FlexNP
@rnflex.bsky.social
Jack of all trades nurse practitioner, trail runner photographer, coonhound rescuer, lover of glucagon agonism in the liver, kidney and pancreas, fascinated by obesity medicine, retatrutide fan boy
I've learned more nephrology from this JC than I ever thought I would. It's been practice altering for me and I'm forever grateful for it. Glad to see it's going to continue forward in capable hands!
November 25, 2025 at 2:16 PM
I've learned more nephrology from this JC than I ever thought I would. It's been practice altering for me and I'm forever grateful for it. Glad to see it's going to continue forward in capable hands!
Those little dips at 4, 8, 12 etc are timed up with dose escalations suggesting rapid weight loss from side effects and/or not eating. So yeah I'm very skeptical of this drug. Oh and all the published. data is locked behind a paywall, FWIW, I also consider that questionable.
November 25, 2025 at 1:09 PM
Those little dips at 4, 8, 12 etc are timed up with dose escalations suggesting rapid weight loss from side effects and/or not eating. So yeah I'm very skeptical of this drug. Oh and all the published. data is locked behind a paywall, FWIW, I also consider that questionable.
Maybe this trial will show something different. But I'd argue either they have to start with an even smaller starter dose to even approach tolerability. Then there's the fact that the high doses did show weight loss trends that suggested the weight loss was from side effects
November 25, 2025 at 1:09 PM
Maybe this trial will show something different. But I'd argue either they have to start with an even smaller starter dose to even approach tolerability. Then there's the fact that the high doses did show weight loss trends that suggested the weight loss was from side effects
Yeah caveats apply on small sample size but this is like, really bad. I'll exclude the high dose 60mg, but 20mg dose had 79% nausea, 53% vomiting, 44% constipation 32% diarrhea & 41% headache.
Starting dose 1.25mg was 50% nausea, 30% vomit, 44% headache.
That's honestly just bad.
Starting dose 1.25mg was 50% nausea, 30% vomit, 44% headache.
That's honestly just bad.
November 25, 2025 at 1:09 PM
Yeah caveats apply on small sample size but this is like, really bad. I'll exclude the high dose 60mg, but 20mg dose had 79% nausea, 53% vomiting, 44% constipation 32% diarrhea & 41% headache.
Starting dose 1.25mg was 50% nausea, 30% vomit, 44% headache.
That's honestly just bad.
Starting dose 1.25mg was 50% nausea, 30% vomit, 44% headache.
That's honestly just bad.
That's exactly my question too. The earlier published data suggests the answer is yes to both.
November 25, 2025 at 12:09 PM
That's exactly my question too. The earlier published data suggests the answer is yes to both.
And as always they don't actually put side effect rate on the pressor.
Earlier data on this drug from the summer showed nearly 60% of patients with nausea and 30% of patients with vomiting. I struggle to call that tolerable
Tirzepatide from Lilly is usually about 25% nausea and ~8-10% vomiting
Earlier data on this drug from the summer showed nearly 60% of patients with nausea and 30% of patients with vomiting. I struggle to call that tolerable
Tirzepatide from Lilly is usually about 25% nausea and ~8-10% vomiting
November 25, 2025 at 11:41 AM
And as always they don't actually put side effect rate on the pressor.
Earlier data on this drug from the summer showed nearly 60% of patients with nausea and 30% of patients with vomiting. I struggle to call that tolerable
Tirzepatide from Lilly is usually about 25% nausea and ~8-10% vomiting
Earlier data on this drug from the summer showed nearly 60% of patients with nausea and 30% of patients with vomiting. I struggle to call that tolerable
Tirzepatide from Lilly is usually about 25% nausea and ~8-10% vomiting
Seeing Hiddo Heerspink on the authors list tells me all I need to know about this study(aka it'll be great and I'll learn new things)
November 24, 2025 at 10:59 PM
Seeing Hiddo Heerspink on the authors list tells me all I need to know about this study(aka it'll be great and I'll learn new things)
I plan to hate watch that movie when it's released. Guaranteed shenanigans.
Ditto with whenever Clone Wars season 9, I mean Ahsoka season 2 comes out
Ditto with whenever Clone Wars season 9, I mean Ahsoka season 2 comes out
November 24, 2025 at 10:08 PM
I plan to hate watch that movie when it's released. Guaranteed shenanigans.
Ditto with whenever Clone Wars season 9, I mean Ahsoka season 2 comes out
Ditto with whenever Clone Wars season 9, I mean Ahsoka season 2 comes out
Regardless I appreciate them even trying this moonshot trial in the first place, and as always I love to see a negative result and I hope it leads to more questions and more trials.
November 24, 2025 at 1:24 PM
Regardless I appreciate them even trying this moonshot trial in the first place, and as always I love to see a negative result and I hope it leads to more questions and more trials.
Also also GIP is an insulin sensitizing agent. Adding that could also help downstream in terms of less insulin, better glucose disposal, lower BP etc. Dementia is pleiotropic in how it starts so any drug IMHO needs to be equally pleiotropic in its effects to combat it.
November 24, 2025 at 1:24 PM
Also also GIP is an insulin sensitizing agent. Adding that could also help downstream in terms of less insulin, better glucose disposal, lower BP etc. Dementia is pleiotropic in how it starts so any drug IMHO needs to be equally pleiotropic in its effects to combat it.
Also as I poster, I wanna see raw data, Kaplan Meier curves etc. Also I think if dementia has set in it's too late. As difficult as prevention trials would be, I think that's where we're at with dementia research overall. Also GIP is expressed in the brain so that could help.
November 24, 2025 at 1:24 PM
Also as I poster, I wanna see raw data, Kaplan Meier curves etc. Also I think if dementia has set in it's too late. As difficult as prevention trials would be, I think that's where we're at with dementia research overall. Also GIP is expressed in the brain so that could help.
Was waiting for your post Mike. Definitely need to try again with injectable. Steadier blood level, more receptor engagement etc. Lilly just launched a bunch of trials of a new dual agonist called Brenipatide, they claim it's their peptide "for neuro diseases" so we'll see what they do
November 24, 2025 at 1:24 PM
Was waiting for your post Mike. Definitely need to try again with injectable. Steadier blood level, more receptor engagement etc. Lilly just launched a bunch of trials of a new dual agonist called Brenipatide, they claim it's their peptide "for neuro diseases" so we'll see what they do
Yeah still hope, but we'll see. May need dual agonists? (GIP in tirzepatide is expressed in the brain) Injectable may give steadier blood level(this was oral dose) May need to give BEFORE symptoms set in? A negative trial but it hopefully will lead to others trying new things.
November 24, 2025 at 1:03 PM
Yeah still hope, but we'll see. May need dual agonists? (GIP in tirzepatide is expressed in the brain) Injectable may give steadier blood level(this was oral dose) May need to give BEFORE symptoms set in? A negative trial but it hopefully will lead to others trying new things.
Yes it is! They shoot up the middle of the stem. More photos to come as it progresses.
November 24, 2025 at 12:41 PM
Yes it is! They shoot up the middle of the stem. More photos to come as it progresses.
Right?! Biggest challenge now is encouraging it to fully bloom + hand pollinate the blooms so it fully sets the fruit. More to come in the next few weeks.
November 24, 2025 at 5:18 AM
Right?! Biggest challenge now is encouraging it to fully bloom + hand pollinate the blooms so it fully sets the fruit. More to come in the next few weeks.
All my patients with resistant HTN/aldosteronism are on spiro + whatever else and none have had hyperK admittedly that's only about 12-15 patients but still, I feel like with good management the risk is minimal
November 23, 2025 at 4:53 PM
All my patients with resistant HTN/aldosteronism are on spiro + whatever else and none have had hyperK admittedly that's only about 12-15 patients but still, I feel like with good management the risk is minimal
I'll keep you updated on progress!
November 23, 2025 at 2:49 PM
I'll keep you updated on progress!
I also try and do things that'll increase T naturally. If they're obese I'll try and convince them to try a GLP1 if I can get insurance to cover. The lack of adiposity will usually bump T levels since they'll have less estradiol
November 23, 2025 at 1:02 PM
I also try and do things that'll increase T naturally. If they're obese I'll try and convince them to try a GLP1 if I can get insurance to cover. The lack of adiposity will usually bump T levels since they'll have less estradiol
Yes for sure. Multi factorial for sure but that erythrocytosis is what I'm most worried about. Like I said I'm super cautious about it while also trying to meet the patient where they are. And I won't do T replacement + SGLT2i at the same time.
November 23, 2025 at 1:02 PM
Yes for sure. Multi factorial for sure but that erythrocytosis is what I'm most worried about. Like I said I'm super cautious about it while also trying to meet the patient where they are. And I won't do T replacement + SGLT2i at the same time.
Anyways it's unfortunately not going away. Same thing with people asking for cortisol/insulin/*insert lab test du jour on TikTok*
I try and educate as best I can but it's a constant thing nearly daily whether it's T or cortisol or whatnot.
I try and educate as best I can but it's a constant thing nearly daily whether it's T or cortisol or whatnot.
November 23, 2025 at 11:39 AM
Anyways it's unfortunately not going away. Same thing with people asking for cortisol/insulin/*insert lab test du jour on TikTok*
I try and educate as best I can but it's a constant thing nearly daily whether it's T or cortisol or whatnot.
I try and educate as best I can but it's a constant thing nearly daily whether it's T or cortisol or whatnot.