Day 5 top up?

[TopUpHat]

So I'm on 7.5mg and just started my second 4 weeks on this dose. I don't want to move up dose yet because the first 2 to 3 days I'm knackered and days 2, 3 and 4 I have lots of suppression so I think 10mg would have me not eating at all!

But come day 5, 6 and 7 it's like I have nothing in my system and am super hungry. This has been the exact same pattern from day 1 when I started 2.5mg. I am getting really sick of the roller coaster high suppression then zero suppression pattern every single week.

I recently started 'topping up' on day 5 with a half dose, or just a bit less. I'm now wondering if I should just take a smaller dose (say 3.5mg) every 3 or 4 days, rather than a big dose (7.5mg) every week.

Has anyone done this? Anyone know if there's any danger in that?

Or can anyone suggest any other way to stop this yo-yo'ing appetite. It's really reminiscent of yo yo dieting and although I don't binge per se on day 5, 6 and 7 I do get very upset at how hungry I feel all day and the constant food noise and the increased snacking. I can't really cope with it to be honest

Or should I just inject every 5 days? rather than every 7?

Any thoughts?

It seems to me the only people qualified to advise would be an endocrinologist but in my local area the NHS endocrinology will not prescribe weight loss injections - but they do in other counties. Does your local area have tier 3 weight management clinic? In mu region they only offer gastric sleeve surgery - not weight loss injections

Our local private hospital doesn't even have an endocrinologist! If anyone can recommend an expert in this area I'd be interested

You’ll be taking a medication that hasn’t been tested in this way, or maybe it has and there’s a scientific reason why it’s not suggested.
re the suppression and food noise what’s your plan long term? It’s normal to feel hungry at all sorts of times and for different reasons, taking a drug that you are going to use off plan may not be the best thing for your long term health

Thanks!

Thanks all. I know it's not the advised way to do things, but I can think of no reason why two smaller doses would be worse than one big dose. If anything I'd imagine it to be gentler on the system. The overall result will be the same, but without a big first dose and spikey appetite and an initial big whammy of a dose to shock the system. I'm just going to risk it because I genuinely think it will be better for me to have a relatively even week than big peaks and troughs. I think my tiredness will be better on a smaller dose too, than one massive dose each week.

I know some people r the cautious types and never ever do anything against the rules etc... but I've never really been like that! Each to their own. I quite like making my own decisions about my body too! So that is what I'll do! I'll give it a try and see what happens, can always revert back!

Thanks all for your advice and thoughts :)

@TopUpHat - I can't disagree with your logic - please come back and update how you get on

I will! 👍

"I know some people are the cautious types and never ever do anything against the rules etc... but I've never really been like that! Each to their own. I quite like making my own decisions about my body too"

It's not about being a cautious type or about mindless rule following. It's about judging risks and possible benefits. There is very little benefit, and far too much unknown risk here for me to agree with you that this is a sensible approach. You are determined to chase constant appetite suppression, which is not a sensible long term approach either, for me.

We all make our own decisions about what we put in our bodies. No one is forcing me to take a particular dose level or inject it on a specific day.

I'm not chasing full suppression, I'm trying to get more on an even keel. I am really struggling with full suppression followed by no suppression. I'd be much happier with mid-suppression the whole week long.

I have really struggled in the last with over-eating then restricting what I eat, then binging again. This kind of yo-yoing is something I want to change, but my pattern so far on mounjaro has been 3 days of quite strong suppression followed by 3 days of no suppression which feels really similar to my previous yo yo binging and it's really stressing me out. I just want to be on an even keel so I can start to form healthier habits.

To me, the benefits of two smaller doses out weigh the negative impact of tiredness and feeling super full for the first few days and then having no suppression for 3 days when I have lots of food noise and just crave chocolate etc.. it's very stressful. I don't believe from anything I've read that there would be likely to be any negative effects of having two smaller doses.

It's just perhaps a case of how we are viewing the risks and benefits! To me, there doesn't seem much risk, but lots of benefit! To you, you perhaps feel there is is not much benefit but bigger risk.

Neither of us are right!!

I know it's not the advised way to do things, but I can think of no reason why two smaller doses would be worse than one big dose.

Without trying to be rude, that is because your risk assessment has not gone any deeper than 4+4=8.

Anyway, good luck.

@mumalummum with a history of gestational diabetes, where your pancreas could not cope with insulin demands, and a higher risk of developing type-2 diabetes I think you would be mad to consider this and any potential risks of overstimulating your pancreas. Please speak to your provider declaring your full history before considering anything this reckless.

Well, I think people can be better or worse at accurately judging risks and benefits, and I think that people can differ in their ability to find information, understand it and judge whether it's relevant. Then of course, after that, people have different attitudes to risk which affects their decision making.

Is it that you are eating far too little on your high suppression days? Then when it wears off a bit you are starving? Could you try being really careful to get enough nutrients and nourishment earlier in the week and see if that helps?

https://glp1plotter.com/

This is an excellent website for plotting doses and it's really interesting to see how the dose builds up in your system.

I have split my dosage to every 4 days and find it works well. I am currently only on 3.75 but I still feel the benefit of not having the highs and lows mentally.

Thank you! That's so helpful.

Basically this
You need to understand the pathways used by the body to metabolise the drug, in theory a metabolite could require the same pathway & therefore dosing more frequently would overload that pathway etc

https://mounjaro.lilly.com/how-to-use-mounjaro

The manufacturer says make sure there are 72 hours (3 days) between doses.

Dr Kevin Joseph is really worth watching on microdosing and dosing intervals:

Yes, the plotter is interesting (there is a newer version of the website from the same guys that is easier to use and allows you to put in doses and dates - called GLP1 plotter calculator or something similar).

It doesn't show, and cannot be used as an indicator in anyway, the risk from the stress of more frequent doses on your body.

Some drugs the efficacy is based on the peak, others the stable state, others the trough. Some drugs damage to organs is based on the peak, others the stable state, others the trough. Just blindly averaging to the same dose is relatively safe for some medications, will render others ineffective, and others still be rendered more dangerous. I don't know this drug well enough to tell whether this is safe or not, but by the sound of it neither does anyone else on this thread, which makes messing around with doses foolhardy.

I inject twice a week. The manufacturer’s advice is that you should leave 72 hours between doses, as a PP said. I find 2.5 twice smooths the desired effects and reduces side effects compared to 5 mg once.

The weekly injection at each dose is designed for convenience and compliance.

For maintenance, some providers are suggesting a wider range of treatment intervals, e.g injecting every 10 days works for some people. But by that point, almost all patients are presumably pretty good at managing their medication and balancing its effects. Earlier on especially, simplicity obviously wins.