Could it be that the industry doesn’t care about effective communication with patients? Ya think?

I’ve been wasting lots of time on multiple patient portals compiling information for my forthcoming doctor change. When I brought up the subject with my wife, she commiserated with me by sharing her own patient portal tales of woe. She hates getting emails telling her she has a message in her patient portal, which is a pain in the ass to navigate. “The word ‘portal’ suggests a connection to The Twilight Zone,” said Jenny. “I can’t get it out of my head.” I’d say she was onto something—an apt characterization of an other-worldly software usability experience.

Who Wrote That Crap?

A friend who has been involved in engineering projects most of his life recently commiserated on the sad state of patient portal software. He is currently dealing with serious health issues requiring coordination of information among multiple providers. However, the poorly designed, antiquated, user unfriendly interfaces of patient portals make them more of an impediment than a useful tool. “You and I have led projects where such garbage interfaces and shoddy work would have been summarily rejected and would have gotten us fired. Are patient portals designed by committees of kids on skateboards, or what? Who is leading them?” My lamely dismissive response was, “The God of Apathy.”

I sure as hell wish the healthcare industry would actually care, but their aim has long been offering token compliance appeasements instead of useful tools. As long as the insurance companies and the federal government are their funding sources, patients will be relegated to their perceived role as necessary evils who happen to carry the key to the insurance reimbursement castle.

Understandably, patients are dissatisfied with the status quo, which suuuuuuuuuuuuuuuucks. Will patient portals ever fulfill their promise or will they top out disappointingly at “not too bad”? Read on and learn how they arrived at their current nadir of usability, then read our proposed solution. As always, your thoughts and comments are welcome!

---

The Patient Portal Problem: Healthcare’s Missed Digital Revolution

Introduction

Imagine, if you will, a world born from the luminous haze of the dot-com dawn—a world where the phrase “patient portal” was uttered in a health IT conference room with the hopeful naiveté of a new millennium. The name endured, calcifying into bureaucratic scripture, while time marched on. Now, thirty years later, what was once hailed as digital progress stands ossified—a relic of static screens and unmet promises, preserved in the amber glow of compliance. In this other world, you’re a card-carrying patient with no name and no face, just a date of birth and a password. You have now entered the Patient Portal Zone… [fade to black]

How the Portal Got Its Groove (and Lost It Immediately)

The ostensible original vision? Empower patients! Improve outcomes! Communicate with ease! Those goals would be attainable in a normal, customer-driven industry, but that ain’t healthcare! What we got instead was a clunky login screen, two-factor authentication that works 50% of the time, and a messaging system that might as well be a wax-sealed letter delivered on horseback.

In the early 2000s, the idea of a centralized digital interface for patients was radical. So naturally, healthcare vendors borrowed the word “portal” from the corporate world, where it meant a homepage stuffed with useless links. The branding stuck—because “screwed-up nightmare” was already taken.

Once Meaningful Use regulations, crafted during the Obama administration, began incentivizing the mere existence of patient portals, vendors rushed to ship half-baked, checkbox-satisfying garbage. The result? Software designed by committee, deployed by fiat, and maintained by people who hadn’t logged in since Bush v. Gore.

Glossary of Patient Portal Bullshit

• Patient Portal: A secure digital environment designed to prevent patients from easily accessing their data while feigning transparency.
• Secure Message: An email-like function where your doctor’s assistant might reply in 7–10 business days with, “Please call the office.”
• Visit Summary: A PDF download of your last appointment, formatted like it was generated by a dot matrix printer in 1987.
• Lab Results: Clinical test values released at 3:27 a.m. with no context, leading you to either WebMD-induced terror or apathy.
• Appointment Scheduling: A tool that lets you see all the available appointments you can’t actually book without calling.

Why We’re Still Stuck in 1999

• Healthcare’s Lack of Competition: Patients can’t shop around easily, so providers don’t have to care. Welcome to health don’t-care. If our patient portal is as crappy as the practice’s down the street, it’s “good enough.” A decade ago Healthcare IT News published a report stating that providers often regard portals merely as compliance tools rather than opportunities for meaningful patient engagement. Little has changed since then. The patient experience is worse than ever.
• Vendor Lock-In: Major portal vendors Epic and Cerner have contracts so long they require parchment scrolls written in cuneiform along with sworn blood oaths. These companies have no incentive for improvement with clients locked into ten-year deals and firmly entrenched Stockholm Syndrome.
• HIPAA as a Scapegoat: Let’s be clear, mateys—HIPAA isn’t stopping innovation. Banks, brokers, and dating apps all involve web sites that work under strict privacy laws and still manage not to suck. Nevertheless, HIPAA has become a convenient scapegoat for lack of progress on portable electronic records and conveyance of useful patient information in the medical industry.
• Insurer-First Revenue Models: As long as the claims go through and the pre-auths get denied on time, patient satisfaction can be safely ignored. This relegates patients to their true function: witless, soulless transporters of the all-important insurance card.

The Portal Experience: A Dramatic Reenactment

You receive a cryptic email: “You have a new message from your provider.”

You log in, reset your password, get a 2FA text, fail, try again, and finally enter a digital anteroom with no clear navigation. Poking around through several hits and misses, you strike paydirt: the proudly announced, promised message.

It reads: “Your labs are back.”

You click an obscure button labeled “Labs,” and find a PDF titled “Document-20240507-73612-Final-Final.pdf.”

ALT: 87. AST: 98. BUN: LOL. No context, no interpretation, no joy.

The Fix: If Anyone Actually Cared

• Design for Users: Start by not treating patients like adversaries with low digital literacy. Try usability testing that includes actual humans.
• Open APIs and Integration: Let wearables, apps, and smart devices integrate seamlessly. Your CPAP knows more about you than your portal does.
• Provide Real Messaging Tools: Look, if you can’t respond faster than the Pony Express, maybe don’t call it “messaging.” Send us real, informative emails and text messages through secure channels we regularly use, not perfunctorily vacuous announcements promising more vacuous messages, but only after the right sequence of incantations.
• Stop Hiding Behind HIPAA: Build secure systems like every other serious digital industry. Patients want access—not a 1982 game of Adventure with no connection to the world beyond. Plugh!

Conclusion: This XYZZY Portal Needs a Bulldozer

Patient portals were supposed to be the digital front doors to modern healthcare. Instead, they’re those rotating glass traps that make you miss the elevator. Token gestures toward engagement aren’t enough. It’s time to raze the cobwebbed ruins and build something functional, frictionless, and maybe—just maybe—actually patient-friendly.

Until then, the portal is probably useful for renewing your prescriptions, given enough lead time. Otherwise, enjoy your secure message. And don’t forget to call the office. Until your next disastrous visit, you are now leaving The Patient Portal Zone.

---

AI: The Quick Ticket Out

While we’re dealing with old TV shows, how about a quick trip to Fantasy Island, where all dreams are possible and I can share my vision of a useful patient portal of the future. The price of the ticket to the magical island involves a paradigm shift: the healthcare industry must fully embrace artificial intelligence (AI) to enhance the patient experience while reorienting itself toward serving real human patients instead of its sacred bottom line. Clearly, this can only happen on Fantasy Island, but please share my pipe dream of a useful patient portal of the future.

My Dear Friends… Welcome to Fantasy Island

Using currently available AI technology, the industry could easily accomplish the transformation by effecting the following improvements:

• Enhanced Patient Communication: Current portals typically rely on basic messaging features that leave patients waiting days for responses. Integrating AI-driven chatbots and virtual assistants would offer immediate, 24/7 interaction, dramatically improving response times and patient satisfaction while freeing the human medical staff from the encumbrance of answering routine questions. No more, “Our office is closed for lunch from 12 to 2 and we’re off on Friday. If this is a medical emergency, dial 911. Otherwise, leave a message and we’ll call you back as soon as possible.”
• Improved Lab Results Interpretation: AI could provide instant, personalized explanations of lab results, contextualizing information based on patient history and current health conditions, making complex medical data understandable and actionable. No more uninterpreted, cryptic PDFs.
• Dynamic Visit Notes: Rather than static, often jargon-filled notes, AI-powered tools could translate provider notes into clear summaries, highlighting important follow-up actions, medication instructions, and key insights tailored specifically for each patient. No more inscrutable dot matrix printouts.
• Efficient Appointment Scheduling: AI can revolutionize appointment systems by optimizing scheduling through predictive analytics. AI-driven portals could anticipate patient needs, proactively suggesting timely follow-ups and eliminating wait times caused by traditional back-and-forth communication. No more, “These appointment times are available. Please call us during office hours to book your appointment.”
• Personalized Health Recommendations: AI integration could continuously analyze patient health data from multiple sources, including wearable devices and prior records, providing personalized health recommendations and preventive care advice directly through the patient portal. This could reveal medical issues long before symptoms would impel you to make an appointment three weeks out.
• Administrative Streamlining: By automating routine administrative tasks such as filling forms, updating medical histories, and managing prescription renewals, AI could significantly reduce both patient frustration and provider workload, freeing up more resources for actual patient care. (I’ve watched my doctor increase staff while patient service declines—they’re all asses and elbows, and he doesn’t even take insurance! What the hell are all those people doing?)

Beyond Tokenism

Forward-thinking innovators have an enormous opportunity to redefine healthcare communication. However, achieving this vision requires industry leaders to embrace innovation, invest in user-centric technology, and prioritize meaningful patient engagement.

To realize their potential, patient portals must advance beyond mere tokenism. The healthcare industry must adopt a competitive, consumer-focused mindset, recognizing patients as engaged participants rather than passive insurance carriers.

I remain cynical about our possibilities of ever getting on de plane to Fantasy Island.

---

The Great Honey Experiment

In my Week 45 Update, I revealed my intent to act as a human guinea pig to test an assertion made by one of those diet/nutritional pseudo-experts on YouTube. Supposedly, slurping down a daily tablespoon of raw, unfiltered honey would not create a blood glucose nightmare, even for a diabetic. At the same time, it was going to lower my blood lipids—particularly triglycerides—by altering my gut microbiota. Wouldn’t it be wonderful if it were true? Eat more honey, fix your triglycerides, normalize your blood sugar, and be sweeter than ever! Yep, I was a doubter.

My obviously non-scientific tablespoon-a-day experiment can neither confirm nor deny the claims, but what I can say is that my HbA1c, which represents about three months of glucose impact, did not reflect the increased carbs and sugar intake. It dropped from 5.4% in February to 5.3%. I can also say that my serum triglyceride number was 108 mg/dL, which is the lowest in recent history. On the other hand, despite my frequent, strenuous workouts, “good” cholesterol (HDL), was down to 46 mg/dL. It was 53 mg/dL in February.

So, what gives? I don’t know. My only conclusion is that an occasional tablespoon of honey won’t kill me—but at this point I’m so sick of that sweet stuff that it won’t ever get the chance!

Other Blood Test Revelations

Aside from the honey angle, my blood test revealed an increasing potassium component, which at 5.7 mmol/L is too high. This mild hyperkalemia could represent muscle breakdown from my strenuous workouts with the added issue of my compromised kidneys. My calculated eGFR was 55, putting me squarely in chronic kidney disease stage 3A. This will bear watching, and I promise not to eat any more bananas.

The good news is that my functional iron deficiency first discovered back in October is a bit less concerning now. After not responding very well to elemental iron (Original Feosol), I switched to carbonyl iron supplementation (Feosol Complete). Since I switched, iron binding capacity and saturation levels have slowly rebounded. None of the numbers were out of range, despite donating a pint of my vintage B-negative on March 30. However, they remain at the low end of their respective scales, which means we’ll need to keep an eye on them.

Now, on to my week.

My Week on Mounjaro

It was another sideways week, which is fine with me. Thurday’s lunch involved a Hawaiian steak and a few bites of Jenny’s key lime pie at Hillstone. Nevertheless, on Friday my weight dipped below 180 pounds. This prompted Jenny to ask me when was the last time I saw numbers in the 170s on the scale. “High school,” I replied. “But I had a lot more muscle back then.” I’m not trying to lose any more weight anytime soon, instead concentrating on getting some of that muscle tissue back. Toward that end, my workouts are doing their job—I set a couple of new one-rep maxes this past week.

The Mounjaro Numbers, Already!

Body Weight: 180.4 lbs (82.5 kg) — down a pound
Fasting glucose: 95 mg/dl (5.3 mmol/L) — down slightly
Average glucose (Stelo biosensor): 106 (5.9 mmol/L) — not bad, not bad.

---

Concluding Thoughts — Still on Mounjaro (for now)

So here we are at the 50-week mark—three protein-shake-fueled seasons of body recomposition, glucose micromanagement, and screaming into the digital void of patient portals. If there’s a theme this week, it’s this: nothing gets better on its own. Not your muscle mass, not your metabolic health, not your iron deficiency, and sure as hell not the software trying to impersonate your healthcare system. As I close in on one year of Mounjaro, my trajectory remains forward—maybe slower and more nuanced, but still forward. The portal may be broken, but my resolve isn’t.

Over the next two weeks I’ll be busy with doctors while hoping to steer clear of their damn patient portals. First, on Tuesday, I’ll have what will likely be my final follow-up with Dr. DeLorean before shifting to the new primary care doc, Dr. Macallan. I will discuss the hyperkalemia and what I believe to be a developing inguinal hernia, which will need repairs. Next week, I have an appointment with a sports med doctor regarding my knee pain, and later, an appointment with the eye doctor for YAG laser zapping to fix cloudiness in my right eye. Three-and-a-half years after cataract surgery, this is a common sequel. Yea, verily, the remainder of May will require my Tesla’s full attention, so it can seamlessly teleport me from doctor to doctor.

A Good Use for the Patient Portal

Toward the end of the month, I will also need to write a nice letter giving notice to Dr. DeLorean of my intent to discontinue his services. The ten-year relationship impels me to magnanimously avoid summarily dismissing his ass with a characteristically snarky letter. However, I am seriously contemplating sending my even-tempered, professionally acceptable letter to him through his bloody annoying, user unfriendly patient portal. Guaranteed non-response!

See you next week, when maybe, just maybe, we’ll hear back from that secure message we sent in February. [Cue Twilight Zone theme music.]

---

For an annotated catalog of all my Mounjaro updates, please visit my Mounjaro Update Catalog page.

Welcome back to another week of Mounjaro madness. Here, I chronicle my progress with this GLP-1 receptor agonist for Type 2 diabetes while taking potshots at whatever medical or legal targets drift into my line of sight. For those who stumbled in here from a Google search or a Reddit rabbit hole, I’m The Nittany Turkey—nom de plume for over two decades—usually squawking about Penn State football but lately redirected toward more personal topics, like staying alive and upright past the age of 78.

Turkey Who?

Permit me a brief reintroduction. I’m a fat old fart with Type 2 diabetes, formerly treated with Janumet, glipizide, metformin, and the usual alphabet soup of pharma fixes—though never insulin. In June 2024, I finally bit the Mounjaro bullet. Since then, I’ve lost 65 pounds (29.5 kilos if you’re on the metric team), brought my blood glucose under control, and ditched several other meds in the process.

But let’s be clear: man does not live by injectable peptide alone. I’ve also revamped my diet and exercise, with a current focus on preserving (and maybe even building) muscle. Rapid weight loss is great for your pancreas but not for your quads, especially if you’re old enough to write cursive and remember what a pay phone is. My iron-pumping regimen is now aimed squarely at thwarting sarcopenia before it turns me into a breakable relic.

Love’s Labor

This blog is a labor of kvetching. No ads, no sponsors, no “influencer” bullshit—just me, chronicling my aches, pains, and numbers. Think of it as your diabetic uncle ranting at the bingo hall, except with fewer suspenders and more trap bar deadlifts. And while I may occasionally sound like I’m giving advice, don’t be stupid—do your own research. Blindly following anything you read here is a fast track to finding out whether Medicare covers leech therapy. (And with RFK, Jr. running the HHS show, who knows?).

Before we get to my personal updates this week, let’s delve into a trending topic: surprise pregnancies associated with GLP-1 drugs. No, it’s not satire. Yet.

Mounjaro-Based Loaves in the Oven

Imagine this: you’re on Mounjaro (or its cousins Ozempic and Wegovy), the pounds are melting off, glucose is in check, and suddenly you find yourself crying over cat videos and craving pickles. Spoiler alert: it’s not the keto flu—it’s an unexpected pregnancy.

Yes, really. Reports are emerging of women becoming unexpectedly pregnant while on GLP-1 receptor agonists. In particular, women with PCOS or obesity-related infertility are suddenly finding their reproductive machinery back online, much to the surprise of their doctors—and themselves.

What gives?

Is it the weight loss? Possibly. Dropping excess pounds often normalizes ovulatory function, especially in women with insulin resistance. There’s ample evidence that even moderate weight loss can boost fertility. Hormonal balance returns, cycles regulate, and boom—baby registry time.

Or is it the drug? There’s another twist. GLP-1 agonists slow gastric emptying, which can interfere with oral contraceptive absorption. Your birth control pill might end up as effective as a raincoat in a hurricane.

Cue the irony: a drug class originally created for glucose control may be an unexpected player in fertility treatment. Some clinicians now proactively warn women of childbearing age about this side effect. Imagine that: Mounjaro might help with pregnancy and weight loss. Just don’t try both at the same time—animal studies have suggested fetal risk, so it’s recommended to stop the meds two months before trying to conceive.

Whatever the mechanism, the takeaway is clear: If you’re on a GLP-1 and think the stork no longer stops at your door, think again. Apparently, along with losing your spare tire, you might also be losing your contraceptive reliability.

This Week on Mounjaro

Now, to the personal side of this circus.

First, a milestone: I’ve found a replacement for my overpriced concierge doc, “Dr. DeLorean.” Enter: Dr. Macallan (named for the Highland single malt I can no longer afford—or drink). He and his wife run a direct primary care practice, and my interview with the good doctor revealed a straight-shooter who hasn’t yet succumbed to the bureaucratic bloat of modern medicine. I’ll hand DeLorean his walking papers after next week’s follow-up visit—likely with a few mumbled pleasantries and averted eyes.

Meanwhile, back at the gym… My supposedly okay left knee has been grumbling again. But oddly enough, after pushing through a deadlift session (40 reps, progressive weight), it felt better—not worse. Could it be that motion is lotion after all? I’ll take that up with the sports rehab doc later this month.

The Mounjaro Numbers, Already!

Body Weight: 181.4 lbs (82.5 kg) — stable
Fasting glucose: 97 mg/dl (5.4 mmol/L) — unchanged
Average glucose (Stelo biosensor): 119 (6.6 mmol/L) — still about 20 mg/dL higher than fingersticks, so: ploo! The Stelo, unlike its higher-priced, prescription-based cousin, the G7, does not permit calibration via glucometer readings, so I must apply a bias based on comparative readings.

Conclusion: Mounjaro, Pregnancies, and DeLorean Exit Plan

No, I’m not pregnant. But it’s fascinating to watch GLP-1 agonists morph into metabolic Swiss Army knives—handling everything from glucose and weight to kidneys, hearts, sleep apnea, and now…babies?

On the provider front, the DeLorean-to-Macallan transition is bittersweet. I’ll miss the warm towels and executive fees like I’d miss a rash. But with Macallan, I’m cautiously optimistic.

Next week: Blood test results are coming in hot, including a full panel to close out my honey experiment (Week 45 readers, you know the drill). I also started creatine again—because clearly, I needed something else to track obsessively. And of course, we’ll revisit the ongoing saga of my iron levels, because nothing says “living the dream” like talking ferritin while bench pressing.

As always, thanks for tuning in to this cranky old man’s metabolic monologue. Until next time, stay upright and mildly cynical.

---

For an annotated catalog of all my Mounjaro updates, visit my Mounjaro Update Catalog page.