Mi Viaje Mounjaro

Week Six Recap and Other BS

Greetings, Mounjarinos and Mounjarettes, and welcome to my as yet unnamed Mounjaro column! Nope, I still do not have a catchy title for this sub-blog, and I didn’t want to spend a lot of time scratching my head. Although I despise the use of the word “journey” to describe a therapeutic process, it was the only thing that came to mind, albeit in Spanish. ¡Hola, amigos!

For a permanent title, in view of my Pittsburgh heritage, I seriously considered “Voyage of the MonJaggoff”, but quickly nixed that idea because I do not want to be offensive(r).

If you are new here, this is a place where I describe my progress with the ridiculously expensive but nevertheless all the rage diabetes drug called Mounjaro, a product of Eli Lilly & Co. Each Monday, I pass along information that I think might be worthwhile to others who are either taking or contemplating taking the drug. As a bonus, I regularly make fun of the plethora of YouTube channels “monetizing” their videos describing their producers’ cosmetic weight loss trials and tribulations.

Today I after summarizing my progress, I will write about which equipment and software I use for tracking my progress. Further down, I will tell you about my “bad blood” follow-up lab testing, and I will wrap up with a few words about supply shortages and my path forward.

Week Six Summary on Mounjaro

My average glucose level for the week was 100 mg/dL, down from 103 last week. Serum glucose reduction is the main effect I seek, although I will take the weight loss as gravy on that roast. The morning fasting glucose average for the week was 97. My goal is to get that down to 82 to match my wife, but I do not know whether or not that is realistic. My next HbA1c test is scheduled for September, and I am anticipating great results!

Weight loss continued this past week, albeit at a reduced rate, a loss of 1.8 pounds for the week. This is a comfortable weight-loss rate for the reasons I have described before. Obviously, fifteen pounds in five weeks is not a sustainable rate. My weight reduction is attributable to calorie deficit, which is facilitated by the drug. Mounjaro signals to the brain to stop thinking about feeding my face all the time, plus it slows processing of stomach contents. What the drug does NOT tell my brain is to get a decent amount of exercise; I must motivate myself to do that. (Someday there will be a drug for that called Offyerazza. But I digress.).

Blood pressure continued its downward trend after last week’s blip, averaging 121/72. This is another important consideration for an old fart with chronic kidney disease (CKD), which I will cover in a later section.

How Do I Track My Mounjaro Progress?

Hey, it is all automation, man! No, I have not yet set up Alexa to recite my weekly numbers for me on Monday morning. Nevertheless, each of my measuring instruments communicates with my smartphone via Bluetooth, and the associated apps keep good track of the data.

Glucose

For glucose, I use the Contour Next One glucometer from Ascensia ($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. The other one is downstairs in the family room to facilitate recreational finger-pricking while watching TV.

A package of seventy Countour test strips costs about $27 on Amazon.com, and the meter does not require coding. (However, every new container of test strips should be indexed with the appropriate test solution for accuracy). The Contour app provides excellent tracking and reports I can share with my docs.

Why No CGM?

Why do I not use a continuous glucose monitor (CGM)? These wonderful high-tech devices have become very sophisticated and convenient in recent years. For example, the Freestyle Libre 3 by Abbott Labs is an amazing piece of machinery! However, aside from the fact that stabbing my fingers several times per day constitutes less bullshit that hanging a piece of plastic on my upper arm, CGMs are notably inaccurate. Additionally, the cost angle is a significant roadblock for me. My old fart Medicare will not defray the cost of a CGM unless I either am using insulin or I am prone to hypoglycemic episodes. Neither is the case here, so I would need to go out-of-pocket another couple hundred dollars a month for this inaccurate pain in the ass. (You can see that I really want one, can’t you?).

Weight

My weight is recorded each morning by the sleek glass and metal pride of China, a Renpho Smart Scale. When I bought it several years ago it was dirt cheap, somewhere around $20. I see that now it is available at $23.99 before applying a $2 coupon at Amazon.com — still cheap for what it does. The scale also does a bio-impedance measurement to determine BMI and body composition, although it does not offer metabolic rate like some of its counterparts. (What do you want for $20, anyway?). Its associated 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 (currently $109.11 at Walmart.com). I have checked its accuracy against two of my doctors’ instruments, finding the results close. Once its Bluetooth link is set up with the smartphone, it automatically transfers each reading. The app does a great job of tracking and averaging blood pressure, plus identifying peaks and heart rate abnormalities.

Food Logging

Finally, for tracking what I stuff into my pie hole, the MyFitnessPal app with premium subscription ($79 per year) makes the food diary extremely easy. It has a barcode scanner and a robust database of food items. Many of the database entries have been vetted for nutritional component accuracy. This is way more than a calorie counter. Instead, it keeps me well informed of macro and micro nutritional intake in comparison with goals I have set. While logging each chunk of food I slurp up is a pain in the ass, this app assuages some of the butt ache. I have used it off and on for four years; had I stuck with it, I would not be so damned fat!

Bad Blood Follow-up

Recall that although neither I nor my doctor associated my abrupt decline in kidney function with the Mounjaro therapy, I was quite concerned about it as I reported last week. I did some re-testing and concluded that my dehydration prior to the previous test was the culprit. Although creatinine is still high at 1.36, it is down from 1.4. I felt relieved when the urinalysis results revealed no albumin and albumin/creatinine ratio (ACR) of 5. An ACR under 30 is normal and good. Back to the blood, my BUN/creatinine ratio was 16, still in the normal range. Sodium and potassium were all in range.

I also did a cystatin-c test to get a more accurate reading of my eGFR. While the eGFR calculated using the creatinine result gave me a 54, the cystatin c test resulted in a 46. The usual estimating procedure for eGFR is not only less accurate, but also has been subjected to some racial perturbation. Previously having different scales for black vs. white populations, in 2021, the woke movement in medicine decided to be racists and declare that there is no difference. The expected result is a compromise scale for all. But I digress.

Whether 54 or 46, this puts me in Stage 3A of CKD, and the absence of proteinuria puts me in subclass A1, which means I have been stable since about 2020. Kidney function declines with age, exacerbated by high blood pressure and diabetes. The previous test gave me an eGFR of 43, which would have classified me in Stage 3B, hence my panic reaction. Going forward, I must avoid dehydration to forestall a further decline. On Mounjaro, dehydration can present insidiously, so those of us taking the drug must hydrate diligently.

What about omeprazole?

I also reported that Prilosec (omeprazole) has been associated with kidney damage. Due to my alarmism in view of several lawsuits against its manufacturer, coupled with what I felt was a decline in kidney function, I discontinued it. However, long-term omeprazole is still recommended by gastroenterologists for avoiding progression of Barrett’s Esophagus (BE), so I will strongly consider resuming it, although I might do so at the minimum dose. Some GI docs have said that for long-term BE therapy it is just as effective at 10 mg per day for BE than 40 mg per day, and produces fewer side-effects at lower dosages.

Mounjaro Supply Shortages

In past weeks I have told you about the explosion of demand for the vogue drugs in the GLP-1 class such as Mounjaro and Zepbound causing supply shortages. These have been acknowledged publicly by the manufacturer, Eli Lilly & Co. Until I placed my order for next month’s supply, I had not been affected by these shortages. However, my pharmacy responded to my most recent on-line reorder by telling me that the drug was out-of-stock and they would order it. Of course, they did not say when to expect it, just that they would send me a text message when it arrives.

Having just injected my Week Seven dose last night, one more Mounjaro injector in the refrigerator for next week. Thus, I am not yet anxious about a potential discontinuity in the therapy. Stay tuned to next week’s column for an update, just in case I freak out then. The possibility exists that I can titrate up to 5 mg from 2.5, although shortages might exist at both of these lower dosages.

Wrapping It Up and Putting a Bow on It

So, I would say that I am making progress on all fronts with the Mounjaro therapy, and I have assuaged my worst fears about a worsening kidney situation, so it is all good. I hope I have provided you with some useful information about tracking equipment and software if you are interested in keeping score for yourself. Finally, we will see where we are going with these supply shortages. Next week should be telling.

I will see you all next Monday with another action-packed post. Thanks for being here, and stay tuned!