Continuing Mounjaro...part 17

[ObsidianTree]

Please note: Mounjaro will only be be prescribed initially if your BMI is above 30. If you have additional health conditions you can get the medication with a BMI 27. (Prediabetes, high blood pressure, high cholesterol or heart problems)

Pointers for newbies:
1 - For taking your first dose you need to twist the pen a lot to get to 1! Make sure the needle is twisted on tightly. Priming will help confirm if the needle is on securely and not faulty.
2 - When injecting, hold down the button until the number goes back to 0. Once at 0, keep holding down the button and count to 5 with the needle still in so no medication is lost!
3 - Your first dose may not have an immediate effect. For some people the effects build slowly. It could take 3 or 4 days to notice anything, it could take a few weeks. Some people don't feel the meds working until they get to 5mg. See titration chart which shows how the medication builds up in your system. Also below you can plot the effect of your doses.
https://glp1plotter.com/
4 - 2.5mg isn't a therapeutic dose, meaning you aren’t meant to lose on 2.5mg. You need to start on 2.5mg to get your body used to the drug and gradually introduce it into your system and get used to any side effects.
5 - Not everyone loses a lot in the first few weeks. Don't feel discouraged if you don't lose a lot initially. Again, you might need a higher dose to start losing. Also, inches can be lost without anything showing on the scales. Start your journey by taking measurements and check them as you go along.
6 - If you do lose a lot in the first few weeks, please don't assume you will continue losing at this rate. The first few weeks it is usually water weight that is lost, after that a good weight loss is about 2lbs a week. Some weeks you might not lose anything, but this is ok too…again, taking measurements might show inches lost instead.
7 - Some people find that they don't need to go up a pen dose each month if the current pen dosage is working well for them. If you are unsure when to go up, speak to your prescriber.
8 - If you are having bad side effects after titrating up or you are struggling to eat your calories each day, your dose may be too high so should consider lowering your dose. Speak to your prescriber if unsure.
9 - Constipation, coldness, nausea, diarrhea, vomiting, headaches, aches, are side effects. There may be other side effects also. Read info here :
www.medicines.org.uk/emc/product/15481/pil#about-medicine
10 - Taking Mounjaro can stop birth control from being effective. If you are on birth control, consider extra protection if you aren't planning on conceiving anytime soon!
11 - Once you take your first dose you can choose to keep your pen in the fridge or somewhere else. It's up to you.
12 - Don't reuse any needles as this could risk infection. If you damage a needle or one isn't working, you can buy a pack of about 100 spares. https://www.chemist-4-u.com/carepoint-pen-needles-31g-4mm-pack-of-100?gclid=Cj0KCQjwiYOxBhC5ARIsAIvdH51rLZBVFQxuvS7mDJooegtK8BMiyT0PwREMRHhH_1atfQIo8TEbsmkaAkA0EALw_wcB
Also there is a 5th dose in each pen. To extract it you can either try a hard twist or use an insulin needle.
https://medbasic.co.uk/bd-micro-fine-30g-1ml-syringes-needles
13 - Protein is important as eating less protein can cause muscle wastage and hair loss.
Some natural sources of protein:
https://www.bbcgoodfood.com/howto/guide/best-sources-protein
https://www.medicalnewstoday.com/articles/321522#high-protein-foods
14 - You can use supplements, some that people use are magnesium(for sleep and constipation), protein(to reduce muscle wastage), collagen (skin elasticity), aloe vera(for constipation), psylum husks(fibre for constipation), electrolytes.
15 - Drink lots of water. Water helps with the weight loss. Try and drink at least 2ltrs a day.
16 - Don't be afraid to feel hungry. It is entirely normal and healthy to feel hungry. Just eat something. Treat it as an opportunity to start good habits around hunger. Eat a nice balanced snack or a meal if it's a meal time. It's ok.
17 - Does it makes any difference where you inject? yes it does! Drugs get absorbed at different rates depending on injection site
In order of fastest absorption, it goes:
• Tummy
• Arms
• Thighs
further reading about injection sites and the effects: https://www.medicalnewstoday.com/articles/316618
18 - Abdominal side-effects are much easier to control with smaller meals. For example, having 4 small meals in the day vs 2 big meals can have an improvement in nausea and burps.
19 - You can track your calories / protein on apps such as My fitnessPal, Carb Manager or Nutracheck. Nutracheck is quite useful and easy to find foods /build recipes.
20 - Some of the places you can order from are:

MedExpress:
2.5mg and 5mg. £149.99. 7.5mg £169.99, 10mg £189.99. 12.5mg £209.99. 15mg £209.99 Coupon codes no longer working!
The Family Chemist:
2.5mg and 5mg £149. 7.5mg £169, 10mg £169, 12.5mg £194, 15mg £199
Zava medical:
2.5mg £139, 5mg £139, 7.5mg £169, 10mg £189. 12.5mg £204. 15mg £204. Zava offer refer a friend discount of 15% off. Ask for a code on here.
Simple online pharmacy:
£149 2.5mg, £149 5mg, £169 7.5mg £189 10mg
Bolt pharmacy:
2.5mg £149, 5mg £149. 7.5mg £169, 10mg £179, 12.5mg £199, 15mg £199
Asda:
2.5mg and 5mg £179. 7.5mg £189, 10mg £189, 12.5mg £204 15mg £204
There are others not listed.
21- You will still be prescribed Mounjaro when your BMI falls below 30. However, it may be harder to move suppliers once you BMI is below 30 if you wanted to move.
22 - Worried about your supply being cut off when you get to a healthy BMI? Below is some info on some places maintenance plans.
The Family chemist :Would consult you as approached healthy BMI to discuss maintenance under close supervision(if you started with family chemist)
Curate: up to 2 years
Cloud: up to 2 years
Boots: Cut off at BMI 23
Asda: Cut off at a healthy BMI
Pharmacy2u: Will supply for maintenance
Bolt:Individual assessment once BMI 22 and does offer maintenance
Zava:Once healthy BMI will stop prescribing this treatment
Med Express: BMI 25 and cut off.
23 - If you want to switch suppliers, make sure you have pics of your Mounjaro box with your name and dose. This will come in useful when other suppliers ask for evidence.

1st thread:
https://www.mumsnet.com/talk/weight_loss_chat/5007744-mourjano-starting-soon?page=1
2nd thread:
https://www.mumsnet.com/talk/weight_loss_chat/5028495-continuing-murnjaropart-2?page=1
3rd thread:
_https://www.mumsnet.com/talk/weight_loss_chat/5037623-continuing-mounjaropart-3?page=_1
4th thread:
https://www.mumsnet.com/talk/weight_loss_chat/5044316-continuing-mounjaropart-4?page=1
5th thread:
https://www.mumsnet.com/talk/weight_loss_chat/5048290-continuing-mounjaropart-5?page=1
6th thread:
https://www.mumsnet.com/talk/weight_loss_chat/5057916-continuing-mounjaropart-6?page=1
7th thread:
https://www.mumsnet.com/talk/weight_loss_chat/5062935-continuing-mounjaropart-7?page=1
8th thread:
https://www.mumsnet.com/talk/weight_loss_chat/5068850-continuing-mounjaropart-8?page=1
9th thread:
https://www.mumsnet.com/talk/weight_loss_chat/5074054-continuing-mounjaropart-9?page=1
10th thread:
https://www.mumsnet.com/talk/weight_loss_chat/5080755-continuing-mounjaro-thread-10?page=1
11th thread:
https://www.mumsnet.com/talk/weight_loss_chat/5085436-continuing-mounjaro-thread-11?page=1
12th thread:
https://www.mumsnet.com/talk/weight-loss-injections/5090788-continuing-mounjaro-thread-12?page=1
13th thread:
https://www.mumsnet.com/talk/weight-loss-injections/5096704-continuing-mounjaropart-13?page=1
14th thread:
https://www.mumsnet.com/talk/weight-loss-injections/5102149-continuing-mounjaropart-14?page=1
15th thread:
https://www.mumsnet.com/talk/weight-loss-injections/5107426-continuing-mounjaropart-15?page=1
16th thread:
https://www.mumsnet.com/talk/weight-loss-injections/5115015-continuing-mounjaropart-16?page=1

Thread for newbies just starting out in July:
https://www.mumsnet.com/talk/weight-loss-injections/5101435-mounjaro-july-2024
Video on how to inject:

After an horrific 4 days of explosive diarrhoea I took 2 immodium and went the other way for the following 3 days. Result is a maintain for this week.

Ive been thinking a lot about maintenance etc
i also gained all ny weight from 3 pretty.much backnto back pregnancies. Previoisly i was a naturally skinny person. I absolutely won't be having any more!

I continued to gain steadly over the followng years. Poor food choices, lots of upf, more treats than most (huge chocolate bar every night, couple of bags of sweets, crisps) pretty much every day

Got out of an abusive relationship and was prescribed antidepressants. Because I'd also (understandably) lost my appetite, my Dr prescribed ones which increase appetite and here I am 4 years later still on them.

Some thoughts, not sure if they'll make any sense.

I've tried all sorts of diets and had some success but haven't been able to keep it up long term. I'm really trying to learn about nutrition, gut health and balanced meals. I see so so many people on tiktok and fb groups eating lots of crap food still. And not watching what they eat because "that's no way to live". Everyone is different of course but I've accepted that for a very long time at least, I will need to weigh and track food.
Not eating all the food at party doesn't mean I'm not living life, doesn't mean I'm missing out. I'm still there, with my friends enjoying their company etc. Thinking eating to excess was the only way to enjoy food is what's got me here.

Sorry a bit of a stream if consciousness, not sure if I've explained what I mean well.

@Ineffable23 I could have written a lot of that!

I lost quite a bit of weight early on in Covid due to stress and also, I suspect, the sheer amount of PPE (12/13hr shifts in Covid theatres changing PPE 3 times a day, 5, 6, 7 days a week). Then the weight crept on. Wine and grazing. Then we moved on to mass vax, and lived off cereal bars and Quality Street. I never lost that last 2020/early 2021 weight. It just climbed and climbed.

For me, the key to my maintenance will be daily weighing. I cannot deviate from that. So far I’ve taken my scales everywhere - it takes the pressure off me. I’m about to go on holiday for 3 weeks and I’m nervous to take them but I will do it anyway.

Grit, willpower and the need to fit into my clothes will have to do it for me, if there isn’t a maintenance drug or dose to be had.

@NiceUnusualDifferent - same!! I can’t eat all the things and will have to be in charge of my food instead of the other way ‘round.

@BlackFriYay @QueenGoo I think I can answer your query about being prediabetic. If you’re worried about prediabetes you could ask your GP surgery for a blood test. The most common test will be checking your HbA1c levels which is your average blood glucose (sugar) levels for the last two to three months. If your HbA1c level is between 42mmol/mol (6%) – 47mmol/mol (6.4%) this means it is higher than normal and you are at risk of developing type 2 diabetes.
This is fairly standard work at the GPs however the problem is often the follow up/support/treatment is inadequate as you have said. Given that prediabetes is nearly always reversible and the implications of becoming T2D are serious this is not good enough. If it were me it would be worth making a fuss and asking for more help although that is not always easy. The NHS is extremely poor at preventing poor health and then gets overloaded with the consequences of it. [Small rant over😠]

Thanks @FlappyFish and @CiderJabs for the honesty, I am somewhat fearful of this stage of the journey! Tho not there yet. Can I ask what was the maximum dose you two went to? I’m on my third month of 7.5mg, losses are slow but aiming to stay on that until I hit target and then to wean down. Also a question for @ObsidianTree - with thanks for this whole thread. If you’re allowed to stay on maintenance for 2 years how do you see it working? Are you thinking you’d keep the dose low enough that the losses would stop?

Just wanted to share a NSV. I've just tried my swimsuits on as I'm packing for my holiday and last years are TOO BIG! I'm throwing out the awful things. I only got them because nothing else fit.

Then I tried on a tankini that I've had a few years and while very slightly tight, it fits and looks ok. Nothing is spilling out of it. I could cry happy tears.

I felt disgusting on the beach last year, I was the fattest there. I'm no supermodel still but I feel so much better. I love Mounjaro!

@FlappyFish @CiderJabs so sorry to hear it's a struggle. Really appreciate you sharing as it helps to be realistic. Although I know deep down the food (and wine) noise has to come back it's easy to get lulled into a false sense of security when it has completely disappeared. Please do continue to update us

Yes my hope is that this period on MJ has given me a really sustained time at living a different lifestyle. I’ve done it before but fallen off the wagon more quickly. For me I’m aiming to keep lunch as a protein heavy salad, not end up having a Pret baguette or the like, ban the 4pm crisps/Twixes when hunger used to hit hard and have nuts and fruit on hand, and keep cooking healthy dinners, none of the processed crap. If I get that right Monday to Friday I think I can enjoy the odd nice dinner out. I think I’ll aim to stay off takeaways for good too, I was never too awful for them but they became a bit of a fallback at the end of the week if work took over and I don’t think they were really worth it. Am in a
good position because I’m slowly running after years of injuries so I’m hoping that upping exercise and doing 3 runs a week will keep me motivated to do the rest. And I agree my experience of MJ - especially on holidays but also at parties has made me much more aware that the good times aren’t all about the food.

I'm sure this has been asked tons of times but there are so many threads here and I can't face searching!

I took the 2.5 mg for four weeks and I'm about to take the last dose of the 5 mg. Suppression has been good, and weight loss has been 17lbs, which is fine, obviously, but not as impressive as some. If I keep going at this rate (about 1 kg per week) then I'll hit my target weight by late November/December.

On the last two occasions I've injected the 5 mg, I've had really bad acid reflux on one occasion. I think that's going to be inevitable for me (also had it on Day 1) and can tolerated it.

Should I titrate up to 7.5, given suppression is low and weight loss isn't as good as it might be? Is that what everyone's doing?

@AgathaMystery inspired by you I bought a half size set of lightweight scales (not UK) and took them on holiday. It really helped and whilst I still watched what I ate and was suppressed I probably ate and drank more then I would have if I didn't have the scales as I could see I was managing to maintain

Good question! I think if I lowered the dose enough, I'd be able to eat maintenance calories. So hopefully won't continue to lose weight but be suppressed enough to not be able to eat massively over my calorie allowance.

Makes sense! I definitely think there is something in doing whatever it takes for the body to adjust to a new set point. Thanks again

Love your username @NiceUnusualDifferent !

I love Kath and Kim 🥰

Sorry, I should have said 'as suppression is good'.

@BlackFriYay that’s brilliant well done you!

Such a great idea to write out how we got here! I’ve been around a size 14 my whole adult life and was never bothered but after the kids I lost 4 stone and took up running and got down to a size 10. It was a huge novelty and lasted about 5 minutes. Then hurt my knee and stopped running. I went up to a 12 very quickly and then for the last decade I’ve been gaining and losing the same couple of stone. The last 5 years it’s been harder and harder to lose. I went into covid in a good phase and had some Zara jeans which I adored but lockdowns meant I stopped exercising properly and drank so much wine. I also blame the fashion of elasticated trousers which meant I was in denial. I also detest weighing myself and I can just avoid it.

Where I am now with MJ is a great exercise plan and good eating habits and a huge realisation that I don’t need so much food and definitely not so much booze.

My plan for maintenance is to weigh daily and track. Any sign of gaining I’ll be reining it in.

My maintenance plan is still developing but includes taking the weight loss slower. I’ve reduced my dose from 7.5 to 5mg and I’m aiming to lose 0.5lb per week on average … basically I am eating more. I’m scared to get down to BMI 25 too quickly (currently just under 28), I know that sounds mad, but my thinking is I need to feel hungry/ let my body get used to being lighter before I contemplate going it alone.

Of course this plan could change depending on external factors as the picture is evolving - it’s not ideal not having a clear plan overseen by a professional….but I’m reluctant to get to a weight where I can’t get access to the prescription as that leaves me nowhere to go. It’s probably the wrong approach but I’m in no hurry to lose the weight because it went on very slowly over years.

@Secretslimmer I went up to 7.5 for 3 weeks and then went back down to 5 for 3 more weeks. Went down to 3.75 last week and planning to do the same this week.

In terms on what led me to gain weight, I think it helps to write it down so here it goes:
Divorce
House sale
Menopause which led to a mad sugar craving
Portions big enough for 2 people
Evening snacking
Feeling lonely / anxious

Since I've been on mj I have:

• started taking collagen - plan to continue
• increased protein - also plan to continue with 1 clear whey per day
• reduced portion sizes - this will be my biggest challenge
• started doing strength training rather than non stop cardio. I've been going to the gym 4-5 times a week and plan to continue
• checked nutrition weight daily - like some of you I avoid the scales when I know I've put on. I need to continue to check my weight at least once a week

I've also bought my wedding dress (!!!) in a size 10. So I need to be able to fit in it in a years time. I'm hoping this will be my biggest incentive!

I’m not doing a weigh in this week as I’m not sure if my scales are broke. According to them I’ve lost half a stone in a week and they are taking ages to get a reading so, just waiting for my son to weigh himself to see if they are accurate or not.

Still having serious stomach issues trying fibre supplements to see if they help.

My main symptom has been acid reflux especially at night, from 5mg onwards. I started taking a single eopremazole tablet [ over the counter under names like Nexium] just after my jab and it has solved the problem. I am now on 7.5.

@FarriersGirl If weight loss is OK and you have suppression I would stay where you are. Going up risks more side effects and may not increase weight loss

I'm sure I have said this before but, for anyone that hasn't heard it before. I have a friend on Wegovy who is close to maintenance. She is with one of the subscription services that offers extra support and asked what happens. They told her that they recommend gradual withdrawal and some people find the lifestyle changes and, possibly, changes to metabolism induced by these meds allow them to maintain. Some others manage the withdrawal but struggle to maintain alone and may need a low dose ongoing, while others can maintain for a while but may need a cycling system of a short course every now and then when they start to regain. They stressed it is very individual

Thanks! I’m thinking I will probably go down to 5mg for a month when I finally hit target but not really thought further ahead.

I think those changes you’ve made sound spot on. Menopause was also one of the things that fuelled some weight gain for me - I think stress eating got a bit worse - and I’m trying to introduce similar steps, protein, collegen, weights. I need to do a bit more on the strength training though, it’s got a bit too occasional.

Portion size is also one I’ll need to work on post MJ.
The size 10 wedding dress is a great result and defo sounds like a strong motivation!

From my research, you can still be insulin resistant and have normal HbA1c levels. I'll collate some research briefly below:

Insulin resistance and diabetes are related but not the same. If you have insulin resistance, your blood sugar is still within a normal range.
https://www.webmd.com/diabetes/insulin-resistance-syndrome

If you develop insulin resistance, the cells in your muscles, fat, and liver are unable to process insulin normally, so the glucose continues to build up in your blood.

The pancreas generates more insulin to little or no effect, while your body stores the sugar in your liver and muscles. When there is no room for more, the sugar is converted into body fat.

Insulin resistance is a precursor to prediabetes and, eventually, type 2 diabetes.
https://www.healthline.com/health/diabetes/insulin-resistance-symptoms#definition

If your doctor is saying your A1c and blood glucose levels are normal and you’re not insulin resistant, do yourself a favor and read this post! The typical protocol of testing for insulin resistance isn’t telling us the full story.

WEIGHT DOES NOT CAUSE INSULIN RESISTANCE!
You may have heard it’s estimated that 65-80% of those with PCOS have insulin resistance. I’ll say this a little louder for the people in the back and for the fatphobic crew in particular, it appears to be independent of weight. Weight gain does not appear to cause insulin resistance, rather they seem to move together in a sort of cycle. Effectively, the more weight we gain, the more insulin resistance we have, and the more insulin resistance we have, the more weight we gain. They perpetuate each other, but don’t necessarily cause each other.

SO IF WEIGHT DOESN’T CAUSE INSULIN RESISTANCE, WHAT DOES?
While research is still emerging to understand the root cause of insulin resistance, we are definitely starting to catch up. Theories range from underlying inflammation, physiological stress, oxidative stress, to potentially an undiscovered hormone causing our bodies to become insulin resistant. So, if your doctor is telling you that weight loss is the answer to all of your problems, tell them to think again. According to the CDC, you do not have to be overweight to have insulin resistance. A number on the scale, or what you look like, does not indicate insulin resistance! I will mention, though, that since insulin resistance and weight appear to move in tandem, untreated insulin resistance can continue to feed the cycle of weight gain and worsen insulin resistance. But it’s the balanced, healthy measures we take to lose weight, not drastic measures, that typically help insulin resistance

INSULIN RESISTANCE IS REALLY HARD TO TEST FOR!
With how often we hear about the omnipresence of insulin resistance, you’d think it would be super easy to test, right? Well that’s what I thought, and I couldn’t have been more wrong! Currently, the most accurate way to test for insulin resistance uses something called the hyperinsulinemic euglycemic glucose clamp technique. It directly estimates insulin resistance as it measures how effective insulin is in promoting glucose utilization. It’s expensive, requires insulin infusion and repeated blood sampling. It is impractical, so doctors have to use surrogate methods to make their best guess as to whether someone has insulin resistance or not. There are even mathematical algorithms that have been suggested as a method to estimate insulin resistance, but procedures have not been standardized.

More info on this link with some other testing methods but not sure how accessible these tests are.
https://www.teal-health.org/blog/insulinresistance

I imagine many of us who have struggled with binge eating and yoyo dieting are insulin resistant, especially if keto and fasting gave your best weight loss before Mounjaro.

I find all of this absolutely fascinating, it shows how we were fighting a losing battle with our biology (I did an emotive post about this here with some podcast links which helped me begin connecting the dots on all of the above!).

Just to clarify, I was posting on these threads under a different username since April but don't want to connect to that name and out myself as I probably said more in here anonymously than id want people IRL to know! So yes I am directing people to my Insta but that's not the only reason I'm here (and also saves me typing up what ive already explained in a post)! This has been my daily read since about thread 3 when FlappyFish was having her stall and I first went down the rabbit hole of what a stall actually is and we had the perosn randomly sharing their Voy code every 10 posts! X

Ooooim going to look for some! Yes I ate a bit more than I would have done without them too. Weird isn’t it.

Ooh I've just had £13.95 credit added to my medexpress account to use against my next order of 7.5 after I emailed them about price matching to pharmulous

Just finally had my pen from zava (ordered Monday). It arrived warm. The ice pack not only completely melted but actually warm to the touch. I've emailed them and will post if I get a reply but I not impressed and think zava is one to avoid sadly.

Well done to everybody's victories big and small. So nice to hear how people are becoming more comfortable and confident in their own skin.