GLP-1 diabetes/weight loss drugs

[SunnyOne]

My twin (fraternal if it matters) has been diagnosed with prediabetes and he is medically obese.

He asked his primary about those popular GLP-1 drugs and even though he has high blood pressure and elevated cholesterol...etc.

the doctor would not prescribe due to the monitoring of thyroid issues and pancreas.

So he then asked his doctor, at what point does the risk of pre-diabetes, obesity and comorbidities, etc. eclipse the risk of the drugs?

Wouldn't give him an answer.

Yes, he does walk and watch carbs, he is just struggling and of course is interested in the drug benefits.

Do any of you take these drugs? any side effects or results you wouldn't mind sharing?

 

[mathjak107]

i am on trulicity .

i lost about 25 lbs but i am not over weight at all .

i am a gym rat and weight lift and run 3.6 miles every day .

but i still need a diabetes drug .

 

[rodi]

There was an interesting thread recently about the GLP drugs - from the perspective of the economy. But a lot of people also talked about their personal experiences.

https://www.early-retirement.org/forums/f38/new-weight-loss-obesity-drugs-could-transform-economy-120563.html

 

[mathjak107]

while old school drugs drop sugar numbers farther , the current thinking is the numbers don’t need to be that low with these new very protective drugs .

i was 6.3 while with trulicity 6.6-6.7 is acceptable

with medicare it falls in the gap easily and so it costs me 250 a month for about 10 out of 12 months

 

[Morgan22]

I don't have personal experience with it. But have begun looking into it for a family member.

The thing that would concern me about your brother is that he is already being monitored for pancreatic issues. There have been findings that people who take GLP-1 meds have an increased risk of pancreatitis. He needs to be aware of the risks if he does find a doctor who will prescribe it to him.

 

[Gallaher]

I know something about theses drugs. I worked for Amylin when we launched the first GLP-1 onto the market, Byetta. We created the market for diabetes.
Also helped my early retirement.

Lots of misnomers re: GLP1 and diabetes.
*First, your body makes GLP1. These drugs are giving you a a super physiologic dose of GLP1, a naturally occurring hormone. The corollary is insulin. Type II diabetics make insulin just not enough. GLP1, same, same.
*Segundo, diabetes causes pancreatitis. If a diabetic develops pancreatitis while on a GLP1 drug, can you attribute it to the drug? Now that we have large numbers of “healthy obese” patients medicated with GLP1 we will learn more about pancreatitis in that population.

I could go on here for about 137 hours but will add one more point. Hit me up if you want more of my valueless info.

Here’s that final point, Doctors really don’t have time to learn a lot about new products. They are slammed by productivity demands at work. Beyond that they have lives too. Families, hobbies, loves and hates they need to manage.
If you are posting on this site, you know how to do online research. Make sure you educate yourself and don’t expect your doctor to educate you.
Everyone is different but, it’s pretty clear that intense exercise is you friend. Especially, lifting intense, heavy weights.

 

[Koolau]

^^^^^^



I mentioned to my PCP that I was trying (and succeeding) at losing weight. He was a lot more negative than I would have thought on the subject of weight loss. After losing 40 pounds, he told me to "stop" or he would have to assume there was something wrong with me and check it out (say what?) My BMI is still too high.



I didn't even mention the GLP-1 drugs and he (uncharacteristically) went off on them. What's up with that? I have no desire to take them, and I'm sure anything this powerful has lots of potential side effects. BUT risk/benefit still applies to all drugs. Some people need a drug to lose weight. If they need to lose weight and they can manage side effects, why not? Just wondering as YMMV.

 

[sengsational]

^Your GP has probably seen it a hundred times... someone gets motivated, looses a lot of weight, but ends up even heavier than before (yo-yo dieting). Not saying that's your fate, but it's probably why the doc has that position.

 

[audreyh1]

Seems like the doctor should be positive and encouraging. Just making sure you are otherwise healthy. It doesn’t matter if they have seen others fail.

 

[tmm99]

Koolau, your PCP sounds a bit like an ahole. Also, what I'm finding out more and more is that a lot of PCPs have no idea about nutrition. They get no training, so if they know something, they read about it themselves or gone to conferences, studied on their own, etc, but no formal training. Losing weight can be a tricky thing because it could cause nutritional imbalance and/or some bad side effects. Talking to a good dietician may be more helpful, especially like in your case, as you don't particularly want prescription drugs. PCPs are good at prescribing medicine for particular symptoms (maybe not GLP-1 drugs but some other drugs.)

Just my two cents.

 

[athena53]

Seems like the doctor should be positive and encouraging. Just making sure you are otherwise healthy. It doesn’t matter if they have seen others fail.

I totally agree. A good friend of mine started out at 260 lbs.- he's maybe 5'10", 72 years old. Over the last year he decided to quit eating junk foods and exercise portion control. (Before that, on a road trip I once watched him eat most of a bag of Pecan Sandies. I'd cheerfully forbidden him to offer me any because I just didn't want to start.) This past weekend he was down to 201 and he hopes to lose another 40. I am SO happy for him. I did tell him he needs to ask his doc whether he can/should discontinue or reduce some of the meds he's on for high BP and other issues.

 

[MarieIG]

^^^^^^



I mentioned to my PCP that I was trying (and succeeding) at losing weight. He was a lot more negative than I would have thought on the subject of weight loss. After losing 40 pounds, he told me to "stop" or he would have to assume there was something wrong with me and check it out (say what?) My BMI is still too high.



I didn't even mention the GLP-1 drugs and he (uncharacteristically) went off on them. What's up with that? I have no desire to take them, and I'm sure anything this powerful has lots of potential side effects. BUT risk/benefit still applies to all drugs. Some people need a drug to lose weight. If they need to lose weight and they can manage side effects, why not? Just wondering as YMMV.

Your PCP may want you to have some "reserves" in the event you can't eat for a period of time. (I was sick then hospitalized in March of 2020 - and lost 17 pounds in under a month.)

With regard to the GLP-1s, it sounds as if your doctor was thinking of some of his other patients - not you - and you got caught in the crosshairs - as it were.

I concur that a risk benefit analysis is applicable.

 

[aja8888]

^^^^^^



I mentioned to my PCP that I was trying (and succeeding) at losing weight. He was a lot more negative than I would have thought on the subject of weight loss. After losing 40 pounds, he told me to "stop" or he would have to assume there was something wrong with me and check it out (say what?) My BMI is still too high.



I didn't even mention the GLP-1 drugs and he (uncharacteristically) went off on them. What's up with that? I have no desire to take them, and I'm sure anything this powerful has lots of potential side effects. BUT risk/benefit still applies to all drugs. Some people need a drug to lose weight. If they need to lose weight and they can manage side effects, why not? Just wondering as YMMV.

Losing 40 pounds is great as long as there is a substantial exercise component to build up and maintain muscle mass while you limit yourself of calories. This is especially true of older folks who have a hard time just maintaining muscle mass. Protein shakes are a good addition as long as they are consumed after a workout.

Keep up the good work!

 

[Koolau]

^Your GP has probably seen it a hundred times... someone gets motivated, looses a lot of weight, but ends up even heavier than before (yo-yo dieting). Not saying that's your fate, but it's probably why the doc has that position.

His ONLY concern was that my efforts at weight loss MIGHT be hiding weight loss due to a condition (like, say, cancer.) Oddly, he has NEVER suggested weight loss to me though my BMI was way up there. I finally just decided it was time and determined how to do it on my own. I've never seen him so concerned with my "behavior" or my overall health - even though I have, in the past, presented with stage 4 cancer and heart disease. Go figure.

 

[ncbill]

After some shocking blood work last week I've been prescribed one of them now.

Assuming it is ever back in stock at the pharmacy.

Hopefully by end of April.

 

[Cayman]

After some shocking blood work last week I've been prescribed one of them now.

Assuming it is ever back in stock at the pharmacy.

Hopefully by end of April.

If it's an Eli Lilly drug you may be able to get it directly from them through their online portal. It's my understanding that people who place their scripts with Lilly through their patient direct program are not experiencing shortages for Zep and Mounjaro. I don't take these drugs, so this is from a trusted source but not my personal experience. Good luck.

 

[ncbill]

If it's an Eli Lilly drug you may be able to get it directly from them through their online portal. It's my understanding that people who place their scripts with Lilly through their patient direct program are not experiencing shortages for Zep and Mounjaro. I don't take these drugs, so this is from a trusted source but not my personal experience. Good luck.

Thanks but I only saw Zep available, not my prescribed med.

 

[Live Free]

I have a friend who, on paper anyway, seems the ideal candidate for these GLP-1 drugs. Morbidly obese, recently diagnosed diabetic (A1C at 6.9), etc. Her GP won't prescribe a GLP-1 and after some reading online, she is convinced it is because insurance companies make it a hassle for doctors because insurance wants other, less expensive drugs to be tried first.

She went around it all by using one of the online doctor services that use compounding pharmacies to prepare semglutides. She is taking Terzipitide (sp? It is Mounjaro). She pays out of pocket ($300?/month) and she has lost A LOT of weight and feels good. The online doctor service requires she does bloodwork that they review every so many months and monitors her weight loss, etc. Her A1C is totally normal and her other bloodwork has shown lots of improvement too.

ymmv

 

[Harris4crna]

My only concern with GLP-1 drugs is the increase risk for aspiration during anesthesia. These medications has completely changed our fasting guidelines before surgery. I have seen first hand the decrease gastric motility and its effects when undergoing surgery. For those one these type of medications, please abide to fasting guidelines if you are deciding to undergo any type of procedure utilizing anesthesia.

 

[athena53]

My only concern with GLP-1 drugs is the increase risk for aspiration during anesthesia. These medications has completely changed our fasting guidelines before surgery. I have seen first hand the decrease gastric motility and its effects when undergoing surgery. For those one these type of medications, please abide to fasting guidelines if you are deciding to undergo any type of procedure utilizing anesthesia.

That's useful information. It also occurred to me that it would require a more rigorous colonoscopy prep- maybe one that starts 2+ days ahead.

 

[Harris4crna]

That's useful information. It also occurred to me that it would require a more rigorous colonoscopy prep- maybe one that starts 2+ days ahead.

We are just having patients hold thier weekly injection. Prep is the same. If on oral meds, hold for 48 hours and clear liquids day prior. This is more significant for EGDs than colonoscopies. It's crazy how long the food stays in the stomach with those who are on these meds.