Weekly Mounjaro Update: Week 25

The Turkey is back with you (in time for Turkey Day) to report on my weekly progress with the type two diabetes drug Mounjaro. My therapy started on the first week in June this year. Since then, my HbA1c has improved from 7.6% to 5.5%, which is excellent. However, lest I succumb to the GLP-1 drug for life groundswell that is making this class of drugs the most profitable in history, my approach is cautiously optimistic. Unlike other pop culture sources on social media, I am not a one-dimensional cheerleader for these products. What you get here are honest observations and cynical comments derived from my personal experience with all aspects of the therapy, positive, negative, and “too soon to tell.”

My annual physical exam is nigh. I have blood test results in hand. So, tomorrow, I will discuss my progress on Mounjaro with Dr. DeLorean (not his real name). Also, my final physical therapy session was last Friday. I’ll update you on all that later. First, I want to give you the GLP-1 story of the week.

Silly Rabbit! Trix Are for Kids!

(But What about Mounjaro?)

The story of the week involves parents seeking GLP-1 agonist drugs for their children to slim them down. I’ll give you a little background. The biggest selling drugs in the GLP-1 class are Mounjaro and Zepbound (both terzepatide), and Ozempic and Wegovy (both semaglutide). While originally the target consumer group was type two diabetics, the market exploded when the weight loss associated with GLP-1s became evident. The weight-loss market, comprised of both cosmetic and medically necessary reduction, is huge and ripe for exploitation. Eli Lilly & Company and Novo Nordisk, manufacturers of these drugs, would love for two-thirds of the world’s population to become addicted to their magical weight loss potions. Toward that end recently, the US FDA has approved Ozempic/Wegovy (semaglutide) for use in treating childhood obesity. The abuse potential concerned with injecting harmful drugs into children seriously bothers me.

One Mom and Daughter

I’ll point you to an article in The Wall Street Journal about a twelve-year-old girl whose Mom has been getting her GLP-1 drugs from compounding pharmacies. Her pediatrician did not feel comfortable prescribing the stuff for the kid, so the insistent mom looked for tele-health companies that are all about making money on compounded versions of the vogue drugs. Many of these companies sprang up when the last explosive class of drugs, Viagra et al., went off patent. They are merely drug pushers, with varying degrees of medical intervention.

Typically, they expect the client to do his or her own follow-up and lab testing; they cede that territory to to the client’s local doctor. Of course, people intent on getting their hands on the drug take a “damn the torpedoes” approach. Once they establish a supply channel, they might skimp on follow-up. Hell, some might not even tell their local doctor. Kids certainly have no control over the process. They must rely on parental responsibility or suffer in the absence of it. If parents seek out shady suppliers who provide their patients just enough information to satisfy their lawyers, they are putting their children squarely in harm’s way.

We know too little about the long-term effects of GLP-1 agonists, but parents are insisting on giving them to developing adolescents. Nutritional concerns abound. With their appetite suppression, how will these drugs with their associated appetite suppression affect physical growth and mental development? The answers are not clear.

Treat Your Children Well

I’m not here to tell anyone how to raise their kids, but I object to giving them GLP-1 drugs, injectable or otherwise. People want to irresponsibly give their kids crappy sugar-laden cereal, ice cream, cake, and candy, then throw drugs at them when they fatten up. Sometimes, they just want their kid to look good in her prom dress or her play clothes. A sad example came from a tele-health provider in an interview with The Wall Street Journal. She quoted a client who told her, “My daughter is size six. She’s body confident. She has friends, she’s very active, but I can’t help but think she would be better at a size 0.” Just think about that one for a while.

Where parents can step in to combat childhood obesity is feeding their kids decent food. Since the end of World War II, what kids eat has gone to hell in a hand basket. Even in my youth, we had crap like sugary cereals like Kellogg’s Sugar Frosted Flakes (“They’re g-r-r-r-reat!” —Tony the Tiger), Hostess Twinkies, Oreos, and Pop Tarts. Incessant advertising targeting children makes it hard for parents to avoid buying crap for them. And so, the childhood obesity pandemic took hold. It has degenerated from there — seventy years of crappy child nutrition. Now the CDC considers 19.7% of American children aged 2-19 to be obese.

Big Government Abetting Big Pharma and Big Fooda

I’ve written before, ad nauseam, about the food industry and Big Pharma holding each others’ hands while together they make the population sicker. Ultra processed food, high on sugars, sicken people. Big Pharma steps in with expensive magic potions to fix what the food industry damaged. And it goes on and on and on. Instead of government fixing the problems with the lobbyist influenced food pyramid and the adulteration of food, they turn a blind eye to the abuses, while green-lighting all the great new expensive drugs Big Pharma can offer. Direct-to-consumer advertising, legal only in the U.S. and New Zealand, closes the loop between the fat man on the street and Big Pharma. It is only a matter of time before the ballsy marketeers from Big Pharma implore you to ask your pediatrician whether Mounjaro is right for your six-year-old.

Harrumph!

Enough of That… Where’s My Update?

Let me start with the weekly numbers, and then I’ll fill you in on the labs and the PT. This past week included my birthday. I didn’t do anything wild, but I did deviate from my typical diet, going way over my self-imposed carb limit. So, it is no surprise that my average glucose increased to 110 mg/dL (6.11 mmol/L). However, morning fasting glucose averaged 91.7 mg/dL (5.07 mmol/L), an improvement from last week’s 100 (5.56).

My weight was flat for the week, at 195.2 lbs (88.5 kg). I am happy to take a break from losing weight, as I have dropped 50 lbs (22.7 kg) way the hell too fast.

I have noticed that my resistance to Mounjaro is increasing. Appetite suppression has waned, but I have cleaned up my diet. I might need one more dosage bump to finish the job I started. As you’ll see below, my insulin resistance is way the hell too high. I need to get that under control. Nevertheless, I hope to conclude the Mounjaro therapy during 2025. None of this “on it for life” BS. We’ll see…

Blood Test Results

If you ignore my fasting insulin level, which I’ll get to shortly, my metabolic results were pretty damn good for an old fart in his eighth decade. HbA1c was 5.5%, which is in the “normal” range, down from 5.7% in September. My eGFR, a calculated measure of kidney function, has improved to 60, which elevates me from the morass of chronic kidney disease Stage 3A to Stage 2. Because of diabetes, high blood pressure, and metabolic syndrome, my kidneys have taken a serious beating for many years. Positive results in this area never fail to elevate my spirits!

But then…

Alas, my fasting insulin rose to 18.7 uIU/mL, which suggests that I am extremely insulin resistant. What is the connection between Mounjaro therapy and this number? I will discuss it with Dr. DeLorean tomorrow, but my bet is that he won’t offer any brilliant revelations. He will tell me that a single test and one number is meaningless. After all, I, not he, ordered the test. But there is a method to my madness. I believe that insulin resistance underlies a cascade of metabolic issues. But who am I?

HOMA-IR

I had tested fasting insulin back in July. At that point, it measured 14. Holy Crap! This is a significant increase, no matter who orders the damn test. Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) is a calculated measure of insulin resistance recognized by metabolically savvy doctors, so I’ll use that score to illustrate the extent of my insulin resistance. HOMA-IR is a function of concurrent fasting insulin level and fasting glucose level. Any score above a 2 signifies insulin resistance. In my case, July’s number was 3.3 and November’s was 4.4.

However, the model is controversial. “The HOMA-IR score should not be used in patients on insulin, and studies have questioned its accuracy in those with impaired glucose tolerance, normal BMI, the elderly, and others.” Well, I am elderly and I certainly have impaired glucose tolerance.

I’m not going to panic. What can I do about it? I have already adjusted my diet and I will be increasing my exercise, now that physical therapy for my back has concluded. But if Mounjaro is causing the decrease in insulin sensitivity, my desire to get off the drug will accelerate. The alternative would be chasing dosages upward while insulin resistance also increases, in an endless upward spiral. That’s all speculation at this point. I need some hard facts, and I’m skeptical about getting them.

Physical Therapy Concludes

I think the physical therapy did me some good, especially, the core strengthening exercises, which enabled me to comfortably hike 8.6 miles (13.8 km) on Thursday. After hearing about this from me, my PT task master gave me a going-away gift by doubling the number of daily exercises I do at home. Facetiousness aside, I will do them diligently.

My back pain still bothers me, but the therapist told me in advance that there were limits to what she can do. Only surgery can assuage some of my back issues and others are not correctable by any means. Still, I think the hard work and the ongoing exercises will pay off.

The numbness and burning in my right thigh persists. I will be seeing a physiatrist (physical medicine and rehab doctor) in early December, hoping to get some relief through non-surgical means. The condition, tentatively diagnosed as meralgia paraesthetica, is annoying but not debilitating. It involves a sensory nerve, which as the name suggests affects only sensation, not control of muscles. Like lots of other annoyances that accumulate with advanced age, I can learn to live with it if the correction would be more of a pain in the ass than the pain in the ass itself!

Get Some Exercise, Fat Boy!

The physical therapist had asked me not to do my usual resistance exercise program while she was punishing me physically, so I obeyed. Now that she is out of the picture, I will get back into it, and then some. In December, I will join the exercise program at the same rehab and will resume the dumbbells and stationary bike at home.

Have a Happy Thanksgiving!

That’s all for this week. I hope to bring you some more egocentric information about my ongoing Mounjaro therapy next week after I see the doctor for my annual physical. On Thursday, I anticipate another dietary deviation at Thanksgiving dinner, but I will try to minimize its glucose impact. No sense killing myself on Thanksgiving!

I wish all of my U.S. readers a very Happy Thanksgiving, and I apologize to my Canadian readers for missing Thanksgiving last month. (Even if I’m not Canadian, I can still say I’m sorry!). See y’all next week!