First Week on Mounjaro and…

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.