Mounjaro Update: Week 37

Yes! We have no URI!

Hello, my metabolically curious peeps! I’m here with yet another boring update about my Mounjaro progress, peppered with amusing tales of my frustrations with the healthcare system and opinions on anything worth an opinion. This week, I’ll be telling the story of my gastroenterologist’s bogus no-sniffles diagnosis, along with the usual update and some news on the Mounjaro front.

I’m a diabetic old fart on Mounjaro (tirzepatide), a GLP-1 RA drug. The purpose of this weekly series is to share my experience with others who are considering Mounjaro or similar drug therapy. Although I am grateful for the positive effects of Mounjaro, I am cynical about unknown potential long-term issues, because GLP-1 RA drugs have too short a clinical history. Thus, I do not view my current prescription as a lifetime commitment to the drug, much to the dismay of Eli Lilly & Company, its manufacturer.

I occasionally use this forum to bitch at the rah-rah weight-loss crowd who promote these drugs as a panacea for obesity, to be prescribed by TeleHealth operations and taken with impunity. We are now supposed to believe that obesity is a chronic, relapsing disease, treatable mainly with major profit-producing pharmaceuticals. That, of course, is clearly bullshit perpetrated upon us by our money-grubbing friends in Big Pharma. Hell, last week, I told you about a study aimed at prescribing these injectable drugs for fat six-year-olds. Sheeit! But I digress wistfully. Let’s get back to my healthcare travails.

Shoddy Reporting in Scroogeville

I suppose I should not blame the good doctor’s rank-and-file employees for the funny screw-up I’ll tell you about here. Back when I lived in The Bahamas, we had a saying that “the fish stinks from the head on down.” So, let’s hold Dr. Scrooge responsible, even though he likely never got close to this issue. What the hell am I talking about? I’ll give you a little background information first, as some of you have not encountered the ongoing saga in earlier issues of this blog.

Iron Deficiency

I consulted The Irascible Dr. Scrooge, my long-time gastroenterologist in late January because of an observed functional iron deficiency, which my primary care doctor, known here as Dr. DeLorean, expressed no interest in chasing. Dr. Scrooge (not his real name, obviously) wanted to first test for celiac disease, then if negative, do some endoscopy to look for GI bleeds, cancer, or chronic inflammatory disease. Yet, he took a side-trip to my urinary tract when I told him that Dr. DeLorean had treated me for a urinary tract infection and I had noted that my urine was pink at one point. I told him about the UTI for completeness and full disclosure, although I thought the pink urine might not be from blood. The pathogen responsible for the infection produces a red pigment, but I said nothing about that. So, Dr. Scrooge ordered a urinalysis to look for blood in the urine.

The lab results for that screening urinalysis came back positive for leukocytes, indicating that the infection had not completely settled down. Dr. DeLorean had successfully treated it with Cipro after a false start with Macrobid, but the abnormal urinalysis inspired Dr. Scrooge or one of his extenders to order a follow-up urine culture. When the representative conveyed this to me on the phone, I thought it was weird. Scrooge was looking only for blood in the urine, not to treat a UTI. The latter would entail referring me back to my primary doctor. But who knows? Doctor’s orders (presumably), and it couldn’t hurt to see if I still had an active UTI, so I complied, giving Quest Labs a cup of my finest amber brew.

The Results Are In

Because I have an account with Quest, I get results instantly when they are published. Then, I typically hear from the ordering doctor a day or two later. Last Sunday, Quest gave me results of the culture, which were negative for any bacteria. Nothing grew, no more urinary tract infection. So, imagine my titillation when I opened my mailbox the next Thursday to find an unsigned letter from Dr. Scrooge’s practice declaring, “Your recent laboratory results did not show that you have a[n] Upper Respiratory Infection.”

It’s good to know that I don’t have a cold. Or was it unreasonable for me to expect that a urine culture would confirm that? Oy, vey! Must be allergies with all the tree pollen in the air around Central Florida. Wait, WTF??? Who said anything about a URI? Someone at Dr. Scrooge’s office must be dyslexic or something. UTI and URI differ by only one letter. And, how about this: urine starts with the three letters U-R-I. Wow! OK, enough already! You get my point. It was innocuously inconsequential in this case, but I wonder whether they proofread prescriptions with the same diligence.

Just a Typo — No Shit?!!

OK, so I called, sarcastically telling the female voice on the phone that I was happy that the results of my urine culture revealed that I didn’t have a cold or bronchitis. She got defensive, saying, “I see the typo, but obviously they meant to say no urinary tract infection.” Then, she was ready to end the call when I asked whether we’re moving ahead diagnostically about the functional iron deficiency. “After all,” I said, “the UTI was a side-trip. Now let’s get back on course.”

She did not seem to know what the hell I was talking about, so I read Dr. Scrooge’s January 27 clinical notes: “Further work up to identify possible GI causes were also discussed, such as VCS, FIT test, and Celiac antibody labs. Advised if labs are negative, patient is to complete EGD and colonoscopy followed by VCS on a separate date if [the EGD and colonoscopy are] negative.” She didn’t believe me, or she couldn’t read, because she asked me where I was reading that. I told her it was the fifth paragraph down.

Get Me Outta Here!

Then, she really wanted to get off the phone. Was this was the first time a patient read the clinical notes? Sure seemed like it. On her end, it was painfully clear that she hadn’t read them. She obviously had no answers, so she would consult with Dr. Scrooge and call me back. That was Thursday, and I have yet to hear from her or from anyone else at the practice. Nothing happens fast in today’s healthcare system in this country.

Piecing it all together, I believe Dr. Scrooge hands off cases to his staff, who drive the process from there. Shouldn’t they be basing it on his clinical notes? If they choose to take their own direction, I might as well deal with Dr. ChatGPT for my care. Still, I will continue to prod the low-level operatives and hold them to the plan. We all must be our own healthcare advocates in this strained healthcare climate.

I am certainly not anxious to be invaded in both ends by probes, and another colonoscopy prep is not a pleasant prospect, but I sure as hell want to get to the bottom of the iron deficiency. If I don’t hear from those dyslexic geniuses by Friday, [insert DJT Gaza-like implicit threat here].

Latest Mounjaro News

Here is a roundup of recent activity on the Mounjaro front, courtesy of the lazy writer’s friend, ChatGPT.

• Supply Issues Resolved: The FDA has announced that the shortage of Mounjaro (tirzepatide) has been resolved, meaning Eli Lilly’s production can now meet national demand. As a result, pharmacies and outsourcing facilities have been given deadlines (February 18 and March 19, 2025) to stop distributing compounded tirzepatide, as compounding is no longer justified due to availability canamericaplus.com.
• Kidney Benefits in Diabetes: New findings from the SURPASS trials indicate that tirzepatide significantly reduces albuminuria in adults with type 2 diabetes. This suggests potential kidney-protective effects, particularly in patients with chronic kidney disease (CKD) healio.com.
• NHS Approval in the UK: Mounjaro has been approved for use in England under the National Health Service (NHS), but access will be phased in over time, with priority given to those with the highest clinical need. The full rollout could take years, with only 220,000 patients expected to receive it initially, despite millions being eligible pharmaphorum.com.

These updates suggest that tirzepatide continues to be a highly effective treatment choice for diabetes and weight management, with extra emerging benefits for kidney health.

It Ain’t All Good News

Yet, some negative information about GLP-1 RAs also emerged this month.

• Recent studies suggest a potential link between semaglutide (Ozempic) and an increased risk of non-arteritic anterior ischemic optic neuropathy (NAION), a condition that can cause sudden vision loss due to reduced blood flow to the optic nerve. A Danish cohort study found that the use of once-weekly semaglutide more than doubled the five-year risk of NAION in individuals with type 2 diabetes. medicalxpress.com.
• The European Medicines Agency (EMA) is currently reviewing all available data on this potential risk, including clinical trial results and real-world studies. The Pharmacovigilance Risk Assessment Committee (PRAC) has initiated an investigation into whether semaglutide use is associated with an elevated risk of NAION. ema.europa.eu.
• Despite these findings, experts stress that the absolute risk remains low. A multinational study using Scandinavian health registries identified only 32 cases of NAION among over 60,000 people using semaglutide, suggesting that while the risk may be elevated, it is still relatively rare. verywellhealth.com.

For patients concerned about vision-related risks, it is advisable to discuss these findings with a healthcare provider, particularly if they have pre-existing risk factors like diabetes, hypertension, or a history of optic nerve disorders.

Updating My Progress on Mounjaro

In the past few weeks’ blogs, I have shared my observation that I might need a dose adjustment. I have been taking the lowest therapeutic dose of Mounjaro since September (5mg/0.5ml). But, since early December, I have observed an increase in average fasting blood glucose, which I have documented here. I put together a graph to give me a better picture, including (gratuitously) body weight, which continues to decrease.

The glucose situation is complicated by my discontinuation of metformin around the end of November. This certainly could be a cause for the steady increase. The body weight line on the graph paints a different picture. I continue to lose weight, but I am no longer experiencing the “fullness”, the absence of “food noise”, and the general appetite suppression that Mounjaro formerly gave me. Thus, I attribute the ongoing reduction to my amped-up workout schedule at the gym coupled with a mindful approach to a low-carbohydrate, high-protein diet.

Remember that weight loss is well down on my list of priorities for Mounjaro therapy. My first priority is glucose control, followed closely by my wish to preserve muscle mass, which is imperiled by the joint effects of rapid weight loss and sarcopenia, the loss of muscle due to aging. The weight loss is an added advantage. But at this stage, I want it to slow down due to the nasty effects of too-rapid reduction.

Offsetting Loss of Muscle Mass

The SCORES study and recent research on GLP-1 receptor agonists (GLP-1 RAs) highlight concerns about muscle mass loss during medically induced weight reduction. Findings show that muscle loss can account for 25–39% of total weight lost over 36–72 weeks, which is significantly higher than with non-pharmacological weight loss techniques. This loss is particularly worrisome because skeletal muscle plays a crucial role in metabolism, glucose regulation, and immune system function.

While GLP-1 RAs improve fat-to-fat-free mass ratios, excessive muscle loss could contribute to conditions like sarcopenic obesity and increase the risk of cardiovascular disease and frailty, particularly in older adults. Experts recommend counteracting this effect with resistance training and adequate protein intake. Some researchers are also exploring myostatin inhibitors as a potential strategy to mitigate muscle loss during weight reduction with GLP-1 drugs.

No More Drugs

I sure as hell won’t be considering myostatin inhibitors. My wish is to get off as many drugs as I can, including Mounjaro. I am trying to create a paradigm to achieve that goal with diet and exercise adjustments, which I will pursue diligently. If I need a dose adjustment or a re-prescription of metformin to keep glucose in check, I’ll do it. I will discuss this with Dr. DeLorean next Monday at my follow-up appointment.

I will have some new lab results for you next week. Aside from HbA1c, which Dr. DeLorean ordered, I have ordered hs-CRP and SED rate on my own to further pursue the iron deficiency. As well, I’m checking testosterone to see whether I really can build muscle. Finally, out of curiosity, I’m checking fasting insulin, and I threw in a comprehensive metabolic panel for an extra $20. Yes, I know, I’m playing doctor, but seriously, my scientific curiosity remains unchecked by the medical establishment’s gaslighting and obfuscation.

The Mounjaro Numbers, Already!

This will be anticlimactic, because the graph above tells the tale. Still, just for shits and grins, here we go with this week’s Mounjaro numbers. Average fasting blood glucose was 107 mg/dl (5.94 mmol/L), about the same as last week. Overall average blood glucose as reported by my Stelo CGM was 115 mg/dL (6.39 mmol/L), up 8 mg/dL (0.44 mmol/L) from last week. I attribute this to deviating from my low-carb diet during my Pennsylvania friends’ visit. Still in all, this would equate to HbA1c of 5.6% (38 mmol/mol), which is up slightly from my last test in November, but still “not too bad”.

Body weight decreased during the week, amazingly enough, reading out at 187.6 lbs (85.3 kg) this morning, a loss of 2.2 lbs (1 kg). I say “amazingly enough” because of the pig-out with friends described above. This entailed consuming significant carbs at our neighborhood Greek restaurant and a German bakery/deli in the middle of nowhere that our friends really like.

Saluting Our Presidents and Signing Off

As always, I hope you have derived something of value from my shared experiences and my information retrieval. I know that you are as happy as I am to know that my urine shows no evidence of bronchitis.

Today, we celebrate President’s Day, which merged George Washington’s Birthday (February 22) and Abraham Lincoln’s Birthday (February 12) into a single, interpolated, undistinguished, mandated Monday Federal holiday. Like Daylight Savings Time, just let the government produce GFIs (not ground-fault interrupters, but rather, Great Ideas), and they’re sure to screw it up. So, let’s celebrate our presidents today, whether it is their birthday or not. I pick one president every year. This year it is Martin Van Buren, who was born on December 5. He’s as good as any of the other forty-four.

Until next week, when I report on the lab results I mentioned and give the usual update, I bid you a Happy President’s Day. May you find the sale price mark-downs you crave on the stuff you want! We know what President’s Day is all about, don’t we?