#40

The current Mounjaro pens are single dose. They cannot be split up the way Ozempic pens can be.

I think the every other week strategy is pretty good given the shortages. I go 8 to 9 days on Mounjaro doses so that I can stretch it out and have a pen or two on reserve to wait out the shortages.

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#41

Umm I have patients who split the doses, primarily in California as getting compounded stuff sent to CA is challenge.

Magnified glasses on. 1 mL syringe with plunger fully pulled out, facing upwards. Mounjaro autoinjector, unlock, cap off, with Mounjaro autoinjector facing down, very carefully put opening of 1 mL syringe over the needle, and press the button on the autoinjector.

Your 1 mL syringe now contains just over 0.5 mL (50 units on an insulin syringe).

So if you are using the 15 mg/0.5 mL Mounjaro pen, and you need 5 mg, then 0.16-0.17 mL per dose which is 16-17 units on an insulin syringe. So you have your 3 insulin syringes - wait 2-3 minutes for the foam to go down in the 1 mL syringe then carefully advance the plunger until the mounjaro solution is need the tip of the syringe and stepwise, pull a little into the insulin syringe, then advance the plunger, repeat until you have 16-17 units, do likewise with insulin syringe 2 and 3 …

In this fashion - 3 x 5 mg doses from a 15 mg autoinjector. Naturally, just like Mounjaro - keep the insulin syringes in the fridge.

Anyway - have patients who have been doing this for a long time … it’s quick and easy - but need to take care that plunger is pulled down to 1 mL on the 1 mL syringe to the syringe to accept the solution, and that the needle is in the 1 mL syringe from the autoinjector. I’ve had people mess up these steps and end up simply spraying the Mounjaro onto the surface …

Hope that helps … but it is easy once you’ve done it one time.

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#42

Thanks. I will explore that. In my case, I’m pretty happy just using a single pen and calling it a day. But. . . while I have you, I’m collecting opinions from anyone with experience with these drugs. Please weigh in if you are comfortable offering an unofficial opinion. I’m trying get a pulse on whether it is better to pursue the biggest tolerable dose or Mounjaro or to go with the smallest effective dose.

I’m taking Mounjaro to control blood sugar, not for weight loss. I have an unusual form of diabetes where I have good insulin sensitivity, but seem to produce relatively little insulin. No antibodies for autoimmune response. I switched from Ozempic a few weeks ago, on the hopes that GIP would help me attain a lower average glucose. Indeed, I’m getting slightly better glycemic control with Mounjaro than Ozempic. Now I’m wondering whether a bigger dose would get me an even better response versus whether it is preferable to get by on a smaller dose. I tolerate the drug really well. No side effects. I’m on the 10mg / .5ml dose.

My average blood sugar is around 110 to 115. I would love to get my A1c in the arena of 5.5 or lower.

BTW, when I say I’m collecting opinions, I am under the care of a good primary care doctor and he pays good attention to me. His advice is to stick with a dose for 4 to 8 weeks and then try upping it or lowering it and seeing how results change. So, I’m really just curious to know what anyone else thinks based on experience with other patients.

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#43

If you’re on the drug for diabetes, I would choose a dose based on your glucose level and A1c.

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#44

I started Rybelsus 3 mg/day about two weeks ago. Plan to complete the regimen of 3 mg for 30 days then start 7 mg. Like you, taking for glucose control, not weight. But actually, the hope is that I can instigate pancreatic Beta cells to replicate and function better. Low c-peptide and low insulin: this tells me there is a problem with Beta cells and insulin production. No antibodies for LADA. Can you please write more aout your “unusual form of diabetes”? I might be experiencing the same thing.

In addition to the Rybelsus I am taking 2000 mg Metformin and 1500 mg Berberine. My fasting blood glucose is in the 100-130 range most of the time and A1C was 5.9.

Mounjaro and Rybelsus are both semaglutide.

I am also taking Harmine. You may want to check out the work of Dr. Andrew Stern at Mt Sinai – there is a good youtube presentation on Beta Cell Regeneration. Long story short, his lab’s work showed that the combination of Harmine, a DYRK1 suppressor, with any GLP1 agonist signficantly increased rates of Beta Cell replication.

4 Likes
#45

Deborah, a few things:

I’m really interested in your Harmine experience. I posted about that a few weeks ago. How did you go about getting Harmine? I have seen online sources, but they seem a little sketchy to me. If you reply, maybe post in the thread below:

I did Rybelsus for a while when I could not get Ozempic pens. It was not that effective for me. I’m guessing this was related to bioavailability versus the Ozempic injection. The injection worked great.

Mounjaro is not Semaglutide. Mounjaro is a different GLP-1 agonist combined with a GIP agonist. In other words, Mounjaor is two drugs in one, and one of the drugs is similar but chemically different from Semaglutide.

I’m curious to know whether the Metformin does anything for you. I got NOTHING from it. My diabetes is not caused insulin resistance or autoimmune response. Rather it seems to be related to low insulin production and it is probably genetic. My dad had something similar.

If you are interested in learning more about your diabetes, you could try enrolling in this study: https://www.atypicaldiabetesnetwork.org/ If they accept you into the study, you will get a diagnosis and maybe some medical advice out of it.

Have you calculated a HOMA-IR value for yourself. This is a measurement of insulin sensitivity that is a function of fasting insulin and fasting glucose. It might give you better insights into your condition. Most doctors don’t screen for fasting insulin. BTW, I give credit to Dr Alan Green for having me do this test. I had no idea that I have an unusual form of diabetes and I was really surprised to learn that I have really good insulin sensitivity. Who even knew that was possible???

One last thing: It seems extreme to take both Metformin and Berberine. You might want to read up on whether that is a good approach. I would imagine that if Metformin works, the Berberine is superfluous. Of course, I’m not an expert in this. I just know that multiple drugs that do similar things don’t necessarily have an additive effect.

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#46

It’s just one drug, but it binds and activates two receptors (GLP1 and GIP). An even newer one in development (retatrutide) is still a single drug/molecule but hits 3 receptors (GLP1, GIP and glucagon).

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#47

GLP agonists may actually increase metabolism of visceral adipose tissue in addition to appetite suppression (this study used liraglutide):

https://onlinelibrary.wiley.com/doi/10.1002/oby.24126

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#48

Do these two have different mechanisms of action?

#49

Berberine (in addition to glucose lowering) has some lipid-lowering effects, decreases PCSK9 which means more LDL receptors keep functioning leading to lower LDL. Berberine is not as bioavailable as Metformin and takes a longer time to start having an effect. I have not seen an explanation of how the mechanisms of Metformin and Berberine are the same or different. In fact, it seems there is not a great understanding of exactly how they work.

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#50

@Deborah_Hall I’ve read that berberine and metformin together have a bigger effect than mono therapy due to the effect on the gut microbiome…leads to higher stable plasma level of metformin. I don’t take much metformin (only around my rapa dose) because I don’t like how it makes exercise harder (mito poison) but I get no noticeable side effects from berberine.

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#51

@Joseph_Lavelle Have you experimented to see if the Berberine makes a difference in blood glucose level?

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#52

No clear cut results from anything I’ve done has affected my HbA1c except Akkermansia. I haven’t done an experiment per se but I’ve used berberine for years with short breaks. I’ve used metformin several times for a few months at a time (did not keep using berberine) but kept quitting due to side effects. Both seem to lower HbA1c by a few tenths (5.9 —> 5.6).

Now I use both around Rapa but quit metformin after a few days (repeat every 2 weeks). I’m aiming for a metformin + Rapa effect but who knows.

Akkermansia knocked my HbA1c down to 5.0, which is clearly outside of the metformin/ berberine effect size for me). When I quit Akkermansia after 3 mos my HbA1c went back to 5.6. So I’m back on it long term. Plus berberine everyday.

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#53

I thought this yt video from Nick Norwitz was pretty illuminating:

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#54

I use berberine everyday. It is a CYP3A4 inhibitor, which might complicate the rapa-game.

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#55

The study used a big dose:

“ …dose of 300 mg three times daily (8 am, 4 pm, and 11 pm) for 14 days”

Still, I wonder if this effect adds to the effect of gfj or if the impact cannot be increased.

#56

I don’t use grapefruit juice, so I guess Berberine is more likely impact my levels of sirolimus, than it is for people that use grape fruit juice.

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#57

Hello. I want to try this. Thanks. So you inject the 0.5 ml pen into a 1 ml insulin syringe. Then I’m confused. How to get 1/3 of this volume (16-17 units) into a separate (2nd syringe) and so on, resulting in 3 divided doses of 16-17 units each in three separate pens?

#58

Message me your email, I’ll send you a video I made … it is easy and obvious ONCE you see it … you’ll just draw this out of the 1 mL syringe with 3 insulin syringes. I have folks who are doing great on 2.5 mg of Tirzepatide, and get 6 doses out of a 15 mg pen … makes the cost a little happier. My patients in states where we have access to compounded meds do so at around $100/month maybe $150 if at 3.75 mg/dose. But in states with a lot of restrictions, like CA, the splitting a standard pen makes sense.

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#60

just curious — considering these interventions and studying price options at the moment. are you getting these prices because you’re ordering large amounts of tirzepatide via compounding pharmacy and reusing the bottle for months? I’m aware of the default beyond use date of multiple-dose containers of 28 days, but curious if folks just end up ignoring those guidelines.

I see e.g. olympia pharmacy compounding 75mg of tirzepatide for $800.

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