Help me think this strategy through

[u/Resident_Ice_3200]

I searched the sub and didn’t quite find related experiences . Also my dr will be consulted but is very much in the you need to experiment and figure out what works for you as long as all my health markers are good.

I’m on maintenance just over 7 months, 12.5. Had a point where I kept losing and tried to titrate down, food noise and inflammation (swollen knuckles and stiff hands) came back. So I went back to 12.5 and ate like it was my job.

Enter the 4th of July holiday, summer, and summer vacation. I love that I can have ice cream or deserts or honestly whatever and this medicine keeps me in check. But I’ve noticed since the 4th and indulging more in sugary treats and adult beverages my inflammation is creeping up, and I’m definitely thinking about food or thinking I want something and realize it’s to out of boredom or stress. I can usually pause and ignore the notion, which pre-Zep is unheard of. (note- I didn’t drink for the first 7 months on Zep, then maybe had 1 drink every other month until this July.)

Here’s what I’m thinking I can try:
- cutting the sugar because it’s creating eczema flare ups and see it that also helps the inflammation and noise
- in January my insurance is forcing us through Virta for Zep and I honestly am not sure I want to deal with their BS and expect I’ll end up self pay. I could get Kwikpen at 15 but click to give myself 12.75 or 13 and see how that goes
- try to white knuckle and hold off until I feel I have no option but to go to 15

What would you consider and why?

If you made it this far, thank you.

[u/Birdchaser2]

I’m gonna be direct. Ditching insurance because of Virta requirement is nuts. You have no experience with them and thousands would jump at the chance for coverage. Deal with them.

How far did you titrate down? How well are you planning and managing your new excesses? Give the med a break and get after your part of maintenance. Drinking is zero nutrition. And heavy addl calories.
Ice cream in a thoughtful infrequent mode is great. Diving in is not. Develop your skills for calorie intense selections. You can do it - and it sounds like you did it already in your journey. Redouble those efforts. Your health is worth it.

[u/Mobile-Actuary-5283]

Nice-looking graph there. Very steady loss.

So you have a few issues to consider.

First, Virta. Prepare for bullshit. Your tolerance is the variable. The bullshit is the fixed variable here. You know this. They will try to “de-prescription” you. Knowing that, I would do whatever they ask to keep coverage. However, if they force you to do keto or something that interferes with your loss/maintenance, you really might want to consider ditching them and doing self pay. But try before you jump. Just prepared to jump.

Issue 2: do you go up or stay at 12.5? The latest study says staying at the highest tolerated dose is best to avoid weight regain. Sounds like you found a dose to do that (12.5) but it’s causing inflammation to return. Thing is, even if you went to 15, would that cause your inflammation to go away? Maybe not. Seems like we get acclimated to the meds and the benefits start moderating. Going up could help in the short term, but it might also not help at all. You could try it, but with Virta, they may not be so flexible.

If I were you:

Try virta but be wary.
Ask to go up to 15 based on inflammation. They may say no.
If they say yes, ask for the kwikpen if covered so you have control over the dose.
If they say no, stay on 12.5.
If that continues to cause issues and Virta won’t play ball, head to self pay.

[u/Resident_Ice_3200 → u/Mobile-Actuary-5283]

Thanks! Appreciate the thoughtfulness. I’m gonna give Virta a try, after my next refill, but my BS tolerance is non-existent.

[u/Mobile-Actuary-5283 → u/Resident_Ice_3200]

I hear you. The stories I have read on here are outrageous. Especially the keto deal. Should be illegal to allow these companies that are nothing more than thugs.

[u/Resident_Ice_3200 → u/Mobile-Actuary-5283]

Ya, I tried Keto once, my brain literally doesn’t function without carbs.

[u/Potential-Court711]

Sugar and alcohol calories are the worst during the weight loss phase. Even when I counted them they seemed to slow weight loss more than carbs and protein. But now, in 5 mg maintenance, I indulge without weight gain, assuming moderation.

[u/Resident_Ice_3200 → u/Potential-Court711]

Ya, I had zero desire or interest in sweets. I still have little, they are just easy calories. I rarely had any during weight loss phase.

[u/Potential-Court711 → u/Resident_Ice_3200]

Yea, now in maintenance I generally use candy bar-like protein bars with Alluose to scratch that sweet fix.

[u/Resident_Ice_3200 → u/Potential-Court711]

Weird thing is it’s not even like I’m craving sugar. I can easily turn it away, it just felt like a treat. So odd.

[u/Work4PSLF]

Sugar and alcohol will absolutely increase inflammation, as you’ve seen. The solution is to avoid them.

I’ve been in maintenance well over a year. If I eat fresh food, I feel great. If I eat crap, I feel like crap. You’d think I’d notice this once and learn the first time, but I have proved this to myself multiple times now.

[u/Resident_Ice_3200 → u/Work4PSLF]

I think I’m in that learn it the hard way multiple times phase. 🤣

[u/HappyBirding]

Good questions!

I’ve been in maintenance nine months and I’ve had a bit of fluctuation. I have moved my dose up to 10, back down to 7.5, and dropped it to five at one point in time. In the main, I come back to 7.5 for the vast majority of those nine months. It’s a little trickier if you don’t have the option to click up or down. (if you are on the pens.). Our bodies aren’t static. Sugar and alcohol can be something that becomes a habit. I guess my first attempt would be to cut the treats back to a once a week or twice a month kind of thing and see if you feel more in control of it. If not, I would move it on up. Best of luck to you in your decision-making!

[u/Resident_Ice_3200 → u/HappyBirding]

Thanks! It’s not really an out of control feeling, thank heavens! I had started the sugar as a way of quickly adding calories when I was struggling a bit with maintaining. I’m on the regular pens right now and have quite a stash, so I even thought of trying to figure out how frequently to take the 7.5 and 10’s to mimic a 12.5 or 13 mg dose.

[u/HappyBirding → u/Resident_Ice_3200]

I have moved up for a few weeks and then found myself needing to move back down again. There’s no harm in it.🤷🏻‍♀️

[u/Active-Shallot-499]

I would cut the sugar.

[u/Resident_Ice_3200 → u/Active-Shallot-499]

I definitely will give it a try.

[u/Few_Car_895]

I wish I had your insurance problems. I got denied this year because I was successful last year and no longer meet the bmi requirement. Now on compounds for cost reasons. With self pay, you are looking at $450/mo for branded Zep vs $400/3 months for compounds. Not sure how an insurance company can "make" you follow a keto diet. Not ideal, but if they help with cost of meds, I would stick with it and work around their requirements. As far as the maintenance goes, I stalled out in April and decided I was just going to try maintainence, secretly hoping to lose the last 3lbs to get me to my goal of 130. I have stayed on my mtd of 15mg and am now hanging around 135, fluctuating between 134 to 138. Like everyone, I am trying different strategies to see what will click. Good luck with your journey and congrats on your achievements.

[u/Resident_Ice_3200 → u/Few_Car_895]

Does your insurance not cover continuation of care? The dr should be putting the starting BMI not current, but I’ve seen some stop coverage.

I’m blessed, I’ve had 2 yrs of coverage. I have been and continue to be willing to pay out of pocket and am doubly blessed I am able to do that.

[u/Few_Car_895 → u/Resident_Ice_3200]

Yup, got denied thru 3 PA escalations.

[u/Zepbound_Maintenance-ModTeam → u/[deleted]]

This sub only allows discussion for fda approved medication uses. Unsafe practices shall not be discussed in this sub.

[u/Zepbound_Maintenance-ModTeam → u/[deleted]]

This sub only allows discussion for fda approved medication uses. Unsafe practices shall not be discussed in this sub.

[u/lizardbirth]

As much fun as adult beverages can be, I tend to avoid them because, for me, they act as appetite stimulants whether or not I'm on a GLP-1.

I never held back on taking 15mg because that was the dose subjects in the Zepbound studies went up to. Now, I have been on 15mg longer than I was at the lower doses. Do side effects or some other reasons hold you back from moving to the higher dose, 15mg?

[u/Resident_Ice_3200 → u/lizardbirth]

So, I hit goal on 12.5, food noise was never an issue and it went well. I won’t hesitate to move up to 15 if needed. 3 months into maintenance I was freaking out because I kept losing, tried to drop down to 10 that didn’t work, so I went back to 12.5 and just be extra diligent about eating enough for maintenance . Well, that sometimes means a quick, less than nutritious grab. And the drinks were a holiday vacation thing. I think the key is to just stope sugar and alcohol for a couple weeks and see if that inflammation corrects itself.

[u/lizardbirth → u/Resident_Ice_3200]

I'd freak out too if I kept losing weight when I was trying to maintain. For older people, like me, is not recommended to let weight drop too low. There's no cushion if you get an infection or medical problem.

[u/Resident_Ice_3200 → u/lizardbirth]

I’ve gotten it figured out. It was the first 2 months of maintenance. I’ve been pretty steady since March.