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Comment by quaffapint | Hacker News Reader

I do wonder how much affect it has. At least in the US most insurance companies won't cover them (unless you already have diabetes, for example) and at over $1,000 a month I can't see how the people who could really benefit from this to lower the numbers can possibly afford it.

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From personal experience, it's ridiculously easy to get a compounded formulation from one of the telehealth suppliers, and it's cheap even though you can't submit it to insurance. I think I pay $200 and get two one month vials for it.

It's been marvelous for me, I was just over the edge into overweight, so no one would prescribe it for me, even though I had a borderline pre-diabetes A1C, and reactive hypoglycemia runs in my family.

My choices were gain another 10 pounds, or find a telehealth that wasn't bothered by not following the FDA rules so strictly. So that's what I did, I got a script from telahealth and now I'm smack dab in the middle of the healthy weight range (-24lb), haven't had a hypoglycemic incident since I started it, and as a bonus my IBS-D went away completely.

I've reduced my dose to the point that I'm at the dose you start out on, and that has let me keep my weight constant without losing more or gaining more. Plan to stay this way for a year and then see about titrating it even more until I'm off of it. I also followed their instructions and only titrated up when I wasn't seeing weightloss, so I never hit the highest dose, and kept my weight loss to .75-1.5 lb/week. Perfectly sustainable.

This has been miraculous, and something that multiple years of consistent dieting hasn't solved. And as a bonus, I can now do my strength training I love without feeling like I have to eat the house on the recovery day

> something that multiple years of consistent dieting hasn't solved

Did you continue to track calories while using the drug?

As somebody who has successfully increased and decreased their body weight over the years (after initially being obese), if you’re able to diet consistently I don’t see why a drug is needed. My guess is whatever diet you were on was consistent for the weight you were at.

I don't find calorie tracking to be very successful. In my mental ecosystem, it penalizes spending calories on healthy foods (why eat that banana if it's just calories), and I don't do so well with a budget, constant go over just slightly.

I had better luck with Weight Watcher with "free" healthy foods and the segmentation between weekly and daily budgets. Then weight watchers tweaked their point values so much that I couldn't stick with it very well, and when I dual tracked points and calories the new WW plan had me at under 1400 cal/day, which isn't sustainable.

> if you’re able to diet consistently I don’t see why a drug is needed

It'd really really really really really really hard to stick to a diet, especially long term. GLP-1s puts eating healthy and good portion sizes all on autopilot. I don't have to plan out how I'm going to manage my hunger and my food noise, it's just auto pilot. I naturally gravitate to eating enough, but not too much, and mostly plants.

I don't think 1400 is unsustainable? it'll lead to losing weight continuously, maybe a half pound a week ish, but that's sustainable for as long as you have weight to lose, isn't it?

This depends on your size and activity level. The last time I dieted, I was losing a pound a week on 2700 calories. 1400 would have been a severe crash diet.

Depends on the person. I'm an active, 6' male with a TDEE of 2600. 1400 calories is absolutely unsustainable. That's nearly 3lb of weightloss per week.

If I was shorter, female and sedentary, sure. But that's not me.

Yes, very likely.

https://en.m.wikipedia.org/wiki/Angus_Barbieri%27s_fast

There's physically sustainable, and then there's mentally sustainable. Based on what I've read about long term fasts, I suspect 0 would be easier than 1400.

Bananas aren't really that healthy. Like you said their nutritional value is mainly just calories.

I'm on Mounjaro for T2D, previously on Ozempic. Besides the weight loss and the blood sugar control it also eliminated my IBS as well. Before the drug certain foods, especially nuts would cause excruciating digestive issues. I can now eat them without worry. It's been amazing.

I 100% know what you mean. I went through a phase where I'd measure out 3 ounces of cashews and have that as a lunch because it was fast, and measuring meant I wasn't taking in too many calories. Always irritated my gut though, anything high in fat did it.

I don't do that on GLP-1s, partially because fat doesn't immediately send me to the bathroom anymore, but also partially because I'm not drawn to high fat meals anymore. Except when thc is involved and then some ice cream might happen.

> And as a bonus, I can now do my strength training I love without feeling like I have to eat the house on the recovery day

I am interested in hearing more about your strength training on this. Do you find that eating less slows your gains and PRs?

I'm sure it does, but I'm not a good enough strength trainer to really notice. I'd say I'm closer to an intermediate lifter than a beginner, but I'm not advanced enough to really notice a difference.

Time in the gym is my biggest blocker today, not what I ate.

Random question about how those compounding pharmacies work. Can you order a higher dose and then just stretch it out by taking the minimum dose to save cost? Do they automatically bill you monthly or can you skip months?

That's kinda what I'm doing. They still send me enough for my max dose reached (1.5mg/wk), but I've titrated down (to 0.5mg/wk) since I'm at the weight I should be at, so I just use a vial for a month, and toss the remainder. They send me two vials at a time.

The vials have a 6 month use by date, though evidence indicates semaglutide is stable for 1 year. I can log into the portal and tell it to skip a month, but since it's a push system, I don't get automatically billed. I actually have to do a checkin and the doc has to approve the refill. So if I have extra vials, I just skip that month's check in.

There's some indication that you don't have to toss the vial after a month, the FDA set those limits assuming it was insulin that is used sometimes more than daily. 4 penetrations of the vial's membrane probably isn't enough to contaminate it, but I'd rather be on the safe side so I don't use the vial for more than a month at a time. My partner is a pharmacist, so that part of the influence for the safer approach.

I think which is usually they start you at a small dose, ramp you up in dosage, then ramp you down when its time to come off, that way you dont suddenly feel much hungrier when it goes away because you've slowly adjusted it.

I am curious, if you don't mind. Have you noticed any other fringe benefits? By that, I mean a reduction in alcohol consumption or other non-food vices? Any cognitive benefits like an increase in focus or concentration?

Any recommendations on telehealth suppliers to contact for that compounded formulation? They're easy to find, but I'm not sure who is trustworthy on this topic.

Mochi / Henry Meds. Mochi is the cheapest.

I just went through the quiz at Mochi and it said I was eligible for their nutrition program but not medication. The FAQ says your BMI has to be over 30 or 27 if you have some other health condition.

Take my advice at your own risk, but nobody is checking your math.

I was 10 pounds or so from qualifying, so I fudged my numbers a bit. Didn't make sense to force myself to gain weight so I could lose weight.

Places like OrderlyMeds doesn't even require a telehealth visit, just the questionnaire and a photo.

Doesn't seem like it will matter. The core patent expires in 2026[0] and the rest expire in 2033. It seems like most will have access to at least some form of the drug affordably within the next five years.

[0]https://www.reddie.co.uk/2024/08/30/the-year-of-ozempic-an-i...

Ozempic is around $100/month in most western European countries, including the country of it's maker, Novo Nordisk.

Sen. Bernie Sanders has been recently calling out this company for charging an order of magnitude more in the US, where it is priced like a cosmetic medical product.

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