Archives for June 2024

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

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

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

Progress after Third Week on Mounjaro

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

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

Weight Loss, or Lack of Same

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

Glucose Control

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

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

Dietary Changes

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

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

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

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

Some Mounjaro Side-Effects

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

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

Constipation

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

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

Dehydration

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

Ants: “Your a idiot!”

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

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

Summing Week Three on Mounjaro

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

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

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

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

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

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

Not a Miracle Drug

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

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

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

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

Dose-Splitting

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

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

Just Nuts and Bolts, Right?

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

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

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

Paid “Influencers”

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

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

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

Unbiased?

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

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

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

Mounjaro Customer Cohort

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

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

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

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

I am a Type 2 diabetic. For years, I have been dolphining through drugs, weight loss regimens, more drugs, lifestyle changes, and more drugs. Recently, my doctor prescribed Mounjaro in addition to my old standby, metformin. This story not only describes my first week on Mounjaro, which I have just completed, but also it expresses opinions about the crap we patients face when prescribed a leading-edge drug that has caught the attention of the humongous weight-loss community.

I’ll start with the standard disclaimer that I am not a doctor and am not offering medical advice. I am recounting my experiences, which might differ from yours. Finally, I have some strong opinions, which might not resonate with yours as well. But that’s life, isn’t it?

I have spent much time researching and gathering all kinds of information about Mounjaro, some of which I will share with you below. I encourage anyone who takes this or any drug to learn all they can about it, both from their doctor and from the copious available literature.

What is Mounjaro?

Mounjaro is a GLP-1 receptor agonist. Pharmacotechnical descriptions and inscrutable jargon aside, the drug is purported to help diabetics control their blood glucose along with their appetite. It is that latter effect that has garnered the attention of the weight loss crowd, whose demand for quick and painless solutions is creating supply shortages for us glucose-challenged minions.

The available doses are 2.5, 5, 7.5, 10, 12.5, and 15 mg. Most doctors start their diabetic patients on the lowest dose of Mounjaro to assess efficacy and side effects before titrating up. As usual, it is wise to be at the lowest effective dose. Well, for diabetics, anyway. The gratuitous weight-loss crowd seems to think that bigger is better. I saw a YouTube “influencer” holding up a Mounjaro 15 mg injector for the camera, announcing, “This… is the king!” Such an influencer, already!

What’s the Gratuitous Weight-Loss Crowd?

What do I mean by the gratuitous weight-loss crowd? I am certainly not referring to those who are fat and have a serious glucose problem, who are legitimately prescribed Mounjaro by a scrupulous and concerned doctor. I am referring to chubby affluent people with no other medical issues who have tried everything aside from long-term disciplined eating and exercising to lose their few extra pounds and have failed repeatedly, who are prescribed the drug for cosmetic weight loss only, by doctors with questionable ethics. Mounjaro is a diabetes drug, not a diet pill.

The likes of sports commentator and former NBA star basketballer Charles Barkley have publicly lauded the wonder-drug, bragging about a sixty-pound weight loss. Really? Just throw some money at it to look better on TV? Just playing a little pick-up game of weight loss H-O-R-S-E?

Is the Round Mound of Rebound diabetic? If so, I apologize.

It’s a Diabetes Drug

Mounjaro is approved for diabetes. A sister drug, Zepbound, is now approved for weight loss. Both are brand names for the generic terzepatide. Eli Lilly and Company manufacture both. So, labeling aside, there is a limited quantity of both drugs, subject to the production limits at the Lilly facilities, which Lilly claims to be expanding worldwide. They acknowledge that they cannot meet the current demand.

With the gratuitous weight loss crowd horning in on the action, diabetics face problems obtaining the drug. Many are seeking compromise alternatives. The squeeze is on, and the size of the ever-expanding weight-loss market will keep tightening the vise. No doubt, Eli Lilly is enjoying its moment in the sun, and could care less about how the drug is prescribed and for what — just as long as those orders keep on rolling in!

Many insurance plans will not cover weight-loss drugs. Nevertheless, the gigantic “easy way to lose weight” sector doesn’t mind buying up retail supplies at full price, which is $1,200 per month. And here, I’m talking about affluent cosmetic purchasers of the drug, like Sir Charles and rich babes with fifteen pounds to lose to fit into a $7,000 gown or something. They are the ones who should be sucking hind tit, but alas, money talks and bullshit walks.

Our Obesity Problem

Mind you, I’m not disparaging the genuine problem of obesity in the western world, a problem created by affluence and merchandising. Capitalists market products like high-sugar cereals and junky, sugary fast foods to make us fat; capitalist big pharma pushes drug solutions. Everybody makes money from fat people. And lots of fat people become diabetic. So, it’s no joke that we’re screwed from all directions.

Will we ever go back to eating healthy diets and getting enough exercise?

Weight loss solutions, be they books pushing miracle diets, drugs, or sometimes dangerous supplements, are big business. Show me a fat person and I’ll show you a sucker for the latest fad diet. If you’re smart enough, you can make money on us porkers, and the gratuitous use of Mounjaro for minor weight loss proves that we are willing to part with vast sums for a quick-and-dirty (sometimes) solution.

Back to My First Week on Mounjaro

I was prescribed 2.5 mg once per week for the first month. The product comes in an injector pen, four in a box, which must be refrigerated. (I’m told that some of the supply problems relate to the production of the pens themselves). My first injection was last Monday and my second was today. In that week, my morning blood glucose measurement dropped ten points and I lost six pounds, most of the latter likely due to the dehydration associated with the drug. Other side effects have been minimal. Aside from a slightly metallic taste in my mouth on the day of the injection, the main effect has been some appetite suppression and oooh, yeah, constipation, which is not much fun.

Too much information? Well, I’ll get back to some non-clinical facts.

Sharps Container

If you are new to the injectable drug community, you need to know that you will need a LARGE sharps container with which to dispose of your injector pens for drugs like Mounjaro. I had some smaller ones that I use for lancets, but no way would the Mounjaro pens fit in them. These pens are huge! Packaging the drug in these fancy devices seems like a waste to me. I know that you can get typical disposable syringes and ampoules of counterfeit terzepatide from compounding pharmacies, which I would not risk. Still, why the hell do we need such large and complex devices?

Well, needless to say, Lilly’s marketing department figured out that people just don’t like syringes and needles and besides, are too stupid to learn how to use them. Following the lead of other “pen” injector drugs, they attempted to camouflage the needle with a cigar-tube-sized mechanical injector pump, an easy and foolproof device to painlessly administer the weekly injections. Wasteful indeed because these things wind up in the medical trash. But I guess when people are paying $1,200 per month to shed a few pounds, that is irrelevant to them. Big pharma wants to make it easy and painless to spend money.

Refrigeration and Inspection

When I picked up my Mounjaro from the pharmacy, it came directly from their refrigerator. Instructions on the package state that it must be kept at between 36- and 46-degrees Fahrenheit (2-8C). However, they also state that the drug may be kept at room temperature for up to twenty-one days. With the typical supply being one month, that’s lots of latitude, assuaging my concern that my trip home in a hot car would spoil the precious 0.5 ml of liquid in each pen. The big caution is never to freeze the drug, which renders it useless.

Before injecting, the user is directed to examine the liquid through the clear part of the pen. It should be a clear-to-slightly-yellow color with no cloudiness or particles. Anything else, and you must discard the damn $300 pen. (I could get a Mont Blanc for less).

The Jab

Yep, they made it easy and painless, as I mentioned previously. Even for those who fear needles, this one rocks! You just take off the plastic cap, toss it in the regular trash, rotate the locking collar to the unlock position, swab the chosen injection spot with an alcohol pad, place the bottom of the pen there, and press the button on top. The first click tells you that the injection has started and the second says it is done. You can keep it there for ten seconds just to make sure you get the whole dose, which is 0.5 ml of liquid. (At $0.15 per microliter, you want to make sure you get every drop!).

The recommended injection sites are on the belly at least two inches from the navel, the upper thigh, and the back of the upper arms. It is easy to reach the belly and thigh, but the upper arms require that someone else administer the injection.

Mounjaro is a subcutaneous injection, which means that it goes into the subcutaneous fat layer just under the skin, where it is absorbed. Thus, the needle is truly short. It is also a fine gauge and is completely painless. I feel more of a prick when drawing a drop of blood from my fingers for my glucometer. Furthermore, unlike some, I have not experienced any issues around the injection site — no “knots”, bruising, itching, or anything at all unusual.

Supply Issues

Knowing that supply shortages exist, on Friday I asked my pharmacy whether their supplies were adequate to fill my next month’s order. At that point they had only two of the 2.5 mg packages (four pens each) and two of the 5 mg packages. They said it was impossible to predict what they would have on hand when my insurer says I am eligible to order my next dose, on June 23. Based on what I have gleaned, I must be prepared for the need to chase down supplies.

Here is what Lilly says about it.

While Lilly continues to manufacture and ship all doses of Mounjaro, due to the unprecedented demand for these medicines, some patients may have trouble when trying to fill their prescription at their pharmacy. We recognize this situation may cause a disruption in people’s treatment regimens. Given local and regional supply chain dynamics, patients having trouble obtaining their medicine at one pharmacy may try others in their area. Alternatively, if someone continues to have trouble obtaining their medicine, they can contact their healthcare provider who can assist with their treatment plan.

Lilly website

I have heard of several people giving up after much unsuccessful searching, asking their doctors to switch them to more readily available Ozempic, a similar but slightly less effective diabetes drug produced by the Danish big pharma outfit Novo Nordisk. I’m obviously not at that stage yet, but that option may exist if things get dire.

Insurance Hassles? Nahhh.

If you are prescribed an on-label use for Mounjaro (i.e., for diabetes, not for cosmetic weight loss), Medicare and many private insurers will approve the drug. However, it still is not cheap. My first month’s supply maxed out my $556 deductible for the year. I’ll pay only $11 per month until I reach the dreaded Medicare “coverage gap”, better known as the “donut hole,” at which point I must pay 25% of the cost of the drug, or $208.75 per month. When I reach $8,000 out-of-pocket Medicare’s catastrophic coverage kicks in and they pay the full bill. This recycles every year, and coverage limits may change.

Finding that glucose rich donut hole won’t take long. It kicks in when a total of $5,030 is paid by both me and my insurer for all drugs in the current calendar year. Mounjaro adds $800 per month to the total, in addition to the cost of the six cheap generic drugs I am taking, so I should be good for about six months until I need to start shelling our $200 per month.

So, no real hassles if you are not a weight-loss junkie footing the bill on your own. However, I wanted to demonstrate that even with insurance, Mounjaro ain’t cheap.

The “Support” Community

It’s a jungle out there. I thought I would join a Facebook group that purported to support users of Mounjaro as a diabetes drug. Having been around Facebook for decades, I should have expected that the group would not live up to its title and be a social nexus at best, but I had to check in just in case. As you no doubt anticipated, my worst fears were founded: it was a damn weight loss group populated mostly by women trotting out all their weight loss trials and tribulations for all to see and fawn over. Oy vey, such a mishugganah bunch!

Straight away, I noted that the first thirty or so posts were by women either bragging about weight loss (often illiterately expressed as “loosing (sic) weight”) or expressing dismay about their weight issues. Those posts contained no useful information for me. Typical of social media, these were people seeking affirmation along with lazy people asking for crowd-sourced “solutions” for which accurate information was easily obtainable elsewhere. It was clear that few had done even basic research on what they were injecting into their bodies, including not even reading the damn package insert and its cautions.

Moreover, as usual, the crowd-sourced responses ranged from completely wrong to correct to completely irrelevant. Arguments (or “arguements” (sic)) abounded. Many were sophomoric treatises from people wanting to appear smart, paraphrasing something the responder had read somewhere else on social media. This is the bane of the fool venturing into social media seeking a valid answer to a question. The filtration process is more onerous than going to an authoritative and credible source in the first place. Other responses were dangerous, urging people who experienced serious side-effects to continue using the drug.

The Fat Lady Group

This reminded me of the Nutrisystem forum I had joined twenty years ago on one of my own weight loss forays. In case you had not heard of it, Nutrisystem is a company that sells packaged food associated with their weight-loss program. In their official, but unmoderated discussion group at the time, questions like “Can we eat watermelon?” abounded, posed by the inept minions who would never think of reading the literature published by Nutrisystem. I nicknamed this forum “The Fat Lady Group”.

Annoyingly, the treatises on why we must drink our eight glasses or water a day were quite common among the Nutrisystemers. The ridiculous crowd-sourced explanation typically involved “you need the water to flush the fat”. I’ll flush YOU! Get the plunger!

So, wouldn’t you know it? In this diabetic oriented Mounjaro Facebook group I briefly joined, the first question I came across was, “Why do we need to drink so much water???” The most frequent answer from the “helpful” Dunning-Krugerites? You guessed it. “It flushes the fat.” Deja vu all over again! Could watermelon be far behind? Oops, I wasn’t disappointed. “We eat watermelon to help with the constipation.” These are diabetics!

Kidney problems (kidney failure). In people who have kidney problems, diarrhea, nausea, and vomiting may cause a loss of fluids (dehydration), which may cause kidney problems to get worse. It is important for you to drink fluids to help reduce your chance of dehydration.

Eli Lilly Mounjaro website

The real reason to drink a lot of water is conspiculously displayed in the drug information that comes in the package and in the information on the Mounjaro website, which apparently no one in the Facebook group reads. Doctors must not spoon-feed people this information, either. Or they do and it goes in one ear and out the other, so if they skipped this explanation in your case, I’ll give it to you here. Not diligently keeping up with hydration requirements will cause kidney damage and could kill you. This particularly applies to diabetics with injured kidneys, which is most of us. Also, not keeping up with hydration requirements will exacerbate constipation, which is also described in the cautions. (Some get their hydration in the form of constipation-fighting watermelon). But passing along the bullshit like “flushing the fat” sounds a lot better than addressing serious risks.

Serious Adverse Effects — Nahhh!

In the same group, a couple of people posted about gall bladder issues. One had landed in the hospital to get a cholecystectomy — gall bladder removal. Both had been on Mounjaro for a while. The group consoled them and told them that Mounjaro had nothing to do with their gall bladder disease, even though the manufacturer cautions use of the drug by people with gall bladder disease, symptomatic or otherwise. Social media, of course, knows better. And if you tell them otherwise, they shout you down, saying “You’re not being helpful!”. Watch my middle finger as I exit.

Gallbladder problems. Gallbladder problems have happened in some people who use Mounjaro. Tell your healthcare provider right away if you get symptoms of gallbladder problems, which may include pain in your upper stomach (abdomen), fever, yellowing of skin or eyes (jaundice), and clay-colored stools.

Eli Lilly Mounjaro website

Next thing you know, someone will turn up there with thyroid cancer and the group will console them, telling them not to blame it on Mounjaro, despite the conspicuous black box warning about individual or family history of medullary thyroid cancer type 2. God forbid that someone with twenty pounds to lose should be thwarted by something like cancer, so let’s just sweep this ugly warning under the rug.

Not a Diabetes Group

The administrator of this Facebook group even publicly rationalized in response to a complaint that too much bullshit about weight loss was crowding out constructive information for diabetics, to wit: “If we restricted people to diabetic issues, we’d get a series of ‘my A1c went from 8.9 to 6.2’ kind of posts and it would be boring.” Yeah, well, my ass is out the door after ONE DAMN DAY! If I want to hear the fat ladies sing, obtain folk wisdom (or lack of same), and get technical misinformation, I can go almost anywhere else on the Internet.

Tell me this, Mr. Administrator: What is NOT boring about “I lost 23 pounds, and I am eating watermelon”? Or “Everybody should be drinking at least two liters of water per day to flush the fat”? Repeatedly. Completely and unequivocally boring to the max. Give me a break!

Before I quietly left, I saw one more extremely annoying post from a babe who published a picture of a wonderful pineapple margarita with all kinds of fruit and cherries and crap hanging on it, saying it was wonderful that she could now indulge in such things with a clear conscience thanks to Mounjaro.

All things are fair game for the “can we have watermelon?” crowd.

Where to Go for Support?

Lilly’s website has some valuable information. It should be the first stop for anyone taking this drug who wants to know more about what they are injecting into their body. I found one pharmacological podcast that resonated with me as well. However, the popular cultural abomination known as social media has proven of no value.

YouTube is especially replete with “Here’s my Mounjaro Weight Loss Journey” videos. Useless. What I would like to see is some kind of moderated forum, perhaps run by Lilly or by endocrinologists, pharmacologists, or other knowledgeable people who can separate the wheat from the chaff.

From what I have read in the literature, Mounjaro is a promising agent to arrest the cardiovascular, renal, and hepatic damage caused by uncontrolled diabetes. These are rarely discussed on social media. In fact, I have found no such discussions in my brief perusal. I certainly would like to see more evidence-based information on this important subject.

Do Decent Social Media Forums Exist?

Social media is a vast sea of misinformation, but I have heard of a few secular Facebook groups that are informative and to the point. Back when I had my hip replacement over twenty years ago, I found an excellent one. Recently, my wife apprised me of a group that deals with animal health issues, administered by a team of qualified volunteer veterinarians who boot lay people who posit incorrect responses to people’s serious questions.

So, they do exist. If you can recommend one that addresses Mounjaro users from the perspective of diabetics who are interested in the medical aspects, please let me know. I’m looking for support, intelligence, and vetted information, not affirmation, validation, and hearsay bullshit.

Would that all of social media could operate that way…

I’ll be back with more as I continue my “Old Fart on Mounjaro” journey.