Boy am I glad our one car is a plug-in hybrid and basically needs gas about once a month or less, especially in warmer weather months.

The one of the next frontiers for GLP1 meds is neuroscience/addiction disorders. This recently published study looking at various substance use disorders and older GLP1 medications shows a modest benefit across the board www.bmj.com/content/392/...

!!!!!!! 👀👀 Trial finished on February 20th...so we should have initial topline phase 3 data for retatrutide and diabetic patients over a 40 week period in late March!!!! Ahhhhhhh!!!!

Another DACRA. Another subpar weight loss result. Just say no to DACRA for weight loss. Petrelintide is a Amylin 3R-Calcitonin agonist. Tolerability was great. Similar to placebo. Weight loss was only 9% and only for the highest dose. No report on other doses.

!!!!!!! 👀👀 Trial finished on February 20th...so we should have initial topline phase 3 data for retatrutide and diabetic patients over a 40 week period in late March!!!! Ahhhhhhh!!!!

Huge announcement by Eli Lilly this morning that undercuts PBMs and their competitor Novo "Zepbound® (tirzepatide) KwikPen® for single-patient use available from Lilly at $449 across all doses through the Lilly Employer Connect platform, with reduced cost-share pricing available to employees"

Is there a word for how it feels when you finally give a patient an actual diagnosis for a disease when for the last 2 years they've had countless tests, seen multiple other doctors with no answers. And then the answer arrives in your Epic inbox. Man. The relief to have an answer to give them

Here's a question for my nephro/primary care folks.... If you have an immunocompromised patient (from biologics, transplant, oncology) would you still prescribe SGLT2i for progressive CKD? There's a risk of GU infections BUT does the benefit outweigh the risk for you? CC: @hswapnil.medsky.social

It’s FINALLY happening and it feels like Christmas morning. Only better. @labcorp.bsky.social @questdiagnostics.bsky.social @ash.hematology.org

Avoid the horrors of the world by finding peace and quiet in the woods, forests and prairies of the world.

No money for health care. No money for cancer research. No money for infrastructure. Always money for war, death and destruction.

Deep cut science post, but related to my last blog post about calcitonin. Another company decides to follow cagrilintide and absolutely hammer the calcitonin receptor and touting it's efficacy in rats. The aversion to food test I think is one of the biggest confounders with this drug development 1/2

Pharmacology win of the month?! Patient with persistently low magnesium despite oral and IV magnesium. Started empagliflozin 9 days ago. Today? Normal magnesium 🎉🎉🎉 Flozination FTW.

Full data published for orforglipron vs oral semaglutide in diabetics. Liver data looks good(which is the big concern with it's weird molecular shape) better A1c reduction is pretty clear. Tolerability slightly "worse" for orforglipron but otherwise another oral pill that just works!

Inspired by Lars I found this very recent publication, treat to target approach for obesity management. I feel like while some subjective measures remain, such as height & waist size, blood pressure this could honestly be a better way to measure GLP1 efficacy in both trials and clinics

If ferritin is 5ng/ml and total iron is so low that lab cannot measure it, is that bad @shematologist.medsky.social 😳👀 Hopefully no push back from insurance for these iron infusion orders 🙈

It's not often in Pharma that you run a head to head trial against your major competition and legit just flat out lose. Cagrisema 23.6% weight loss vs Tirzepatide 25.5% weight loss over 84 weeks. This result is horrid for Novo Nordisk.

I genuinely can't wait for access to improve for GLP1 meds. One of my diabetic patients deliberately stopped their other diabetic medications just so their A1c would elevate because insurance said "their diabetes was well controlled...at A1c of 8.5%" Absolute absurdity 🙃 🙈

Spot the ahem HUGE transcription error that my health insurance company made. They asked for a waist circumference. My PCP put 91cm. Somehow my insurance company turned that into 43 INCHES when I have a BMI of 24 🙃 The same folks who routinely deny care can't even do a simple metric conversion.

To Claire's point, antibiotic resistance is an ever shifting target and what works for one patient may be completely resistant in another. It's one of those things we constantly have to keep track of. We even have resources that collate trending resistance patterns locally it's a big deal.

This was an interesting one to write, dual Amylin-Calcitonin receptor agonists (see: CagriSema) are a hot topic in obesity these days, but they're actually a bit of a mixed bag for diabetes thanks to calcitonin. Read on to find out why!

This was an interesting one to write, dual Amylin-Calcitonin receptor agonists (see: CagriSema) are a hot topic in obesity these days, but they're actually a bit of a mixed bag for diabetes thanks to calcitonin. Read on to find out why!

And that's autoimmune disease #2 (plaque psoriasis) that improves with tirzepatide. The improvement is modest but apparently statistically significant and the trial was short, only 36 weeks so this is rapid improvement! A much longer trial is currently ongoing as well.

The as yet unfulfilled promise of GLP-1 medicines and neurodegenerative disorders @jclinicalinvest www.jci.org/articles/vie... dm5migu4zj3pb.cloudfront.net/manuscripts/...

This is my experience as well. If I ask it for "publications about how GLP1 changes insulin sensitivity" it is actually helpful because it's just collating from Pubmed basically and I can focus a search quickly that way. But it's otherwise....useless. Just a fancier search engine IME

Update from this: CPK down to 301(still high but better!) However, my hemoglobin dropped to 12.8 from my usual 14.5ish and RBC count is 3.9 (low for those who don't know) so I guess iron supplements for a minute as well. Thankfully liver enzymes and renal function were normal for me.

Dr R lives not far from me and she's spot on. Me and my wife got lucky to find a good PCP without super long wait times. Seeing as I'm a PCP myself my patients also say the same thing to me. Shocked I am available(but it's only because my patient panel isn't full yet)

My blue beauty Weber doing yeoman's work in 48 degree February weather with a flat iron steak!

Putting the finishing touches on my next blog post. Why dual Amylin-Calcitonin receptor agonists(DACRAs) like cagrilintide, which is one half of the CagriSema drug being developed by Novo Nordisk, are turning out to be less effective in diabetes than expected. Calcitonin is a liability!

On Valentine's Day my love requested wings. I obliged.

Barkley Marathon on Valentine's day weekend?!

Found out today Eli Lilly is presenting the full data readout for my retatrutide clinical trial at ADA 2026 conference and I'll be there to see it live!!! Debating on making this design into a T-shirt to where the day it's presented because I'm a huge ass nerd who's so excited for it

Well this is fun. I get to stop my statin because I nearly ended up in rhabdo from it. Checked CPK this week and it was 684u/l 🙃🙈 Nearly 4x the upper limit of normal! In late January I noticed some increased muscle aches but figured it was just from my increase in running and lifting 🧵

Fascinating preclinical work on my favorite topic, glucagon. This study suggests glucagon is doing a lot more than just futile cycling glucose substrates and inducing ketogenesis & lipolysis for weight loss.

I know everything is crazy but let's celebrate some wins. I diagnosed a patient with new onset diabetes and heart failure last June, initial A1c 14% EF 21% As of last week, EF has improved to 35% A1c is 6.2% (!!!!) and patient has lost about 40lbs to a near normal BMI. (Tirzepatide + flozins!)

Moreover, the most critical advantage of the mRNA tech is the speed at which it can be produced. Under a properly functioning regulatory apparatus, when we got surprised with H3N2 subclade K, we could have had an updated vaccine within ~2 months.

Patient to me today about their cancer care: 'They cured my cancer but didn't care about my humanity afterwards' That has stuck with me all dang day. We cannot just treat the disease and forget the human.

Patient to me today about their cancer care: 'They cured my cancer but didn't care about my humanity afterwards' That has stuck with me all dang day. We cannot just treat the disease and forget the human.

In continuing the theme of GLP-1s are overpowered Mary Sue drugs, we have our first glimmer they may actually rebuild cartilage in knee osteoarthritis. This tracks with some real life anecdotes I've seen here and in clinic @eecklund.bsky.social @stresshoop.bsky.social www.cell.com/cell-metabol...

In continuing the theme of GLP-1s are overpowered Mary Sue drugs, we have our first glimmer they may actually rebuild cartilage in knee osteoarthritis. This tracks with some real life anecdotes I've seen here and in clinic @eecklund.bsky.social @stresshoop.bsky.social www.cell.com/cell-metabol...

Lemme tap these two slides from obesity week 2025. Our bodies regulate our weight almost down a couple calories to maintain weight. And yet at the same time we've created such a world of excess in terms of food AND reduced energy expenditure it's basically a given that obesity is so prevalent.

Eli Lilly is already on that. They're also looking at smoking cessation as well for this dual GIP/GLP-1 agonist. I can mirror your experience. I had 2 beers for Super Bowl Sunday. That's dramatically less than it used to be. clinicaltrials.gov/study/NCT072...

I've been predicting this would happen. I suspect they'll get banned in certain sports where weight matters, biking, rowing, etc. Even more so when glucagon agonists come around(that requires more than 300 letters to explain)

That's the 3rd GLP1 ad (Also I appreciate that commercial not being a bunch of white people! Minorities in the USA have high rates of obesity too!)

Superb Owl beverage. Coconut rum barrel aged stout. SO. DAMN. GREAT.

GLP1 commercial count for the Super Bowl: 1

The ice is over a foot thick on the river. It was a bright and sunny morning. So I did some exploring, almost to the Canadian border on the frozen river. Magnificent ice and snow formations!!

Seeds! There might be snow on the ground but it's time to start tomatoes, peppers, leeks and cabbage indoors!