Archives for December 2024

This old fart has been on the type 2 diabetes drug Mounjaro for half a year, with dramatic results even on the lowest therapeutic dose (5 mg weekly). My latest HbA1c result was 5.5% (37 mmol/mol), I’ve lost 57 lbs (25.9 kg), and anecdotally, I believe my inflammation is reduced.

Last week, I completed my annual physical exam, which involved a lengthy review of my myriad ailments with Dr. DeLorean (not his real name), and the usual prodding and probing. After my requisite editorial opinion piece, I will report on the salient features of our discussion. Finally, I will report on Mounjaro influenced results of the week, and look at where I am going from here with diet and exercise, including some exit plan ideas.

Biden Administration Wants Medicare to Cover Fat Drugs

Long standing legislation prohibits Medicare and Medicaid from paying for weight loss drugs. However, now that interested parties, namely Big Pharma and their sycophants in the medical community, have classified obesity as a chronic disease, their co-conspirators in government wish to spend taxpayer money on this crap at an estimated cost of $25+ billion. Please do not be so naive as to think that government has any money of its own. This expenditure will hit our wallet. All of us. Simply stated, it is a transfer payment from the taxpayers to Big Pharma, who will use the logical fallacy that obesity is only treatable through their drugs as a justification for this plunder.

On the governmental side of the equation, what is the political impact? The lame duck Biden Administration is flipping a big, populist bird at the incoming Trump Administration, hoping to either embarrass them into preserving the policy or use the repeal as public attack material to gain an edge in the mid-term elections, spending taxpayer money to do it. Fat people vote; seniors vote. Folks, it is all about money and power, not about public health. That’s my opinion and I am sticking with it.

The Real Fix Is Not Throwing Drugs at Obesity

If the Federal government wants to do something about obesity, it should start by blowing up the crony laden USDA, FDA, NIH, and CDC. Although I regard RFK, Jr as a crazy person, perhaps he’ll be crazy enough to accomplish that objective with the listed three-letter agencies. Also, I have high hopes for sane and rational Dr. Marty Makary heading up the FDA. In any case, the damn food pyramid essentially created by lobbyists, needs to be fixed and the government must devote significant energy toward regulation of ultra-processed food. It is the crap we eat and our sedentary lifestyle that is making us fat, not some mystery disease that only drugs can fix. Let government deal with that aspect, instead of lining coffers of Big Pharma with costly purported miracle cures!

Do I practice what I preach?

Am I a hypocrite? After all, I’ve lost 55 lbs and Mounjaro is responsible for much of that. I have type two diabetes, which, thanks to Mounjaro, is well under control. That was my primary goal, not weight loss. Furthermore, my plan is to get off Mounjaro at some point my doctor and I agree upon, after I have completely committed to permanent lifestyle adjustments, which I touch on below. I’m sorry to disappoint Big Pharma, but if their plans are for me to be on this stuff for the rest of my life, I’m hopping off that train as soon as possible. Alas, that profit-driven desire from the Big Pharma boardroom is the impetus for pushing Medicare to cover the GLP-1 drugs, because doing so will open new, geriatric doors for exploitation.

In my opinion, although proponents push the use of weight loss drugs as a preventive measure to forestall chronic metabolic disorders, the blanket authorization by government will be an expensive mistake that promotes abuse. Its estimated cost, as I mentioned, is $25+ billion, which like most government estimates is way the hell too low. The suggested threshold for approval is a minimum Body Mass Index (BMI) of 30. But I would expect that coverage will extend to people desiring cosmetic weight loss who do not necessarily meet that blanket criterion, exacerbating the waste of taxpayer money.

As I have stated many times in past updates, a basic principle of economics is There Ain’t No Such Thing As A Free Lunch (The TANSTAAFL Principle). Medicare Part D premiums will surely rise if this program is implemented. And fat people will rapidly realize that their co-pays will be huge, while Big Pharma and their government partners smile derisively at the hoodwinked public.

Another Problem: Waste, Fraud, and Abuse

Medicare abuse is rampant, and no one seems to be doing anything about it. In fact, I have been involved in at least two incidents where Medicare paid for crap I or my doctors never ordered. In one case, I was receiving dozens of Covid tests for several months from two different sources to the extent that I had an unmanageable stockpile of them. The Explanation of Benefits (EOBs) told me that those unscrupulous scammers were making thousands on the fraud. In another, even more ridiculous one, I received an EOB saying some outfit in Brooklyn had supplied me hundreds of urinary catheters and was, again, paid thousands of dollars. I reported both. The process is tortuous, and my firm belief is that benumbed government workers throw such claims in the Federal Workers trash can, because otherwise, they would need to do some work.

So, no, I do not endorse this obvious political maneuver. Too much of that one-hand-washes-the-other crap in Washington is too much, already. Let us work together to improve our food system, which after all is what made us fat, and let us encourage people from eight to eighty to increase their activity. Take that $25 billion and buy every overweight man, woman, and child in the United States some unbiased nutritional counseling and an exercise plan. Fix school lunches so they’re not pushing pure crap at our kids, establishing fattening up habits for the rest of their lives. Remember that a concerted effort in eliminating cancer and COPD deaths from smoking produced astonishing results. Much as we conquered our smoking habit, we can vanquish our crappy eating habits!

Thank you for reading another editorial rant from The Nittany Turkey!

Back to My Progress on Mounjaro

Dr. DeLorean expressed approval over my reduction in A1c, which at 5.5% (37 mmol/mol) is now below the pre-diabetes range in an area the medical industry considers “normal”. I told him my target was 5.2% (33 mmol/mol). He asked me why I wanted it that low. My response was that I had seen that number before, earlier in my life, so I set my sights on returning to it. Very unscientific, but I’m using it as a motivator.

Getting My Fat Butt in Gear

I got the doc to sign off on an exercise authorization for the local sports med and rehab gym. Today and tomorrow, I’ll be meeting with my personal trainer there to create a workout plan to augment the back and core strengthening exercises and dumbbell workouts I have been doing at home. My wife now classifies me as a gym rat. I’m not, but I do not mind working hard to achieve my objective.

I hiked roughly 8.5 miles (5.3 km) on two occasions in the past two weeks. The second hike turned into a swamp tromp, wading through fetid water, getting stuck in mud, dealing with aggressive attacks by thorny vegetation, and crossing a barbed-wire fence line four times. (I did not plan that bushwhack, but I’m relentless and stubborn when I set my sights on something, which was reaching a particular point on a trail that Hurricanes Helene and Milton had recently obliterated). At age 78, I believe the core strengthening exercises have increased my hiking endurance, which I intend to further test in the coming weeks. The current cool weather is a motivator. Alas, it never lasts long here in Central Florida. Soon enough, I’ll be out there dehydrating myself again on 95°F/35°C days with matching humidity.

Getting Off

Dr. DeLorean felt that it was too early to get me off Mounjaro, but felt that when the time came, I may start lengthening the interval between injections. He and I are well aware of rebound effects when withdrawing from GLP-1 drugs. It is my hope that when the time comes to get off this stuff, my diet and exercise patterns will have become permanent features in my daily existence.

I had been taking metformin concomitantly with the Mounjaro. Continuing the discussion about when I can get off the Mounjaro, doc said I can dump the metformin now. I am always happy to decrease the number of drugs I am taking, and the results you will see below reflect my metformin freedom since Tuesday.

My Mounjaro Numbers for the Week

Recall that Thanksgiving happened during the week. My Dexcom Stelo CGM tells the story. The instantaneous value shown at 9:07 PM on Thanksgiving evening during the Dolphins game, 121 mg/dL, needs to be adjusted downward by about 16 mg/dL to 105 mg/dL ( 5.82 mmol/L) to accommodate the bias against my measured blood glucose using a finger-stick blood glucometer. Stelo does not do that automatically, like the non-dumbed-down Dexcom G7. The Stelo measures glucose in interstitial fluid, not blood, so there is a difference in time and level. Anyway, what we’re interested in is the shape of the spike, not the absolute glucose value.

Thanksgiving dinner was nominally at 2:00 PM, although perfectionist turkey carver Aliya prolonged the anticipatory salivating agony. When the dinner bell finally rang, I avoided bread, stuffing, mashed potatoes, and gravy — and especially, sugar-laden cranberry sauce — concentrating on the delicious turkey Aliya had roasted beautifully. Additionally, I doled out some quintessential green bean casserole and a portion of the Greek Salad I made for the occasion. My major carbohydrate indulgence was a slice of pumpkin pie, which I suspect was responsible for the spike you see in the screenshot.

The Day After

Interestingly enough, my morning glucose on Friday morning was an outlier, still at 96 mg/dL (5.33 mmol/L); the average fasting morning glucose measured by my Contour Next One glucometer was 85 mg/dL (4.71 mmol/L). The Stelo tells me that my average glucose for the week was 115 mg/dL, so applying the bias I mentioned in the lead paragraph gives us 99 mg/dl (5.49 mmol/L). Not too shabby!

Weight loss for the week was 2.8 lbs (1.3 kg). Although I am still too fat, I want to flatten out the curve so I am not losing too much weight too quickly. If you have followed my progress at all, you’ll know that I have dropped precipitously from 245 lbs to 192 (111.1 to 87.0 kg) in six months, which can have some negative health consequences like treatment induced neuropathy of diabetes (TIND), which I described in the July 22 edition of this update.

That Should Do It for Another Week

So, as you now know, I made it through Thanksgiving, which is significant for a diabetic, old Turkey. I have progressed nicely with blood glucose, and I am working on strength, agility, and endurance along with cleaning up dietary habits, especially avoiding ultra-processed crap. As well, I continue to hope for a renaissance in the governmental agencies that allowed us to get fat, who now want to take the easy path of selling out to Big Pharma with the taxpayers’ wallets.

See you next week!