Yes! We have no URI!

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

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

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

Shoddy Reporting in Scroogeville

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

Iron Deficiency

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

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

The Results Are In

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

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

Just a Typo — No Shit?!!

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

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

Get Me Outta Here!

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

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

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

Latest Mounjaro News

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

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

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

It Ain’t All Good News

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

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

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

Updating My Progress on Mounjaro

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

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

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

Offsetting Loss of Muscle Mass

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

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

No More Drugs

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

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

The Mounjaro Numbers, Already!

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

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

Saluting Our Presidents and Signing Off

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

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

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

I’m back with another update about my experience with the Type 2 diabetes drug Mounjaro. This week, I continue last week’s discussion of the tools I use to track my progress, and I’ll add some comments about weight loss drugs for children. As usual, I close with the current status of all my old fart conditions.

How I Track My Exercise

Last week, I provided an incomplete list of equipment and software apps I use to monitor my progress. What I left out were the two tools with which I track exercise: a Fitbit smart watch and the Jefit exercise tracking app.

Fitbit Versa 4

I’ve used Fitbit Versas since 2020. I bought a second Versa 2 after an unfortunate accident with the first one, and more recenly, I bought a Versa 4 (available from Amazon.com for $149.99). It does everything you would expect from a fitness tracker: heart rate, sleep quality, respiration, pulse oxygen, steps taken, etc., at a much cheaper price than competing products from Apple, Garmin, and Samsung. And it can tell time, too.

Although I have a couple of nice, traditional (dumb) wristwatches, I find myself wearing the Fitbit all the time. I like that it will automatically log exercise if it detects fifteen minutes of activity. It even tries to guess the type of activity. If I am taking a hike, its internal GPS receiver creates a map showing the path I took, giving me heart rate and pace for each segment. If I am at the gym, I start it up before my warm-up and wear it throughout the workout. When I’m done, it gives me my stats.

The associated app is wonderful for analyzing workout exertion with its heart rate graph. The Versa 4 has loads of features. With the basic package, I have found that I get everything I need without spending additional money on the premium membership subscription fee.

Jefit App

How do I keep tack of which exercises I do, how much I lift, how many reps? The Jefit app does all that and much more. You can download it free from the Apple App Store or Google Play. If you want the full features, you’ll need to pay an annual subscription costing $69.99. Paying the big bucks ties you in to their huge exercise database, where you can search for exercises targeting specific muscle groups. You can filter results by equipment, like dumbbells, barbells, machines, body weight, etc. Each exercise has a video showing how to perform it, as well as detailed, written instructions.

You’ll find that a bit of a learning curve is necessary to master how to set up workouts and do the tracking. For me, the time invested in learning how to use Jefit was well worth the effort. Aside from the ability to track progress from workout to workout, at the end of each workout Jefit reports which muscle groups you have worked and which have been neglected. It uploads the data to the cloud so I can access it on multiple devices. I set up Jefit to track my workouts both at the gym and at home.

That wraps up what I wanted to share with you about how i track my health and fitness. Next, I move on to vent my opinion on some current research. As those who know me well can attest, I have an opinion or two, and when I get torqued up about something, I vent.

Big Pharma Takes Aim on Our Chilllldren

Being a career hypochondriac, I receive daily digests from the Journal of the American Medical Association (JAMA) and the New England Journal of Medicine (NEJM). A study published recently in the latter journal caught my eye: Liraglutide for Children 6 to <12 Years of Age with Obesity — A Randomized Trial. This annoyed me, so I dug into the abstract, wading through the medicalese and statisticalese describing the trial until I arrived at the final, parenthetical sentence: “(Funded by Novo Nordisk; SCALE Kids ClinicalTrials.gov number, NCT04775082.)”

Novo Nordisk is the Danish manufacturer of Victoza, their brand name for liraglutide, as well as Ozempic and Wegovy, similar GLP-1 RA drugs whose generic name is semaglutide. Of course, the practice of studies funded by Big Pharma is nothing new — we live in a money-driven world where self-interest is no longer a conflict. Their marketing effort is a full-scale assault on society from all directions. Direct-to-consumer advertising targets Joe Citizen, who they command to: “Ask your doctor if Victoza is right for you!” Funded studies published in prestigious medical journals like NEJM aim at not just the endpoint prescribers, but also at the broad medical community. It is an all-out blitz.

How Can I Bilk Thee? Let Me Count the Ways.

The aim is to establish prescribers as an extension of the marketing arm of Big Pharma, and from the reported sales numbers of GLP-1 RA drugs, they’re succeeding big time! Treating obese patients, many doctors now just skip the counseling about lifestyle interventions like diet and exercise and go straight to prescribing the vogue weight-loss drugs from Big Pharma, notably Novo Nordisk and Eli Lilly & Company.

To make that pill easier to swallow (pun intended), the medical community is removing the personal responsibility aspect of being fat. If we can be convinced that we are fat through no fault of our own, we can take lifestyle improvements off the table and go straight to the high-cost alternatives. I encountered some suggested practice guidelines from the UK, published in JAMA, which counseled physicians to avoid the subjects of diet and exercise and never, ever mention the word “obese” within earshot of a patient. Be gentle, Doc. Wouldn’t want to hurt anyone’s sensitive feelings.

It’s Not My Fault That I’m Fat

WTF! We know we’re fat and we know what we must do about it. Now, they want to facilitate creation of a class of victims. The article went on to say that the practitioner should introduce the subject kindly, referring to earlier conversations, like, “Didn’t you tell me last year that you would like to lose some weight?” Oy, gevalt! What will follow, once the subject is on the table, is easy to imagine. “Have I got a drug for you! Now that it is your idea to lose weight, we’ll get you started!” However, if the patient shows signs of wanting to avoid a conversation about avoirdupois, the doctor must immediately clam up or change the subject. So goes the learned author team’s advice.

The current mantra promoted by Big Pharma and their dutiful servants in the medical community is that obesity is “a complex, chronic, relapsing condition”. Some go as far as to call it a disease. Leveraging this characterization, Big Pharma has reoriented the doctor-patient relationship to find angles that strike paydirt by conning patients into making it their idea to ask the complicit physician, “Is Wegovy right for me?!” Now that patients have been absolved of responsibility for being fat, having been told it’s not their fault that they caught a treatable disease, we can jump right into the pharmacotherapy for same with no shame, no stigma, and best of all, no nasty diets or exercise. (Or so patients may be led to think).

No Easy Way

If physicians must avoid suggesting that we fatsos get up off our asses, go to the gym, shitcan the donuts and start eating broccoli, then the alternatives are drugs and bariatric surgery. These are both worth more money to the medical services and pharmaceutical industries than kickbacks from dietitian referrals and gyms. (Unfair accusation, I know. I don’t know whether such graft exists, but that’s beside the point. What I am saying here is that surgery and drugs are big money-makers whereas recommending traditional lifestyle adjustments does not significantly pump-up medical revenue).

Back to my original point. The prepubescent market is out there and it is ripe for exploitation, uncharted territory for the profiteers. Thus, now, we want to target six- to twelve-year-olds: “Tell your mommy to ask the pediatrician if Victoza is right for you!” Never mind that you’ll be subjecting your kids to a once-daily subcutaneous injection of a foreign substance. It’s all about parents seeking society’s approval. We don’ wan’ no freakin’ fat keeds! Parents take heed! Drug your kids and make them addicts for life, but they’ll look maaahvelous!

Let Kids Be Kids

How long will they need to stay on the drug, and at what cost to their family and to society? No one knows. In this one-sided so-called war on obesity, getting the foot in the door is 90% of the battle. The street-corner drug pusher knows that once their clients start, many will be customers for life (suitably shortened by malnutrition and overdoses). Same thing for Big Pharma. Get ’em started young! Damn the torpedoes! Full speed ahead!

We’re not fixing the problem. We’re allowing the food industry to proceed unchecked, making our kids unhealthy. Instead of doing something about the crap we feed our kids, we are coerced to subject them to expensive, injectable drugs to fix what the food industry fucked up while we sat back with our thumbs up our asses. Why do we allow this perpetual motion machine to wreak havoc on our youth? We make them sick, then we drug them. We’re not fixing their lives. We’re ruining them.

Parents, stop feeding your kids crap. Stop tolerating school lunch programs that serve crap. Get their asses off the video gaming chair and into the playground. And please don’t drug your children!

My Health Update: Mounjaro and Whatever the Hell Else

First, I’ll tell you that we finally have closure on the urinary tract infection. A urine culture ordered by The Irascible Dr. Scrooge came back with no indication that anything is growing in my pee. The first urinalysis he had ordered a couple of weeks ago showed som leukocytes, which indicated that the infection had persisted. That is why he ordered the culture. Now, it looks like the Serratia marcescens have departed. Good riddance!

The rest of the tests ordered by Scrooge came back negative, too. Negative for celiac disease, and negative for occult blood from the digestive tract. These are all good things. However, along with the good comes the need for further invasive exploration to determine the cause of my functional iron deficiency. What Scrooge had originally proposed was an upper GI endoscopy and a colonoscopy, followed by a capsule endoscopy of the small bowel. I imagine I’ll be getting a call from his people to schedule those diagnostics.

Mounjaro by the Numbers

I mentioned last week that I have noticed a rebound in my numbers, suggesting that my Mounjaro dose might need an increase. I have been at the minimum therapeutic dose of 5 mg/0.5 ml since September. (Earlier, I was at the starter dose of 2.5 mg). This puts me on the horns of a dilemma, as I do not want to be chasing increasing doses up to the maximum dose of 15 mg. If my aging carcass develops a resistance at that level, then what?

Recall that I had discontinued metformin back in November. The key to getting this situation back under control might be to resume the metformin along with a modest increase in the Mounjaro, to 7.5 mg. I will discuss this with the doctor at our February 24 encounter.

My average blood glucose for the week was 108 mg/dL (6 mmol/L), about the same as last week. However, fasting glucose, my first thing in the morning reading, has sucked, averaging 107 mg/dL (5.94 mmol/L), up from 100 mg/dL (5.56 mmol/L) last week and 93 mg/dL (5.17 mmol/L) the previous week. This puts me back in the pre-diabetic range. Apart from clinical thresholds and characterizations, the increased glucose levels will cause damage. That ain’t good.

My weight was up 1.6 lbs (0.8 kg) for the week. I wanted to hold at the current level, so the gain is yet another indication that something is awry.

What have I been doing differently that might be responsible for the reversal? If anything, I have increased my energy expenditures by adopting a rigorous exercise schedule. At the same time, I have diligently tracked daily protein intake, which I have increased commensurately with the workout program. Perhaps I am getting too much protein, which can’t help my marginally functional kidneys.

That’s it for this week. Thanks for reading! Writing this drivel is therapeutic for me, as well as imposing the need to keep track of my numbers on a weekly schedule. If anyone else can derive some benefit from my shared experiences, I’m doubly happy. Stay healthy!

Still Awaiting Lab Results

Hello and welcome to my latest weekly update of my experience with the Type 2 Diabetes drug Mounjaro, along with some insights into my approach to controlling the condition. Although I give too much information (TMI) about my various health issues, it is my hope that you will find my experiences helpful in some way.

Today, I’ll share some information about how I track various health and wellness factors: glucose, weight, blood pressure, diet, and exercise. I covered this ground back in Week Six, but I have changed a few things since then. I’ll also give you a progress update on the current health mishegaas, my functional iron deficiency. I’ll wrap up this edition with the usual Mounjaro progress by the numbers. But first, for the sake of my new readers, I’ll give you a little background.

Who Am I and What Am I Doing Here?

I’m a seventy-eight-year-old Type 2 Diabetic who has been injecting the GLP-1 RA drug Mounjaro weekly since June 2024. The lowest therapeutic dose of 5mg/0.5ml has done the job well thus far. Still, I might need an upward adjustment. My HbA1c has improved from 7.6% (60 mmol/mol) to 5.5% (37 mmol/mol) (as of November 2024). Mounjaro is only a part of the story. While using the drug, I have adopted a high-protein, low-carbohydrate diet and a vigorous exercise program hoping to preserve muscle mass and bone density.

I avoid using the word “journey” to describe my health progress because that is the stupidest metaphor ever. I am not Marco Polo, just a fat old dude with some chronic conditions to treat. I’m not a poet, either. I’m just here to give you straight information and my curmudgeonly opinions. Invoking the words of the late sports wordsmith, Howard Cosell, I tell it like it is with a dose of sarcastic humor. He made that phrase his own, and now it is mine.

How Do I Track My Mounjaro Progress?

I want to share how I track my progress with weight, glucose, blood pressure, etc. Each of my measuring instruments communicates with my smartphone via Bluetooth. Their associated smartphone apps keep good track of the data. Below, I’ll tell you about the devices and their cost.

Glucose

Blood Glucometer

For glucose, I use the Contour Next One glucometer from Ascensia (free from Ascensia if you are privately insured or $28.50 at Amazon.com). I have verified its readings with lab tests processed by Quest, finding the results remarkably close. For convenience, I have two Contour Next Ones. I keep one in the master bathroom upstairs for morning, fasting readings. The other one is downstairs in the family room so I can enjoy recreational finger-pricking while watching TV.

A package of seventy Contour test strips costs about $27 on Amazon.com. The Contour Next One does not need a code entry with each new batch of test strips. (But I need to index each new set of strips with the appropriate test solution for accuracy). The Contour app provides excellent long-term tracking and detailed reports I can share with my doctors.

Continuous Glucose Monitor (CGM)

Back in September as I was recovering from COVID-19, I discovered that the FDA had approved a new product from Dexcom. Called Stelo, it is a wearable device like a continuous glucose monitor (CGM). It does not need a prescription and is available to anyone directly from the company for under $100 for a month’s supply, or $90 for a monthly subscription.

I had earlier eschewed CGMs, like the Dexcom G7. Our Medicare regulators would not cover their cost for Type 2 diabetics unless they: 1) are on prescribed insulin, or 2) have had documented hypoglycemic episodes. Even if my doctor were to prescribe a CGM, the out-of-pocket cost would have been over $300/month. Thus, this new Stelo product offered by Dexcom for less than $100 per month piqued my interest.

Whyfor the Stelo?

Dexcom, makers of the flagship, full blown continuous glucose monitor G7, saw the need for people in my category who want to track their glucose variations. They developed Stelo, a dumbed-down version. Each monitor, which sticks to the back of my upper arm, works for fifteen days. Dexcom labels Stelo as a “glucose biosensor”, not as a continuous glucose monitor. The distinction must be clear only to the Dexcom legal department.

The Stelo app provides a graph that displays 3, 6, 12, or 24 hours at a time in five-minute increments. The sensor updates information via low-power Bluetooth every fifteen minutes. The app covers a limit of twenty-four hours and “loses” the trailing information. Nonetheless, Dexcom stores the numbers in the “cloud” where I can access them through Dexcom’s “Clarity” app. Clarity, also used with the G7, displays detailed, downloadable longer-term data and graphs.

In its advertising, Dexcom presents Stelo as an information device rather than a serious medical device. You must not base your medical decisions on its readings under penalty of the Dexcom legal department declaring you an idiot. For example, you can’t integrate Stelo with an insulin pump. Also, Stelo reads interstitial glucose, which differs from blood glucose in a couple of respects.

So what good is it? While the absolute numbers will be off, it is useful tracking glucose spikes from eating carb-laden food. I also can view the relative effect of exercise on my glucose. Thus, I use Stelo as a training device to give me a visual depiction of my insulin response.

Weight

My weight is recorded each morning by the sleek glass and metal pride of China, a Renpho Smart Scale. Currently, it costs $19.99 at Amazon.com, and the app (available for Android and iPhone) is free (no damn subscription, thank God). The scale also does a bio-impedance measurement to find BMI and body composition. The phone app does an outstanding job of tracking weight and all those body composition measures over time, providing handy interactive graphs to show progress or lack of same.

Blood Pressure

Blood pressure tracking is via an Omron BPS5450 Platinum Series (presently $109.29 at Walmart.com). I have checked its accuracy against two of my doctors’ instruments, finding the results close. Once you set its Bluetooth link with the smartphone, it automatically transfers each reading. The app does an excellent job of tracking and averaging blood pressure, plus identifying peaks and heart rate abnormalities.

Food Logging

Finally, for tracking what I eat, MyFitnessPal app with premium subscription ($79 per year) keeps the food diary. It has a barcode scanner and a robust database of food items. The developers have vetted many of the database entries. MyFitnessPal is way more than a calorie counter. It keeps me well informed of macro and micro nutritional intake in comparison with goals I have set. I have used it off and on for four years.

Lab Tests

Sometimes, you want to track your progress scientifically. Typically, doctors stick with staid protocols. Most doctors lack the time and patience to deviate. So, if you’re like me, your scientific curiosity impels you to want test results beyond what the doctor orders. I can order my own blood tests via Ulta Labs. They work with the usual storefront labs like Quest. You order the test, they generate a lab order, and you take it to your neighborhood Quest for the blood draw.

Ulta reports results directly to you. If you have a Quest account, you get them from Quest, too. Costs vary with the type of test. For example, the HbA1c test costs $21.95, which Ulta typically discounts 15-20% as a daily or seasonal promotion. At the other end of the scale, a comprehensive celiac disease panel consisting of 79 biomarkers goes for $644.95.

Of course, the results do not automatically go to your doctor. The lab order comes from a house doctor at Ulta. Nevertheless, Quest provides a straightforward way to fax results to your preferred doctor if you have a Quest account. Otherwise, you can communicate the results directly — at your own peril. (Editorial comments follow).

Ramifications of DIY Testing

Depending on your doctor’s psychological maturity level, you’ll get a defensive reaction from him, her, or “them” when you discuss results of self-ordered tests with them. Some will hand-wave away results if the test wasn’t their idea in the first place. The haughty, self-protective medical profession wants to stick with its bulk-processing protocols. I pity the fool who wants to explore his own body operation without a medical degree and a license to practice. It is not uncommon for doctors to gaslight us, attempting to convince us that we’re idiots, even if we have the mental capabilities to do research and interpret studies. This amounts to protection of territory. In the next section, I’ll tell a relevant story about how my own doctor reacted defensively.

Back to the Iron Deficiency

Exploration of my functional iron deficiency was an example of the medical gaslighting paradigm. At my September follow-up visit, I had remarked to my doctor that graphs provided by the blood bank that my hemoglobin has been low. He told me to stop giving blood and did not order any tests. So, I had my iron, ferritin, etc., tested on my own and communicated the adverse results in October. Again, he told me to stop donating blood. Further, he suggested Feosol (an ferrous sulfate supplement) and a follow-up blood test in sixty days.

So, I stopped donating blood, took the supplement daily, observing the manufacturer’s instructions, on which I was never briefed by the doctor, and had the re-test. The test results came back with even worse numbers than before two months of supplementation. So, again, his simple, dismissive advice was to stop giving blood. Further, he stated that he did not know why free iron was low while ferritin was in the normal range. No range of possibilities, just stonewalling. In other words, a blow-off.

Say What? You Don’t Know? That’s It?

I can accept “I don’t know”, but if the topic is of concern to me, I want more information. I’ll be the one to decide whether to go further. Some research on my part convinced me that I was right not to accept the handwave. Several scenarios exist where iron is low but ferritin is in range. Subclinical gastrointestinal (GI) bleeding is one cause. In that area, I have a history of chronic erosive gastritis, esophagitis, colon polyps, etc. Furthermore, anemia of chronic disease (like colon cancer) is a possibility, as is poor absorption of iron due to GI issues. The in-range ferritin can result from its role as an acute phase reactant. Recall that I had a urinary tract infection (UTI) at the time of the follow-up blood test.

Taking Matters into My Own Hands

So, I told my doctor that the handwave was not good enough. I scheduled an appointment with my gastroenterologist, The Irascible Dr. Scrooge, which I chronicled last week in this column. To summarize the visit, he reviewed my history and the iron blood tests, then ordered blood tests for celiac disease, a fecal test for occult blood, and a follow-up urinalysis to confirm that my UTI had not left me with lingering microhematuria (small amounts of blood in the urine). The urinalysis is something my regular doctor should have ordered even though the UTI had resolved.

Results from the lab tests from January 28 are still pending as of this morning. It turns out that the celiac test can take up to two weeks. Quest will hold up the simple tests to report everything together.

Path Forward

If the celiac disease test is positive, it can explain why I am not absorbing efficiently. That would entail treatment for celiac plus continued iron supplementation. (Not much one can do about celiac disease other than avoiding gluten). If the celiac test comes back negative, the gastrointestinal fun will start. Dr. Scrooge feels that what I need is a capsule endoscopy of the small bowel. Being sensitive to the whims of the health insurance industry, he tells me that they won’t approve the capsule endoscopy without having a recent upper endoscopy and colonoscopy to rule out issues in those areas.

A capsule endoscopy is a diagnostic procedure to examine the small intestine. It involves swallowing a small, pill-sized camera that takes thousands of images as it travels through the digestive tract. This method is particularly useful for detecting bleeding, Crohn’s disease, small bowel tumors, celiac disease-related damage, and other abnormalities that may not be visible with traditional endoscopy or colonoscopy. Kinda cool to have a camera free-falling through my gut. (My electronic background might inspire me to retrieve it and do an autopsy on it).

And so, I wait.

The Week’s Mounjaro Numbers

In the intro, I mentioned that I might need a dose adjustment, as my numbers are flattening or increasing. The body can acclimate to drugs, so perhaps I am at that point. I see no other reasons for the numbers increasing. I have not significantly changed my diet, and I have increased my activity level at the gym and at home.

Fasting glucose, my first thing in the morning measurement, averaged 100 mg/dL (5.56 mmol/L), up from 93 mg/dL (5.17 mmol/L) last week. Overall average blood glucose, as measured by my Stelo, was 108 mg/dL, up from 105 mg/dL (5.83 mmol/L). This is equivalent to HbA1c of 5.4% (36 mmol/mol). My target value, which admittedly I pulled out of my ass, is 5.2% (33 mmol/mol).

Body weight was nominally the same from last week to this week, at 188.2 lbs (85.5 kg). My eventual goal is around 160 lbs (72.7 kg) (oh, yeah, for Brits, 11 stone 6). Still, I want to get there very slowly while I tackle the need to preserve muscle mass and bone density. So, I’m not expecting any dramatic weight loss numbers anytime soon. Obviously, I want to deal with glucose first, and any weight loss is a collateral benefit.

Wrapping It Up

My big concern right now is the functional iron deficiency and its causes. I am patiently awaiting the results of the celiac test from which we decide on the path ahead. Meanwhile, I will keep the diet as-is and continue to pursue the exercise program. I am keeping an eye on the numbers to decide whether I should discuss with Dr. DeLorean (not his real name) whether a Mounjaro dose increase is “right for me.”

Because I did not want to make this a three-hour read, I left out some devices and apps I use for tracking my exercise progress, namely my Fitbit smart watch and the Jefit exercise tracking app, which I will cover next week. Also, after I put this week’s article to bed, I received lab test results. The blood tests were negative for celiac disease but the urinalysis still showed signs of lingering UTI. Next week, I’ll give some added insights into these results. See you then with more information about Mounjaro and my approach to controlling Type 2 diabetes. Go Eagles!