doctor meets with patient about type 2 diabetes and weight loss

Dr. E's Case Study

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This case is important to highlight because it’s one of the most common situations I see in the diabetes clinics at the VA hospital and UCSD Medical Center in San Diego. 

So many patients struggle with obesity and poor diabetes control, and both of these issues can lead to serious complications down the road. Helping this patient lose weight and improve his blood sugar control not only turned his medical syndrome around, but it had a huge impact on his emotional health as well.

Meet the Patient: Oliver

Oliver is a 57-year-old male who developed type 2 diabetes approximately 12 years ago. He has a family history of type 2 diabetes, and in his 30s he took on a stressful job and started gaining weight. When he came to see me last year he weighed 230 lbs, and he’s only 5’8” tall. His body mass index was 35 and his A1c was 9.4%.

Oliver’s Diabetes Regimen

Oliver’s medication regimen included 1000 mg of metformin, the SGLT-2 inhibitor Farxiga, and one injection of long-acting basal insulin each night because his morning blood sugars were especially high.

The Problem: Obesity, Diabetes, and Metabolic Syndrome

Through the years, he tried every diet known to man. Occasionally he’d have some success, but as we all know, it’s very easy to gain weight and very hard to lose (and keep off). 

He also told me that his work and poor control of his weight were causing mental anguish and irritability, which was rubbing off on his family who were not that sympathetic and would say, “Just stop eating so much, Dad!”

Oliver’s obesity not only caused problems with his glucose control, but he also developed coronary artery disease, obstructive sleep apnea, and fatty liver disease – three very serious conditions that are seen together as components of metabolic syndrome and can worsen over time.

What Is Metabolic Syndrome?

Metabolic syndrome is a cluster of conditions that increase the risk of heart disease, stroke, and type 2 diabetes. 

It includes:

  • Elevated blood pressure
  • High blood sugar levels
  • Excess body fat around the waist
  • Abnormal cholesterol or triglyceride levels

Having one of these conditions doesn’t mean you have metabolic syndrome, but the combination of these factors amplifies health risks. 

what is metabolic syndrome

The Solution

When I saw Oliver last summer, he was really ready to address his high blood sugars and excess weight. I put him on Mounjaro for type 2 diabetes because it reduces glucose and contributes to significant weight loss. Tirzepatide, which is the main ingredient in Mounjaro, has also recently been proven in clinical trials to help with obstructive sleep apnea at certain doses.

Zepbound vs Mounjaro

Since Oliver has type 2 diabetes, his insurance approved him easily for Mounjaro. Insurance is where there are often a lot of questions regarding Zepbound vs Mounjaro. If Oliver didn’t have diabetes but he still had obesity and a BMI over 27 with cardiovascular risk factors, I would have put him on Zepbound. Zepbound is essentially the same medication as Mounjaro but with a different name and an indication for obesity.

Oliver started on 2.5 mg of Mounjaro once a week for four doses, and he titrated slowly up to the maximum dose of 15 mg per week, escalating the dose by 2.5 mg every month (this is what I typically recommend if tolerated). When I say he titrated slowly, I mean slowly – the process of going from 2.5 mg to 15 mg took five months. The key to mitigating side effects (primarily nausea) is to titrate slowly.

The Results

After five months of being on Mounjaro, Oliver lost over 40 lbs, and his A1c decreased to 7.2% (and is still on its way down). His sleep apnea, cholesterol levels, blood pressure, fatty liver, and cardiovascular status also improved significantly.

Along with these very important life-saving improvements, his attitude was markedly changed for the better. He started exercising more because he felt lighter (which he was), he was motivated to take up physical hobbies like pickleball, and he had an all-around feeling of well-being. 

In addition to eating less (which we expected with Mounjaro), he also started making better food choices, and he even brought me homemade plant-based energy bites (which were really quite good).

The Takeaway: Type 2 Diabetes and Weight Loss

Mounjaro is the best diabetes medication for weight loss compared to other products. So many people are in the same situation as Oliver and would be good candidates for this medication.

In fact, over 30 million Americans have type 2 diabetes and over 80% live with obesity, which is one of the main causes of metabolic syndrome (a core abnormality associated with cardiovascular-kidney-metabolic (CKM) syndrome as well as fatty liver disease).

When I met with Oliver at the end of last year, I told him that he should plan to be on Mounjaro for life. It’s not a drug to start and stop. Going off this medication would most likely lead to him regaining the weight he lost and losing the other health benefits as well. 

My job at this point is to make sure Oliver’s authorizations are in place, and his job is to get his prescriptions filled and take the medication religiously (not just on Christmas and Easter!) so he can continue to reap the benefits – and probably beat me at pickleball.

If you are one of the millions of people struggling with blood sugar control and excess weight, talk to your doctor about getting on a GLP-1 or GLP-1/GIP medication. They really can save your life.

For more information on diabetes medications that also help with weight loss, check out the resources below and visit the TCOYD® video vault.

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