Apparently you can get essentially the same thing from a “compounding pharmacy.”
That’s good. You don’t need to start at the top when it comes to real diabetes treatment. They’ll probably start you on Metformin and encourage you to do some diet and exercise changes and see where you’re at after a year. If things don’t get better you may go on an oral drug like Januvia.
Plenty of people are able to reverse T2 diabetes with just diet and exercise, or diet and exercise + Metformin. I think one of our Dopers did it. My friend Jon did it.
And if you can’t do it, maybe an injection will be right for you. But in a couple years.
So glad your doc isn’t just throwing the most expensive option out there.
Compounding pharmacies can be wildly expensive, I had some experience with them back when I was still working and they were often a workaround to price controls.
QFT. First diet and exercise, then metformin, worked for me for years.
I had no issues with availability until I went up to the 1 MG dose (which, woohoo, finally arrived from Dropped’em a week ago); the local pharmacy had no problem with the smaller-dose pen.
I’m surprised your doc didn’t put you on Metformin ages ago, if your A1C just now hit 7.1 - I think the cutoff for being formally diagnosed is 6.4.
Mine hit that years back, I was put on Metformin, and it did well, but had been creeping up in recent years. It was 6.4 or so again, last time I had it tested pre-Ozempic. I don’t know if the doc would have put me on another med or not, if the weight loss discussion had not come up; I was at a pretty high dose (2000 mg / day) of the Metformin.
My weight had plateaued a bit, largely due to travelling last month. Even though I did not overeat much, we had trip snacks, plus fluid retention from sitting in a car for 12 hours. But it seems to have dropped off, again.
I will start on the 1 mg dose next week. I still have half a lower-dose pen, and one unused lower-dose pen; I’ll just use 2 doses at a time from those before starting on the higher dose unit. Not looking forward to the increase, really - my stomach issues have gotten better in recent months, and I expect they’ll get worse again.
My wife and mother are on Metformin, and have both struggled with gastrological issues when taking it. So, I’m fine if my doctor takes some time with it.
And that’s only if THEY can get semaglutide, the active ingredient.
I remember when reading up on the stuff, when I was first put on it, wondering “why don’t they add this to the water supply!” since there are so many potential health benefits.
Is metformin a wonder drug? - Harvard Health
I didn’t find the digestive problems to be an issue, though I DID develop diarrhea a couple years after getting to the higher dose. It was definitely not a “bump up the dose, and RUNNNNNNNNN” correlation, I’d tended to the occasional bout of same for many years, and my gallbladder had left the premises, so there are lots of potential causes; I suspect that adding aging to the picture allowed all the factors to final synergize in a truly messy manner.
I finally went to the doctor specifically for this, and was put on Welchol (a bile acid sequestrant used to lower cholesterol, which many people do not tolerate due to constipation). MIRACLE drug.
Interestingly, the Ozempic is helping as well, with the digestive slowdown and the overall lower volume of food. Not enough to skip the Welchol, without truly regrettable results…
I’d be very, very careful about getting the stuff from a compounding pharmacy.
Is Compounded Semaglutide Safe? Here’s What You Should Know - GoodRx
thanks for that. I didn’t know all that, but it makes sense. I’m getting the “real” stuff, but my doctor did mention compounding as an alternative if we face a shortage. I’ll certainly have a long discussion before I go that route.
There’s a lot of fear uncertainty and doubt being sown, often by the drug manufacturers themselves. Lilly, as an example, is working a full court press with their sales reps to convince everyone that compounded tirzepatide is basically rat poison, but less pure.
The reality is that a ton of places are eyeball deep in shady practices, for sure. Med spas in particular are buying a lot of “for research only” source materials and mixing it up in their back rooms.
But you can also find plenty of reputable compounders working to FDA standards. I can’t get Zepbound right now through the normal route, so I’m on a compounded version. The pharmacy I’m getting it from is sourcing the tirzepatide peptides from an FDA monitored facility (in fact one of three so monitored, and one that Lilly sources from as well) and doing the compounding work in their FDA 503a and 503b approved facilities. They certify that every batch of raw peptides goes through a full testing protocol to ensure purity and suitability for purpose.
If I could get the ‘official’ product, I would, mostly because insurance might cover it. But in the meantime, I feel good about the compounded version. Given that my insurance had not yet decided to approve my prescription when I started, compound is cheaper as well, $350/mo for the compound vs $550/mo with the Lilly discount card or $1100/mo without.
This landed in my inbox today…
RESPONSE OF ALLIANCE FOR PHARMACY COMPOUNDING CEO SCOTT BRUNNER TO ELI LILLY’S ASSERTION THAT COMPOUNDING PHARMACIES NEED TO BE PUNISHED
May 15, 2024
In its May 14 statement on settlement of litigation with certain med spas, Eli Lilly lumps legitimate pharmacy compounding by state-licensed pharmacies with drug counterfeiters and says that compounding pharmacies “put patients at risk” by selling “unsafe products” and should be punished. What utter, self-serving nonsense.
Perhaps the Lilly folks need to re-read the Food, Drug & Cosmetic Act. Compounding is authorized in federal and state law and has been a necessary therapeutic option in the U.S. for generations. It’s essential when a prescriber judges there’s no appropriate FDA-approved drug for a patient or the appropriate FDA-approved drug is not available.
Maybe they should be reminded that compounding pharmacies are sourcing tirzepatide API from the very same FDA-registered manufacturers that media report Lilly has used.
Or maybe they just need a refresher on the regulatory framework in which compounding pharmacies operate, including the sterile compounding standards of the U.S. Pharmacopeia, which are enshrined in the pharmacy laws in the states.
This illustrates my point about being careful about getting the stuff compounded: you ARE being careful! With the popularity of these drugs, however, there are likely a lot of shady providers out there for the unwary.
Finally started the 1 mg dose two days ago. I don’t know that I feel any differently, at the moment, though last night I had a peanut butter sandwich for dinner and was burping PB-flavored burps for 3-4 hours.
I have one more .25/.5 mg injector; I guess I’ll do with that the same as I did the other day - just dial up .5 mg and inject, twice in a row. Then I’ll start using the 1 MG injectors.
Interesting article at Washington Post about the company paying plus-sized influencers to tout their product.
Ozempic, weight-loss drugs target body positive influencers for marketing - The Washington Post
Assuming you can even GET the stuff…
Me: 3ish weeks on the higher dose now. Weight hasn’t started going away any faster, but I’m definitely still not eating enough. I may start adding protein powder to smoothies. Doc said “you must be feeling better - more energy!” which is similar to what my SIL said when I saw her a couple months back.
Nope. I definitely do not feel any better - to be fair, I’ve got some fatigue-related issues that weight loss won’t help. My apnea may be a little better; supposedly my average pressure on my CPAP has been trending down.
But to be honest, I overall feel WORSE. Stomach is dodgy most of the time, and my blood pressure control has gone through the floor. I’ve had several incidents lately where I got extremely light-headed while shopping, and one the other day where I got halfway to the grocery store and realized that was not a good idea.
I still think the weight loss is worth it, but I’m seriously considering requesting cardiac rehab. I don’t quite qualify for a POTS diagnosis, because my pulse doesn’t spike quite that much, but it is quite frankly disabling.
I’ve gained back the weight I lost on Ozempic initially, but I’m still quite nauseated and have food aversions. I’ll see if it’s holding my a1c steady; if not, I’m out.
Still on .5mg after just over a year. Other than improved IBS symptoms, an A1C that dropped from 7 to 5.5, and a ~12 lb weight loss I have no other side effects. My doc sees no reason to increase my dose.
That’s a major disappointment! (I assume you wanted to lose the weight).
Friends claim that the other injectable (Mounjaro) has fewer side effects, if you and your doc feel that you need something in this class. But other than that, yeah, no point in being miserable if other choices will work better or let you deal with less side effects.
I weighed myself after posting earlier - and for the first time in 20 years I weigh less than 200 (and that was transient at the time). Down 10ish in about a month, per my home tracker entries.
My son and I went out for lunch today and I got a 4 ounce hamburger. I forced down about half of it. I will see the doctor again this week - evidently the message I sent about falling, and being unable to do some basic activities, got their attention.
I may ask about dropping my dosage back to 0.5 mg. I was losing weight on that, and frankly at this weight, while I’m still “overweight”, I’m so much healthier, supposedly, and I’m sick of feeling wretched.
Thanks. Mounjaro isn’t in my formulary. I’m impressed you could eat a burger. I can’t even go into a place that smells like burgers, read about Mexican food, or eat most meat warm. Vegetables are really hard, too, which makes my diet stupidly worse with Ozempic than it was before I started.
I don’t know if I’m lucky or unlucky. I’m on the 2mg/wk dose and my appetite and food preferences have not changed one bit. I also have not lost any weight despite being on it for almost a year (although to be fair I haven’t weighed myself in several weeks). I have some nausea but it seems to be triggered by certain things like brushing my teeth or drinking certain liquids like Glucerna or black tea. In fact I’ve given up my morning tea routine, which is something I am sorely disappointed in.
As I think I noted upthread my last A1C was 2 points lower than the one prior to that, when I was still on my 1mg/wk dose. However, at the beginning on the year I had more-or-less successfully cut out a huge number of the carbs I had been eating, but my resolve has slipped lately and I’m sure I’m eating more sugars than my doc would be happy with. I suspect a big part of my lower A1C number was due to diet changes. My next one is in late July and I’m trying really hard to jump back on the low-ish carb wagon so I am curious what my number will be then. Honestly, I have no idea how much the Ozempic is helping any of this. It certainly doesn’t seem to be having the “weight loss and reduced appetite” side effect that my doc wants.
One plus is that I’ve never had any problem getting it, knock on wood.
I never quite know what I can eat. Sadly, oftentimes the things I can down most easily are laden with simple carbs and/or fat. Not fried food, but I’ve never been a huge fan of deep-fried stuff. But when we were driving home from Vermont, in January, NOTHING seemed like it would sit well. I wound up buying some shortbread cookies at one rest stop, and a milkshake at another. Not exactly the most nutririous options, but each seemed to, well, not settle my stomach, so much as dull the roar slightly and not UNsettle it. I order something at a restaurant with the expectation that I’ll eat maybe half, or less. I did swipe 3-4 of my son’s French fries, and that was quite enough. I hated to throw away that burger half though.
I have cravings (well, not “cravings” like people get when they’re pregnant, but “hey, I’ve loved this in the past, and it sounds like it would be tasty now”) for some oddball stuff… that I suspect I’d regret.
Like, a nice bowl of chili. Spicy but not too much so. Loads of protein, and fiber (from the beans / tomatoes). Or deviled eggs. Especially a “buffalo deviled eggs” recipe I made a few years ago (the filling includes buffalo sauce and blue cheese dressing). Yummm. In fact, the other day when I tried to go to the grocery after the bank, I was heading in to get the fixings for that.
I don’t know that my diet is WORSE, but I am definitely not getting sufficient protein. I really need to find a way to fix that.
Interesting article on Ozempic; the author was prescribed it for T2DM and has experienced significant weight loss as well. He had, among other things, significant lower-GI problems (has not been an issue for me; I tend toward diarrhea anyway, and the Ozempic has helped that).
I Lost 60+ Pounds on Ozempic. Here’s the Truth About How It Works (goodhousekeeping.com)