Still Awaiting Lab Results
Hello and welcome to my latest weekly update of my experience with the Type 2 Diabetes drug Mounjaro, along with some insights into my approach to controlling the condition. Although I give too much information (TMI) about my various health issues, it is my hope that you will find my experiences helpful in some way.
Today, I’ll share some information about how I track various health and wellness parameters: glucose, weight, blood pressure, diet, and exercise. I covered this ground back in Week Six, but I have changed a few things since then. I’ll also give you a progress update on the current health mishegaas, my functional iron deficiency. I’ll wrap up this edition with the usual Mounjaro progress by the numbers. But first, for the benefit of my new readers, a little background.
Who Am I and What Am I Doing Here?
I’m a seventy-eight-year-old Type 2 Diabetic who has been injecting the GLP-1 RA drug Mounjaro weekly since June 2024. The lowest therapeutic dose of 5mg/0.5ml has done the job well thus far. However, I might need an upward adjustment. My HbA1c has improved from 7.6% (60 mmol/mol) to 5.5% (37 mmol/mol) (as of November 2024). Mounjaro is only a part of the story. While using the drug, I have adopted a high-protein, low-carbohydrate diet and a vigorous exercise program hoping to preserve muscle mass and bone density.
I avoid using the word “journey” to describe my health progress because that is the stupidest metaphor ever. I am not Marco Polo, just a fat old dude with some chronic conditions to treat. I’m not a poet, either. I’m just here to give you straight information and my curmudgeonly opinions. Invoking the words of the late sports wordsmith, Howard Cosell, I tell it like it is with a dose of sarcastic humor. He made that phrase his own, and now it is mine.
How Do I Track My Mounjaro Progress?
I want to share how I track my progress with weight, glucose, blood pressure, etc. Each of my measuring instruments communicates with my smartphone via Bluetooth. Their associated smartphone apps keep good track of the data. Below, I’ll tell you about the devices and their cost.
Glucose
Blood Glucometer
For glucose, I use the Contour Next One glucometer from Ascensia (free from Ascensia if you are privately insured or $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 for morning, fasting readings. The other one is downstairs in the family room so I can enjoy recreational finger-pricking while watching TV.
A package of seventy Contour test strips costs about $27 on Amazon.com. The Contour Next One does not require a code entry with each new batch of test strips. (But I need to index each new set of strips with the appropriate test solution for accuracy). The Contour app provides excellent long-term tracking and detailed reports I can share with my doctors.
Continuous Glucose Monitor (CGM)
Back in September as I was recovering from COVID-19, I discovered that the FDA had approved a new product from Dexcom. Called Stelo, it is a wearable device like a continuous glucose monitor (CGM). It does not require a prescription and is available to anyone directly from the company for under $100 for a month’s supply, or $90 for a monthly subscription.
I had previously eschewed CGMs, like the Dexcom G7. Our Medicare regulators would not cover their cost for Type 2 diabetics unless they: 1) are on prescribed insulin, or 2) have had documented hypoglycemic episodes. Even if my doctor were to prescribe a CGM, the out-of-pocket cost would have been over $300/month. Thus, this new Stelo product offered by Dexcom for less than $100 per month piqued my interest.
Whyfor the Stelo?
Dexcom, makers of the flagship, full blown continuous glucose monitor G7, saw the need for people in my category who want to track their glucose variations. They developed Stelo, a dumbed-down version. Each monitor, which sticks to the back of my upper arm, works for fifteen days. Dexcom labels Stelo as a “glucose biosensor”, not as a continuous glucose monitor. The distinction must be clear only to the Dexcom legal department.
The Stelo app provides a graph that displays 3, 6, 12, or 24 hours at a time in five-minute increments. The sensor updates information via low-power Bluetooth every fifteen minutes. The app covers a maximum of twenty-four hours and “loses” the trailing information. However, Dexcom stores the numbers in the “cloud” where I can access them through Dexcom’s “Clarity” app. Clarity, also used with the G7, displays very detailed, downloadable longer term data and graphs.
In its advertising, Dexcom presents Stelo as an information device rather than a serious medical device. You must not base your medical decisions on its readings under penalty of the Dexcom legal department declaring you an idiot. For example, you can’t integrate Stelo with an insulin pump. Also, Stelo reads interstitial glucose, which differs from blood glucose in a couple of respects.
So what good is it? While the absolute numbers will be off, it is useful tracking glucose spikes from eating carb-laden food. I also can view the relative effect of exercise on my glucose. Thus, I use Stelo as a training device to give me a visual depiction of my insulin response.
Weight
My weight is recorded each morning by the sleek glass and metal pride of China, a Renpho Smart Scale. Currently, it costs $19.99 at Amazon.com, and the app (available for Android and iPhone) is free (no damn subscription, thank God). The scale also does a bio-impedance measurement to determine BMI and body composition. The 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 $109.29 at Walmart.com). I have checked its accuracy against two of my doctors’ instruments, finding the results close. Once you set its Bluetooth link 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 eat, MyFitnessPal app with premium subscription ($79 per year) keeps the food diary. It has a barcode scanner and a robust database of food items. The developers have vetted many of the database entries for nutritional component accuracy. MyFitnessPal is way more than a calorie counter. It keeps me well informed of macro and micro nutritional intake in comparison with goals I have set. I have used it off and on for four years.
Lab Tests
Sometimes, you want to track your progress scientifically. Typically, doctors stick with staid protocols. Most doctors lack the time and patience to deviate. So, if you’re like me, your scientific curiosity impels you to want test results beyond what the doctor orders. I can order my own blood tests via Ulta Labs. They work with the usual storefront labs like Quest. You order the test, they generate a lab order, and you take it to your neighborhood Quest for the blood draw.
Ulta reports results directly to you. If you have a Quest account, you get them from Quest, too. Costs vary with the type of test. For example, the HbA1c test costs $21.95, which Ulta typically discounts 15-20% as a daily or seasonal promotion. At the other end of the scale, a comprehensive celiac disease panel consisting of 79 biomarkers goes for $644.95.
Of course, the results do not automatically go to your doctor. The lab order comes from a house doctor at Ulta. However, Quest provides an easy way to fax results to your preferred doctor if you have a Quest account. Otherwise, you can communicate the results directly — at your own peril, I might add. (Editorial comments follow).
Ramifications of DIY Testing
Depending on your doctor’s psychological maturity level, you might or might not get a defensive reaction from him, her, or “them” when you discuss results of self-ordered tests with them. Some might hand-wave away results if the test wasn’t their idea in the first place. The haughty, self-protective medical profession wants to stick with its bulk-processing protocols. I pity the fool who wants to explore his own body function without a medical degree and a license to practice. Some doctors gaslight us to convince us that we’re idiots, even if we possess the mental capabilities to do research and interpret studies. This amounts to protection of territory. In the next section, I’ll tell a relevant story about how my own doctor reacted defensively.
Back to the Iron Deficiency
Exploration of my functional iron deficiency was an example of the medical gaslighting paradigm. At my September follow-up visit, I had remarked to my doctor that graphs provided by the blood bank that my hemoglobin has been low. He told me to stop giving blood and did not order any tests. So, I had my iron, ferritin, etc., tested on my own and communicated the adverse results in October. Again, he told me to stop donating blood. However, he suggested Feosol (an ferrous sulfate supplement) and a follow-up blood test in sixty days. Those results came back with even worse numbers after two months of supplementation. So, again, he told me again to stop giving blood. Further, he stated that he did not know why free iron was low while ferritin was in the normal range. In other words, a blow-off.
Some research on my part convinced me that the condition needed further investigation. Subclinical bleeding could cause low serum iron coupled with in-range ferritin. Although absent overt symptoms associated with anemia, I must proactively proceed. I have a history of chronic erosive gastritis, esophagitis, colon polyps, etc. Furthermore, anemia of chronic disease (such as colon cancer) is a possibility, as is poor absorption of iron due to GI issues. The in-range ferritin might have something to do with being an acute phase reactant, as I had a urinary tract infection (UTI) at the time of the follow-up blood test.
Taking Matters into My Own Hands
So, I told my doctor that the handwave was not good enough. I scheduled an appointment with my gastroenterologist, The Irascible Dr. Scrooge, which I chronicled last week in this column. To summarize the visit, he reviewed my history and the iron blood tests, then ordered blood tests for celiac disease, a fecal test for occult blood, and a follow-up urinalysis to ensure that my UTI had not left me with lingering microhematuria (small amounts of blood in the urine). The urinalysis is something my regular doctor should have ordered even though the UTI had resolved.
Results from the lab tests from January 28 are still pending as of this morning. It turns out that the celiac test can take up to two weeks. Quest will hold up the simple tests to report everything together.
Path Forward
If the celiac disease test is positive, it can explain why I am not absorbing efficiently. That would entail treatment for celiac plus continued iron supplementation. (Not much one can do about celiac disease other than avoiding gluten). If the celiac test comes back negative, the gastrointestinal fun will begin. Dr. Scrooge feels that what I need is a capsule endoscopy of the small bowel. Being sensitive to the whims of the health insurance industry, he tells me that they won’t approve the capsule endoscopy without having a recent upper endoscopy and colonoscopy to rule out issues in those areas.
A capsule endoscopy is a diagnostic procedure to examine the small intestine. It involves swallowing a small, pill-sized camera that takes thousands of images as it travels through the digestive tract. This method is particularly useful for detecting bleeding, Crohn’s disease, small bowel tumors, celiac disease-related damage, and other abnormalities that may not be visible with traditional endoscopy or colonoscopy. Kinda cool to have a camera free-falling through my gut. (My electronic background might inspire me to retrieve it and do an autopsy on it).
And so, I wait.
The Week’s Mounjaro Numbers
In the intro, I mentioned that I might need a dose adjustment, as my numbers are flattening or increasing. The body can acclimate to drugs, so perhaps I am at that point. I don’t see any other reasons for the numbers increasing. I have not significantly changed my diet, and I have increased my activity level at the gym and at home.
Fasting glucose, my first-thing-in-the-morning measurement averaged 100 mg/dL (5.56 mmol/L), up from 93 mg/dL (5.17 mmol/L) last week. Overall average blood glucose, as measured by my Stelo, was 108 mg/dL, up from 105 mg/dL (5.83 mmol/L). This is equivalent to HbA1c of 5.4% (36 mmol/mol). My target value, which admittedly I pulled out of my ass, is 5.2% (33 mmol/mol).
Body weight was nominally the same from last week to this week, at 188.2 lbs (85.5 kg). My eventual goal is around 160 lbs (72.7 kg) (oh, yeah, for Brits, 11 stone 6). However, I want to get there very slowly while I address the need to preserve muscle mass and bone density. So, I’m not expecting any dramatic weight loss numbers anytime soon. Obviously, I want to deal with the glucose first, and any weight loss is a side-benefit.
Wrapping It Up
My big concern right now is the functional iron deficiency and its causes. I am patiently awaiting the results of the celiac test from which we determine a path forward. Meanwhile, I will keep the diet as-is and continue to pursue the exercise program. I am keeping an eye on the numbers to determine whether I should discuss with Dr. DeLorean (not his real name) whether a Mounjaro dose increase is “right for me.”
I’ll be back next week with more information about Mounjaro and my approach to controlling Type 2 diabetes. Go Eagles!
