Mounjaro Update: Week 38

Blood Results Are In; Another Week, Another Doctor!

Hiya, fellow Type 2 diabetics and other curious souls. I’m back with another weekly update and commentary on my progress on Mounjaro. I cover many aspects of my health, which I hope will help others who are in the same or similar boats. At age seventy-eight, I bit the bullet, using GLP-1 RA drug Mounjaro along with major lifestyle modifications to lose sixty pounds, reduce my HbA1c from 7.6% (60 mmol/mol) to 5.4% (36 mmol/mol), and lose sixty pounds (27.3 kg) of fat since last June.

I have accomplished a lot in a short period, but I want the final push to knock off another twenty-five or thirty pounds, and get my HbA1c down to 5.2% (33 mmol/mol) consistently over two three-month periods. While I feel that Mounjaro is only a part of the story, I don’t think I could have done all this without it.

Still, I’m not a rah-rah cheerleader for Big Pharma. I’m hoping to kick the Mounjaro habit at some point when my condition has stabilized. I realize that this comes at a peril, as many who have discontinued GLP-1 RA drugs have regained weight and lost control of blood glucose. I am hoping to be the the antithesis of that cohort’s rebound propensity. Although I will not hop off the Mounjaro train anytime soon, I want to get my ass in the proper gear to be in a position to do so by the end of this calendar year.

I am at the lowest therapeutic dose of 5 mg/0.5 ml injected weekly. After my visit with Dr. DeLorean (not his real name), which I will describe later, I will increase the dose to 7.5 mg/0.5 ml. But first, I’ll bore you with the results of my blood tests, as I promised you last week.

Are You KIDNEYing Me?

My blood test results showed the usual elevation of BUN and as a result, eGFR of 59. This is just over the line into chronic kidney disease Stage 3A territory, but that’s a continuing saga, which is fortunately stable. Let’s move past my kidneys to the HbA1c and insulin results.

HbA1c Still Improving

My HbA1c improved from 5.5% (37 mmol/mol) to 5.4% (36 mmol/mol) for the period between November 19, 2024 and February 18, 2025 (three months). Note that this period included Thanksgiving, Christmas, Hanukkah, New Year’s, MLK Day, and the annual visit from snowbird friends, which all involves diet compromises. I’ve mentioned before that my personal target is 5.2% (33 mmol/mol).

My doctor asks, “Why so low?” My answer is always, “Why not?”

IR Coming HOMA

Homeostatic Model for Insulin Resistance (HOMA-IR) is a calculated number some use as an indicator of insulin resistance, which is the precursor to Type 2 diabetes and a whole host of metabolic disorders. Insulin resistance is also implicated in general inflammation and cardiovascular problems, so it is like a gun that shoots time-delayed bullets at one’s body. (Screwed-up metaphor, already, but you get the point). To calculate your HOMA-IR, you need to test fasting insulin and fasting glucose at the same time, then apply a formula.

Why Don’t Doctors Test Insulin?

The rub is that many doctors do not test insulin, just glucose. Mine does not seem to care about insulin levels, having once stated to me, “Insulin resistance is why you have diabetes. If the Mounjaro is increasing your insulin levels, it is doing its job. You must balance the negative (inflammatory) effects of insulin with the glucose control.” Yet, he also declares that prescribing exogenous insulin is a last resort for treating Type 2 diabetes. Anyway, I ordered this test myself out of scientific curiosity. Knowledge is power.

As of February 18, my fasting insulin was 11.8 µIU/L (70.8 pmol/L) and my fasting glucose was 98 mg/dL (5.44 mmol/L). My most recent prior insulin level was 18.7 µIU/L (112.2 pmol/L) back on November 19. My fasting glucose on November 19 was 96 mg/dL (5.33 mmol/L). You can find the mathematical formula elsewhere, but meanwhile, here is a link to a calculator. Using it, all those numbers boil down to a HOMA-IR score of 2.9 now as opposed to 4.4 in November, still indicating insulin resistance. Although the threshold and the meaning of the HOMA-IR score is controversial, some researchers consider a value greater than 2.0 to signify insulin resistance. I’m insulin resistant, but far less so than three months ago.

Inflammation Markers

Concurrent with these diabetes tests, I also ordered three tests for inflammation, namely hs-CRP, homocysteine, and Westergren SED rate, all of which came back in normal ranges. Reduced inflammation tracks well with reduced insulin levels, in my layman’s opinion. But I do not attribute the recent improvements primarily to Mounjaro, which I have been taking for almost nine months. Read on to learn more about my integrated approach.

Move Yo’ Ass!

What changes did I make to achieve this improvement over a mere three months? Not my diet, which has been consistent in its low-carbohydrate approach since last June when I started my Mounjaro therapy. Indeed, I have loosened up the low-carb diet due to holidays and friend visits. What I will hang my hat on here will disappoint some of you who believe GLP-1 RA drugs can fix your Type 2 diabetes without needing to significantly change the sedentary lifestyle and crappy diet that put you in that position. Yes, friends, I passionately believe that my renewed commitment to resistance training and cardio workouts along with eliminating ultra-processed crap food are jointly responsible for the improvement. Both are essential to overcome Type 2 diabetes. You already know about diet, so I’ll focus on exercise here.

Working Out to Avert Muscle Loss

My training schedule is six days per week, one-and-one-half to two hours per day. Three of those days are at a gym run by a large, local hospital organization’s sports medicine and rehabilitation division. I did my physical therapy there over the years for various injuries and surgeries, so it was familiar territory. They have equipment that would cost me big bucks to duplicate, especially for lower body training modalities. So, in my sessions there I concentrate on legs, glutes, and cardio, while at home I train upper body, back, and core.

At home are a bench, a set of 52.5 lb (24 kg) adjustable dumbbells, a kettlebell, an EZ-curl bar and straight Olympic bar, weights, a stability ball, a TRX suspension system, some resistance bands, and a yoga mat. My wife pokes fun at me for buying and using the yoga mat, something she would have earlier never linked to my condescending ass! Finally, my still quite usable forty-year-old Schwinn Airdyne stationary bike sits in the garage, which reaches over 100°F (37.8°C) in the Florida summertime. There, I can sweat off a few pounds if I’m bored or just add cardio time as needed.

Take a Hike!

Lastly, I enjoy walking and hiking, especially the latter. I like to get out on the trail once a week or so to enjoy the terrain, the heat, the snakes, and the bugs. I typically hike between five and seven miles, but the last time out a couple of weeks ago, I did nine. Twenty years ago, when I was a mere lad of fifty-eight, I could hike twelve or thirteen miles, but my old knees and back think better of that distance now. Still, getting out in the sun (or liquid sunshine) to commune with nature is rewarding even if you can hike only a mile or two!

Resistance or Cardio? Both!

My informed judgment tells me that resistance training is the more important priority versus cardio, but aside from any hiking, I do at least forty-five minutes of cardio three days a week. That leaves about eight or nine hours per week for working against resistance, be it weights, machines, resistance bands, or body weight. Is it enough? We’ll see. Every day, I look forward to my workout session with eager anticipation, so I must wonder why the hell I hadn’t set aside time for it earlier in my life. So, I’m hoping that this newfound commitment to exercise is not too little and too late.

Visit with Dr. DeLorean

That brings us to this morning’s visit with my primary doctor, who I have dubbed “Dr. DeLorean” here because among his car collection is a shiny, stainless steel bodied DeLorean vehicle. The first words out of his mouth today were, “Your A1c is better than mine! We usually want diabetics below seven, but 5.4 is excellent.” That my A1c is better than his is no small feat, as Doc is a marathon runner, yoga addict, and fitness guru. We discussed the Mounjaro dose, and my characterization of “food noise”, which supported an increase to 7.5 mg/0.5 ml. Done and ordered from my friendly PBM.

I reviewed my exercise program, my wish to preserve muscle mass, and my body weight goal with the doc. The testosterone tests have not yet arrived, so I couldn’t discuss them directly. DeLorean said he bet the results would be between 225 and 350 at my advanced age, and he added that he would not recommend supplementation at that level. His feeling is that if I am marginally low, I can live with it, and supplementation — unless huge, body-builder doses — would not contribute much to maintaining and building muscle mass.

Yet, he did agree with my goal to preserve as much muscle mass as I can and grow some more if I can. He stressed higher protein intake and possible supplementation with creatine monohydrate, both of which I am doing.

Ironically…

In the past few issues of this report, I have chronicled my functional iron deficiency. I won’t go into great detail about it here. Suffice to say that I have a deficiency characterized by normal ferritin but low free iron, iron saturation, and TIBC. I pursued the possibilities of malabsorption or low-grade gastrointestinal bleeds with my gastroenterologist (known here as the pre-eminent Irascible Dr. Scrooge), which was a dead end. So, absent signs and symptoms of anemia, we might be back to Square One.

Doc DeLorean still thinks that because my hemoglobin and hematocrit were both in range (as of November), the iron deficiency is related to my penchant for donating blood. Naturally, he asked if I had donated blood recently, to which the answer was “no”. My last donation was in November 2024.

So, the path forward will be to continue supplementation, with a switch from Original Feosol to Feosol Complete, the latter of which is heme-iron, more easily absorbed than inorganic iron salts. That was my idea. DeLorean’s stressed not to donate blood, which I will not do. We will follow up with blood tests for iron along with a CBC in March, and my follow-up visit will be in May (or sooner, if something flares up).

Who Said Anything about UTIs?

Speaking of UTIs (I know, we weren’t), I enlightened the good doc about the pathogen that caused mine: Serratia marcescens. I told him that my conjecture about why my urine had been pink during the infection was not that I had hematuria (blood in the urine), but that the pretty color resulted from the pigment produced by these bacteria. When I told him they were the same bacteria responsible for the pink plaque one sees on shower tile grout, and that it was in the soil and everywhere else, I observed the glow of intrigued recognition on his face.

“That was the stuff in the shower in my daughter’s new house that I helped her scrub off!”, he remarked. I pointed him to the Wikipedia article about it, which has a picture of a Petri dish with a bright red growth on its culture medium. He looked it up and marveled at it, saying, “I thought it was a fungus in the shower.” Then, thinking back to my UTI, he asked, “Did you rub your penis on the sink or something?” Comedian!

The Week on Mounjaro: The Numbers

Fasting glucose levels averaged 98 mg/dL (5.44 mmol/L) for the week, down from 107 mg/dL (5.94 mmol/L) last week. I’m happy to see it declining. I won’t give you average glucose this week because my Stelo biosensor is farblondzhet. I opened a service ticket with Dexcom hoping to get it replaced. My weight is 187.2 lbs (85 kg), nominally the same as last week.

Time to Skeedaddle

That wraps up another week on Mounjaro. Highlights are the dose increase, favorable blood test reports, and my ambitious exercise program. Hope you enjoyed it! Until next week…