scroll all the way down if you wanna go straight to the before-and-after pictures.

I could update on any one of a number of things but it seems any story I tell, needs to have another story first to set the scene.

This is why I never liked Twitter – even a short story, for me, runs long. I can’t even, as I used to say, clear my throat in 140 characters.

But anyway, i’ll loop back to family and job crap later and let’s just talk about ME for now.

Three months ago, give or take, I mentioned my progress with fitness, given that I was (at the time) four months out from rotator cuff repair.

Since that time, i’ve continued physical therapy, continued diligent and disciplined pursuit of strength and muscle mass (really, the only thing in my live i’ve ever been able to describe using words like diligent and disciplined.)

Muscle gains at my age (61) come slow, but it’s coming. The workout tracker I use (https://www.strong.app/) shows consistant progress in terms of what i’m able to lift; more reps, more weight, etc.

But it’s a completely separate area that’s really changed for me in the last few months.

I don’t know that i’ve ever mentioned diabetes here, since it was during the long downtime of moronosphere.com that I was diagnosed, but i’m type 2 diabetic, diagnosed as such about 8 years back. It’s been well controlled for a long time; I naturally eat a diabetes-friendly diet (not much sugar, no sodas, no juice, candy, etc, focus on protein, vegetables, whole grains, relatively low carb – not because I have to, but just because that’s how I like to eat). For many years i’ve controlled that well with a couple of medications (metformin, mainly). Alas, as is the way with T2D (Type 2 Diabetes), it sometimes just changes without any obvious reason. Despite good eating habits and a drastic increase in fitness level over the last 2 years, my blood sugars started to get worse.

3 months ago I started seeing a specialist, who suggested a big change in medication – she put me on a med i’d never heard of, called Tirzepatide (Mounjaro), a once-per-week injectable medication (which comes in a handy pen style injector for home use, self-injecting in belly or thighs with no fuss and no special training needed).

I’ll come back to ME, because that’s what this is about, below, but for those who are not familiar, here’s a bit of background on Mounjaro.

 

Mounjaro is extremely interesting; it controls blood sugar by triggering certain blood sugar controlling hormones, which differs from traditional medications which tend to treat insulin resistance by decreasing glucose production in the liver, for example. Tirzepatide and other similar meds instead go after more direct control. If you want to get into the pharmacology of this, go start with wikipedia, because it covers the technical details adequately and i’m not gonna try to cover that here.

What’s happened though, as treatment with Tirzepatide went through trials and then rollout a few years ago, is that it was found to have a major, positive side effect; weight loss.

Because treatment with this med tends to produce slowed digestion and a greater sense of fullness, it has a major impact on appetite control; patinets on it for T2D tended to also lose weight, sometimes significant amounts of weight, without specific diet regimens. Meds like Tirzepatide, and it’s predecessor Semaglutide have proven so successful at this that they’re now being prescribed for weight loss for non-diabetioc patients. I’ve seen studies (and I can’t find them now, but will attach if I find) showing that Tirzepatide approaches the efficiency some gastric surgeries like the sleeve gastrectomy in terms of sustained weight loss.

While Tirzepatide isn’t yet FDA approved as a weight loss medication, that’s getting close, but meanwhile, increasingly, it’s being prescribed as such, ‘off label’ as they call it, to considerable success.

So that’s pretty amazing; it’s not news to anyone that weight loss is a difficult thing for many people, and that better ways to manage weight are a Good Thing (and I say that not in a fat shaming sense, but just as a  broad statement that health is good, and management of weight is, for many people, part of being health for all sorts of reasons; T2D for example, is massively improved if one can lower body fat percentage).

There are issues, of course. First and foremost, Tirzepatide has absolutely gnarly side effects, including nausea and all sorts of GI impacts; it’s not unusual to have patients starting on it barfing all day or completely unable to eat. Less common side effects include insomnia, fatigue, aches, etc.

Worse though, for patients, is that it’s fucking expensive; a grand ($1000) per month if you have to pay out of pocket. Insurance in the US being what it is, coverage is complicated. Some insurance just won’t cover; some want patients to exhaust all alternate medication options (including having to try insulin, in some cases). The insurance coverage for this is a maze for some patients, and as always, US provate insurance is often structured to avoid-paying-at-all-cost, since ultimately it’s all for-profit business. There are, evidently, manufacturers coupons to help offset cost for those not covered, but likewise, THAT is a maze, which is often complicated and which keeps changing.

I’ve seen stories though, of patients having huge success, getting blood sugar/A1C under control, and then being classed as ‘non diabetic’ and having coverage withdrawn (curing diabetes isn’t a thing, you have it forever; medication manaages it, but doesn’t cure it). This is akin to telling a bipolar patient that because mediucation makes them functional, they’re cured and don’t need medication. yes, it’s that absurd.

But then there’s the whole, complex question of off-label use of a diabetic medication, for non-diabetic patients.

Sometime in the last couple of years, with the success of use for weight loss, fitness influencers and celebrities began flogging the two meds (ozempic/mounjaro) as magic weight loss solutions, and prescription for non-diabetics took off. I don’t know the exact story about when and who started this trend, though you can find mention of it herehere and on redit, threads like this. Googling will find you a hundred more.

This is all terrific for patients who find it useful, but it’s had a couple of unexpected side effects, so to speak. First, the manufacturers of both meds, Novo and Eli-lily respectively, hit on a gold mine and had stock prices take off. But second, because production of things like this is complex and expensive, both medications ran into supply problems as demand suddenly outpaced supply capacity. Suddenly patients are unable to get a medication they need to take every week without skip, and which, for diabetics, could potentially cause life threatening effects. While I expect that to resolve itself as Eli-Lily ramps production in 2023, it makes for an extremnely stressful situation for patients like me who are now on this med to manage T2D.

 

All that aside, the experience for me has been extremely interesting.

I’ve been heavy my whole life – since I was a kid. While some of that time I was extremely strong, even at my peaks of fitness (as a teenager when I hiked daily and lifted weights over, and then later in my 30’s when I had my first go at the gym rat lifestyle and power lifting), I was never anything you’d call ‘cut’; the muscles were all well padded. My weight peaked out at something like 265, which was a lot on my 5’9″ frame, even though i’m broad shouldered and deep chested. While my upper body is just big, my lower body isn’t, and at 265 I was a big guy.

Gradual lifestyle changes over last 10 years got my weight down around 225, where I hovered for a long time, but as I got into my late fifties and dealt with onset of T2D, that was more than my doctor wanted me carrying. But i’m not, and never have been, a dieter. That never worked for me. The lowest I ever got in my adult life was around 200 lbs, and that was after a significant illness ten years ago or so.

The last two years, my increase in weight lifting got me down to around 210 (which is what my driver’s license says I am, and has sinnce  got my license in 1977, but which really hasn’t been correct since around then).

But then I started on Mounjaro three months ago.

I touched on side effects above in a general sense, but it’s been nasty. The first few weeks, on lowest dose (2.5) I was so nauseous I barely ate, about 3 days of each week. Even when not nauseous, I had absolutely zero interest in food. I more or less stopped eating those first 3 weeks, aside from what I could force myself to eat (mainly protein since without that, building muscle is impossible). Cooking Thanksgiving dinner was a huge chore and eating it was only to share the event with family, not because I wanted it. My birthday (that same holiday week), I wasn’t able to eat at all.

The side effects, as is typical, have tapered off; as I have gone up in dose, I get a bad few days on the first injection, but then stabilize. I’m able to get enough food in now that my weight ins’t crashing downwards, i’m mostly able to get my 1g proton per pound of body weight target for muscle building. But my appetite remains suppressed. I just don’t feel like eating at least 3 days of the week. I’ ve also suffered a lot of insomnia and fatigue and had to take some vacation days in early Dec because I was too fatigued and ill to work.

So, what’s the effect on by blood sugar, which is the point of all this? I’m still at a low dose (5mg, going to 7.5 next week), so I don’t yet expect a lot of improvement. But i’m seeing my sugars mostly in target range (between 80 and 130), which is better that it was. But i’m not yet sufficiently contriolled, and my A1C isn’t where we want it, so i’ll continue to increase in dose and to monitor my levels.

But the effects on my body is dramatic. My prior lowest weight of adult life was around 200 lbs, and that was one time. Today, the scale showed 182, which is a trend now of a couple of pounds lost per week, after an initial drop of 10 lbs.

I’m continuing to work out and focus on protein, and for the first time ever, i’m seeing the beginnings of a six pack. I can see my obliques. I can see my pecs growing, despite the fact that i’m lifting far less weight and the muscles are far smaller than in the past. But actually seeing it, for the first time in my life, it’s pretty amazing for me.

I used to wear XXl tee shirts and sweat pants, not that long ago. I’m now buying size L tee shirts, and my size M sweat pants and now too big for me (I have no hips to speak of); i’m currently wearing my daughter’s size S sweat pants.

I wish i’d had the foresight to take nude or at least shirtless pix when this started. I can’t find any. But below are before and after shots, best representing the changes in my body over the last few months.

The one on the left is xmas 2020, with a beasutiful guitar my family bought me for xmas.

The one on the right is Jan 26, 2023, same guitar, but lesser by about 35 lbs.