Uh oh! Time to get serious (again).

Hi, folks! Here I am again. So glad to see that you are all here and all willing to help with your knowledge and support.

I am sorry for this long post, but I think I need to fill you in about my T2D experiences over the last 5 years.

I was diagnosed with T2D 20 years ago. My endo at the time thought that any A1c <7.0 was fine (I now disagree but who was I to argue?). I maintained A1c 6.5 - 7.0 for several years with diet, exercise, metformin and insulin. However, when I quit smoking in 2012, my eating, weight and A1c shot up rapidly. Happily, I did succeed in quitting smoking (hooray!) but then my A1c was >7.0. I joined Diabetes Daily in 2014 to help me better manage my T2D and my weight. DD was great. I learned a lot, changed my diet, lost some weight and my A1c has been between 6.2 and 6.6 for several years now. Great!

So here we are, 10 years later. I'm now in my mid-70's. I have tried almost all of the GLP-1 agonists (Byetta, Victoza, Ozempic and now Mounjaro). My A1cs are still in a good range of 6.4 to 6.6 and, best of all, with either Ozempic or Mounjaro, I can eat any and all of the carbs I want and my A1c remains "in range". Super-duper!

BUT... (you knew that there was going to be a "but" didn't you?) although my A1c looks good, my organ systems are not doing so well.

Part 1: A Coronary Artery Calcium CT (CACT) showed that I have very high levels of calcium and plaque in my coronary arteries. There is not YET any damage to the coronary muscles, but there could be soon. The basic prescription for a pre-heart attack condition like mine is the ubiquitous "lose weight, exercise, stop smoking, stop drinking, yada-yada-yada." So what else is new? It's the same thing they recommend for anything from menstrual cramps to cardiac arrest. (Honestly, I received those same recommendations for both of those conditions over the years.) So why should I take it seriously? I didn't. However, during the last 2 or 3 months I have noticed developing some cardiac symptoms like shortness of breath when just walking and swelling of the legs/ankles. Not good. Maybe I should take some steps?

Part 2: Five years ago, I was told that I had "mild" non-alcoholic fatty liver disease (NAFLD). It is very common among T2D. It is usually benign and none of my doctors seemed concerned, so neither was I. Last week, a new liver scan showed "severe hepatic steatosis" (fatty liver disease). Not cirrhosis (yet) but definitely not good. And, of course, the prescription was "lose weight, exercise, stop smoking, stop drinking, yada-yada-yada". However, there is evidence (including some posts here on DD) that attest that reduced carb intake plus regular exercise can slow or even reverse NAFLD. Again, maybe I should take some steps?

Part 3: Ozempic and Mounjaro. I have been on several GLP-1 agonists over the years including Victoza, Ozempic and Mounjaro for several years. The good news (from my point of view) is that, while I was taking Ozempic or Mounjaro, I could eat any and all carbs I wanted and my A1c stayed in the target range. So in my (admittedly short-sighted) point of view that meant that I could eat all of the carbs I wanted (spaghetti and meatballs, mac and cheese, occasional sweet desserts, etc). I never went "whole hog" on the carbs but I did frequently indulge myself.

But now I am wondering if the Ozempic/Mounjaro was doing me a disservice. Yes, my A1c is fine. But by keeping my A1c in line, these medications enabled me to eat many more carbs than I had been eating. As I consequence, I think my liver got overloaded with demands on its carbohydrate metabolizing functions and poured all of that excess glucose calories into hepatic fat. Hence, the increased NAFLD. Furthermore, I chose to switch from Ozempic to Mounjaro 6 months ago because Mounjaro is better for the heart. But Mounjaro is not working for me. Yes, my A1c is still good, but I am experiencing urgent diarrhea several times a day and severe, explosive diarrhea several times a week. And, as I said, I am experiencing some cardiac symptoms and my NAFLD had increased a lot. So between the diarrhea, the heart symptoms and the liver, I think I need to change my health strategy. In other words... it's time to get serious about health-related behavioral changes.

My plan:
1. After considerable research/reading/talking I have decided that both my heart and my liver will benefit from some consistent mild exercise (at least 150 min/week).
2. I have decided to stop all GLP-1 agonists for now. Although they do reduce appetite, promote weight loss and control FBG levels, I'm concerned about the chronic diarrhea I get. I also worry about which other organs may be affected by these drugs. So I'm going to stop every thing and go back to "first principles" (i.e., carbs <100 gm/day, exercise 150 min/week, exogenous insulin to achieve A1c < 6.5). Basically, I consider this a "reset" of my glucose metabolism system for a few months.
3. I have to get my average daily carb intake back down to ~100 gm/day. What I would call "moderate" carb, not "low carb".
4. I have to face the fact that the only way to track carbs and calories is with a daily food log. I HATE to weigh-and-measure-and-record everything I eat, but it's the only system that has worked for me in the past to get my clinical values where I want them to be. UGH!

So, given my latest medical test values, I am now embarking on a new phase of my D2M journey. If I can be consistent (a big "IF") I expect to see significant improvements in T2D, cardiac values and liver values.

Stay tuned for further developments.

You can do it, Chrysalis and we’ll be here cheering you on.

Welcome back Chrysalis! You are on your way to better health with a whole lot of folks clapping their hands for you

With all due respect, and while I certainly wish you well, I think #1 in ypur plan needs to be weight loss. That is, hands down, the most effective treatment for non alcoholic fatty liver. By the way, days long water fasting, and even time restricted feeding, usually 20/4 (ish), has been shown to be very helpful in preferentially targeting liver fat. There are water fasting clinics if you have the ability and need the support. Check with your doctor, of course.

Your comments read like Ozemoic and the other GLP meds did not cause issues, just the Mounjaro? If so, switch back. The appetite supression should be helpful, while following a low carb time restricted eating plan. The med didn't do you a disservice, every diabetes meds says it is to be used in conjunction with a healthy diet (for a diabetic) and exercise.

Thank you for your suggestions, kcs2018. I realize that restricted feeding can be a very effective way to lose weight and also control T2D and perhaps also NAFLD. However, that lifestyle is not something that I could sustain for the long run (like more than one day ). Actually, even The Buddha advised his followers to eat only one modest meal per day. He said that would cleanse the body and clear the mind. But I can't/won't do it.

Once I complete my current T2D "reset" plan, I might go back on one of the designer drugs. But for now, I feel most comfortable getting back to the most bare-bones T2D program. Frankly, at this point I have no idea of how much exogenous insulin I will need if I keep my carbs <100 gm/day. Ten U/day? 25? 55? And I do know from prior experience that if I control my carbs and exercise in moderation, my weight will decrease. So I'll try that first.

If GLP-1 keeping your A1C in check, stopping it and using insulin seems counter productive, since will/may cause weight gain, and possible lows.

Hi Chrysalis. Thank you for sharing your story, thoughts and going forward “treatments plan”. I like yOu find out 67% of my liver is all fat 2 years ago. After many appeals to my insurance carrier, they approved Mounjaro for me. My endocrinologist told me I really need to get off or reduce my insulin dosages to get my liver back to healthy. I have been on insulin for over 25 years. Mounjaro was a game changer for me. i was able to lower my insulin dosage by 80%. I stopped gaining weights from the excess inulin. However, the down size is GI issues, not too serious but tolerable. last visit with my endo 6 weeks ago, I told him my decision is to stay on the baby dosage as he called it and just use little bit of insulin as needed. I wish you all the best with your plan. Keep us posted.