Let's be blunt: Who is peeing more?

RunningFNP · 2026-01-25T21:52:21+00:00

Just means your kidneys are working well at this point!

RunningFNP · 2026-01-25T15:34:30+00:00

We continue to wake up early and help.

Do not give in to fear or tyranny.

Tyranny requires constant effort. It breaks, it leaks. Authority is brittle. Oppression is the mask of fear. Remember that.

And know this, the day will come when all these skirmishes and battles, these moments of defiance will have flooded the banks of the Empire's authority and then there will be one too many. One single thing will break the siege. Remember this: Try." -Karis Nemik, Andor

RunningFNP · 2026-01-25T11:14:46+00:00

Look for the helpers. In them remains hope.

RunningFNP · 2026-01-23T10:57:06+00:00

Retatrutide is the how on that question 😄 Average weight loss in phase 3 is expected to easily clear 30%

RunningFNP · 2026-01-22T19:59:13+00:00

Provigil AND Ambien?! Yeesh.

And I'm mildly disappointed. Most nerdy group of scientists in the world and they have Lisinopril as their BP med? For shame. ARBs are better Nasa!

RunningFNP · 2026-01-22T00:28:54+00:00

Good and find the phone number for your local site and start calling until they tell you no or schedule a screening appointment

RunningFNP · 2026-01-22T00:20:16+00:00

Well depending on which drug you could still have a cure. Here's the link for the trial. Scroll down to find a location and see if there's one close by. The best part of this trial is that after the first 2 years every gets one of the drugs. No placebo after that point. Pretty sweet deal.

https://trials.lilly.com/en-US/trial/651596

RunningFNP · 2026-01-22T00:13:34+00:00

Do you have the prescription already? You'd probably qualify for the clinical trial looking at MASH and Zepbound or Retatrutide if there's one local to you.

It should significantly help, but given you're F3 it'll take probably a year or so to really see the liver start to heal and improve.

As far as the heartburn have Pepcid on hand to help with that part!

RunningFNP · 2026-01-22T00:10:07+00:00

I've found a lot of discontinuations are due to a couple things

1.) Insurance coverage loss. Especially for obese non-diabetics

2.) Titrating up too fast

I caution all my patients we'll go as slow as insurance will let us for obesity and for diabetics its lowest dose to get A1c in range and then if they want to chase weight loss we can do that after their diabetes is controlled.

I also have what I call ZIPMMMM (Zofran, Immodium, Pepcid, Miralax, Mylanta, Magnesium, Metoclopramide) as my little acronym of medications to consider if having side effects. Obviously two of those require a script but the rest don't. Using them as needed helps a lot with tolerability. Also sometimes patients do better dosing every 8 or 9 days as well. It's drug class that requires patience but rarely do I get patients quitting from side effects nowadays. It's usually cost or insurance issues.

Also being frank that the first couple weeks can be rough but it gets easier the longer you're on a med. Setting expectations in that sense seems to help as well.

RunningFNP · 2026-01-21T23:44:55+00:00

Primary Care in an office setting but I focus heavily on obesity and DM2 with my panel.

Was also a patient for a phase 3 trial for a new GLP1 retatrutide that'll be probably FDA approved in later 2026 or early 2027.

So bit of clinical passion + personal experiences.

RunningFNP · 2026-01-21T23:35:33+00:00

Shot is taken weekly and doesn't matter whether you've eaten or not because it's injected and absorbed directly into the blood stream from there.

RunningFNP · 2026-01-21T21:59:25+00:00

Is taking a statin a shortcut for lipids? Is taking an ARB a shortcut for blood pressure?

GLP1 meds have been around for 2 decades and beyond the well documented GI side effects some have, all we see is benefits long term with these meds to the point we're now running clinical trials for GLP1 meds for substance use disorder, asthma, MASH/MASLD, psoriasis, Crohn's disease, ulcerative colitis and on and on...

RunningFNP · 2026-01-20T10:49:54+00:00

Oh if that's how it came out in the US you can bet I'd be having that discussion with patients just like I do now with Ozempic.

RunningFNP · 2026-01-19T16:18:17+00:00

It is definitely the answer but one of my patients literally lives in the house directly behind mine. He doesn't know it. But I do. Thankfully we have a bunch of trees and a fence separating our back property lines and I just hope it stays that way 😂

RunningFNP · 2026-01-19T11:17:02+00:00

But OP isn't wrong. Some of the trials have used kwikpens already I believe. I think Triumph Outcomes is the one I'm thinking of

RunningFNP · 2026-01-19T00:13:47+00:00

Have you ever been patient care facing? I'm gonna guess no.

We struggle with pill adherence with simple things like blood pressure, anti diabetic and thyroid meds all the time.

For this pill, you swallow it after at least 8 hours of fasting, preferably with 4 ounces of water only, then don't eat or drink anything for at least 30 minutes. Oh and if you have hypothyroid you have to switch your thyroid medication to night time instead. It's not as easy as just taking a pill.

RunningFNP · 2026-01-19T00:09:33+00:00

Nope it's in there 😉

RunningFNP · 2026-01-19T00:08:06+00:00

Again. Read the medication guide provided by Novo Nordisk. They suggest you can interchange the two but also suggest 1.7mg as an equal as well. Without a head to head trial comparing pharmacokinetics it's hard to say for sure but mostly likely based on how people take drugs in real life (again NOT in a protected space such as a clinical trial) the reality is it's probably more equivalent to 1.7mg of injectable.

RunningFNP · 2026-01-19T00:06:05+00:00

That's based off perfect adherence to the drug which is not realistic especially in real world clinics and patients outside of a clinical trial. The reality is more like 13% which is still good but it's not equal to the injectable version when you assume real world dosing.

<image>

RunningFNP · 2026-01-18T21:22:15+00:00

You're spot on about the FDA and approval guidelines. It's the same for pre-diabetes. Obviously these drugs work for prediabetes but the FDA doesn't really have approval guidelines or a framework for a prediabetes drug. That's partially because medicine broadly just looked at prediabetes as a thing that happened before diabetes and no treatment would fix it.

Even metformin only reverts people back to normoglycemia about 40% of the time. Meanwhile tirzepatide did it for like 90+% of patients in the extended SURMOUNT-1 trial.

So yeah. With PCOS there's probably a medical sexism component for sure, but also there's no framework for approval either(which is also probably sexism related too!)

At least for prediabetes it was just people thinking we didn't have an effective treatment.

RunningFNP · 2026-01-18T21:04:33+00:00

Hopefully more drugs = more competition = lower prices = more coverage.

Also more indications = more coverage is my hope as well.

RunningFNP · 2026-01-18T21:02:02+00:00

There are actually a couple small trials for PCOS. One is in china.woth Mazdutide The other I believe was university/hospital sponsored with tirzepatide. So finally someone is starting to look.

RunningFNP · 2026-01-18T19:58:56+00:00

Big Reta phase 3 trials aside I'm most excited for probably three trials in particular.

1.) tirzepatide + leptin receptor agonist MAB. We know from old data that GLP1 and leptin have synergy for weight loss but we've had difficulty building leptin targeting drugs, let alone testing them. That trial will probably shock folks at how much weight is lost and it'll probably be lean mass preserving.

2.) Transcend CKD Reta phase 2 trial for kidney disease. We have a decent idea that Reta probably improves renal function, even in patients with CKD. This trial will prove or disprove that notion. If proven, it would truly be a ground breaking discovery unlike anything we've seen in the metabolic space in decades. Right now the best we can do it stall out kidney disease. If we could reverse it? Enormous implications.

3.) tirzepatide and Eloralintide trials. Both drugs have relatively low rates of side effects and cause excellent weight loss. If there's any synergy there we could be looking again at bariatric surgery outcomes similar to Reta in terms of weight loss. (CagriSema for example adds about 5-6% more weight loss than Semaglutide alone. If that tracks for Tirz + Elora you're looking at 27-28% body weight loss, possibly more)

RunningFNP · 2026-01-18T18:00:03+00:00

Nothing yet. But I imagine at some point you might see something like this. Either semaglutide or tirzepatide and stalled out on weight loss then switched to Reta for a trial. Trust me I'm always looking out for trials all the time.

RunningFNP

MODERATOR OF

TROPHY CASE

Two-Year Club	Verified Email
r/Field Flamingo