#1699 On the Pen with David Knapp

Summary

Juicebox Podcast: Type 1 Diabetes – Episode #1699 “On the Pen with David Knapp”

Host: Scott Benner
Guest: Dave Knapp, founder of On the Pen
Date: December 4, 2025

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Main Theme & Purpose

This episode dives into the real-world impact, science, public discourse, and future of GLP-1 medications (like Ozempic, Mounjaro, etc.) from a patient perspective. Dave Knapp shares his personal journey with type 2 diabetes, his advocacy and educational work via On the Pen, and discusses the broader implications of GLP-1s for diabetes, obesity, metabolic illness, and possibly even beyond.

The episode aims to demystify GLP-1s, debunk misconceptions about their use, and emphasize patient narratives over medical or investor perspectives.

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Key Discussion Points & Insights

1. Dave’s Story: Diagnosis and Motivation

• Diagnosis “out of nowhere”: Dave describes being diagnosed with type 2 diabetes in 2021 after a year of extreme fatigue and kidney stones, despite lacking the “classic” buildup and not being a stereotypical over-eater ([05:10], [08:49]).
  • “I didn’t really fit the bill... I wasn’t a candy eater. I wasn’t a sugary soda drinker. Still, I was overweight.” ([08:49] - Dave)
• Family history & urgency: The presence of type 2 throughout his family tree and his father’s early death from heart disease motivated him to seek solutions for longevity and quality of life.
• Obesity is a disease: Dave stresses how metabolic factors, not just diet, contributed to his health. His lifetime of yo-yo dieting (especially Atkins/keto) made things worse, leading to a rapid diabetes diagnosis ([06:50], [08:49]).
• Psychological toll of weight swings: Both he and Scott relate to the cycles of public praise and private shame that accompany yo-yo weight changes ([11:30]).

2. The Patient Perspective & Content Creation

• Why “On the Pen”? Dave saw an information gap: “Everything that's out there is for a doctor... But nothing exists for the patients. And that's where On the Pen came in.” ([00:14], [02:40])
• Transition to advocacy: Initial videos chronicling his own experience quickly shifted to sharing science, clinical trial news, pharma earnings calls, and breaking developments in GLP-1s. He became a go-to source for patient-focused updates ([15:01], [15:53]).
• “Release the Vials” campaign: Dave led a viral movement pushing pharmaceutical companies to improve access and pricing, with tangible results like the release of Zepbound in direct-to-consumer vials ([17:23]).

3. GLP-1 Medications: How They Work, What They Change

• Metabolic mechanisms: GLP-1s (and combo versions like Mounjaro/tirzepatide) mimic hormones in the gut that regulate satiety and insulin release. They address a root problem in people with metabolic disease, where “DPP4” enzymes destroy the body’s natural GLP-1 ([21:59]).
• “The antidote to dysregulation”: Dave sees these meds as direct corrections for the hormonal chaos induced by modern life, possibly worsened by environmental/lifestyle exposures ([25:54]).
  • “These medications...are the antidote to whatever the culprit is...creating a hormonally dysregulated body.” ([25:54] - Dave)
• Side effects, fear, and public debate: The stigma of “cheating” by taking medication is dissected. Real patient benefit—weight loss, normalized A1C, improved energy—takes precedence, even if the mechanism isn’t fully clear ([18:34]–[25:54]).
  • “I don’t know why my body doesn’t work the way it’s supposed to, but it clearly doesn’t. And you add this GLP to me and I’m better off.” ([18:34] - Scott)
• Unexpected improvements: Beyond weight and blood sugar, users report benefits such as reflux and anemia improvements, possibly due to altered gut hormones ([25:54]–[28:29]).

4. Broader Applications & the Future Pipeline

• Inflammation and beyond: There’s mounting evidence that GLP-1s reduce systemic inflammation, potentially helping with autoimmune conditions and even slowing Alzheimer’s progression ([29:17]).
• GLP-1 plus GIP (Tirzepatide): New drug combinations target a broader range of metabolic/immune pathways.
• Muscle loss & “quality weight loss”: Research is increasing on optimizing GLP-1s for fat loss without muscle wasting ([29:17]).
• Heart-protective effects: Even without weight loss, GLP-1s have been shown to lower cardiovascular events by ~20% ([29:17]).
  • "There's something specifically protective in the heart about the GLP-1 molecule." ([29:17] - Dave)
• Historical/scientific anecdotes: The original GLP-1 drugs were derived from Gila monster venom, which mimicked the human hormone ([29:17]).

5. Access, Dosing Innovation, and Compounded Forms

• Early widespread availability: At first, Mounjaro was available via coupon for $25/month to anyone, sparking huge demand and shortages ([17:23]).
• Micro-dosing and compounding: The injectable pen doses aren’t ideal for all; some need much less, but current products don’t cater to that. Compounding pharmacies (legally allowed during shortages) are making custom doses and even oral forms ([48:17]).
  • “You have now millions of people who have gotten benefits...of getting on an individualized dose of these medications and finding that 2.5 mg of tirzepatide is the starting dose commercially. But I...took 10% of that a week and got similar benefits.” ([48:17] - Dave)
• Weekly vs. more frequent dosing: There's no science to support weekly being "ideal," but rather a convenience for pharma, payers, and pharmacy logistics ([55:33]).
• Oral and sublingual forms: For those needle-averse, compounded oral versions are emerging, though with less regulatory oversight ([53:52]).

6. Barriers, Biases, and the Need for Patient Advocacy

• Medical resistance and outdated ideas: Some providers still default to old objections (e.g., “muscle wasting") without nuanced understanding ([28:29]).
  • “That guy doesn’t understand this functionally at all and he’s out there giving advice.” ([28:29] - Scott)
• Complexity in Type 1 diabetes: The conversation shifts to off-label use among Type 1s, who sometimes see insulin needs plummet (sometimes almost to zero) on GLP-1s, but this is not universally true, and carries certain health risks ([37:22]–[64:15]).
• Insulin resistance & functional application: For some, especially those with co-existing insulin resistance, a tailored approach (microdosing, off-label use) can be transformative ([51:08]–[53:52]).
• Caveats about safety: Strong warnings not to attempt self-treatment or stop insulin without careful management ([62:55]–[64:15]).

7. Social Consequences, Economics, and Hope

• Impact on US healthcare: Dave predicts GLP-1s could “save the healthcare system” if made accessible and affordable ([41:33]).
  • “Almost everyone who lives in this country should be considering the idea of talking to their doctor about whether...these medications could benefit them in some way.” ([44:16] - Dave)
• Upcoming price reductions: Recent policy moves will bring prices down substantially, especially for Medicare and Medicaid recipients. Cash-pay prices expected to drop to $250/month ([60:05]).
• Societal mindset shifts: Scott highlights decades of “weight loss at any cost” culture morphing into new criticisms of “cheating” with meds, underlining human inconsistency ([37:00]).
• Big Pharma’s role: Skepticism, hope, and the business realities of pharma are discussed openly ([58:40]).

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Notable Quotes & Memorable Moments

• On the patient mindset:

  • Scott: “I tell people I have a GLP deficiency. That’s what I tell them, because it shuts them up.” [28:42]

• On transformative results:

  • Scott: “My brother...lost, like, 70 pounds. His A1C’s dropped way down...and still, he was with a doctor the other day who said...‘I wouldn’t be using this GLP medication.’ ...That guy doesn’t understand this functionally at all and he’s out there giving advice.” [28:29]

• On stigma & public response:

  • Scott: “I’m not a person who’s like, put everybody on medication. I’m really not. But, like, now that I've seen what it’s done for me, I'm not down with just yelling like, ‘you’re cheating if you’re doing this thing.’” [18:34]

• On med innovation and compounding:

  • Dave: “Clinical trials are designed for regulators and they’re designed for investors. They’re not really designed for patients...We're starting to see a shift in that.” [48:17]

• On expanding indications and hope:

  • Dave: “I really believe these medicines...have the power to save our healthcare system in the United States.” [41:33]

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Important Timestamps

• [05:10] Dave’s diagnosis story
• [08:49] Metabolic effects, yo-yo dieting, and family consequences
• [15:01] Genesis of On the Pen; learning the science as a patient
• [17:23] Viral “Release the Vials” campaign and Mounjaro coupon heyday
• [21:59] GLP-1 mechanisms, DPP4, and metabolic dysfunction explained
• [25:54] The “antidote” theory and broad relevance beyond weight loss
• [28:29] Provider misconceptions and frustration
• [29:17] Inflammation, autoimmune, heart protection – GLP-1’s next frontier
• [37:00] Society’s double standard on weight loss solutions
• [41:33] Policy change and hope for access; “saving the healthcare system”
• [48:17] Compound pharmacies and personalized GLP-1 dosing
• [51:08] Microdosing, functional dosing intervals, and personal experiences
• [53:52] Oral/sublingual tirzepatide, injection avoidance, and practical hurdles
• [60:05] Upcoming Medicare/Medicaid/cash price changes for GLP-1s
• [62:55] Warnings on insulin reduction and the need for careful management

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Flow, Tone, and Closing Thoughts

The conversation is candid, pragmatic, and passionate, reflecting both men’s lived experience and broad empathy for anyone facing metabolic illness. Dave brings focused, research-informed insights; Scott draws out the everyday frustrations, triumphs, and deeply human consequences behind the clinical headlines.

Both stress that patients must drive the conversation with their healthcare teams and push for individualized solutions—even as science, pharma, and policy slowly catch up.

Closing Reflections

“Everything that I share...I just want people to have better conversations with their doctor. And if your doctor doesn’t know about it, ask them to know about it or find somebody that does.” — Dave ([65:15])

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Summary Table: Key GLP-1 Topics

| Topic | Insights from Episode | Timestamps | |---|---|---| | Patient experience | Yo-yo dieting, weight stigma, lack of patient-facing resources | 05:10, 08:49, 15:01 | | GLP-1 mechanism | Mimics gut hormones, corrects dysregulation, multi-system benefits | 21:59, 25:54, 29:17 | | Stigma & “cheating” | Public narrative lags behind science; real-world results matter | 18:34, 28:29, 37:00 | | Dosing flexibility | Microdosing, compounding, personalized intervals vs. “packaged” clinical doses | 48:17, 51:08, 53:52 | | Access & policy | Early coupon access, viral patient advocacy, coming price drops | 17:23, 41:33, 60:05 | | Type 1 diabetes | Potential but unpredictable effects, insulin reduction cases, risks of mismanagement | 37:22, 51:08, 62:55 |

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For Listeners

This episode challenges popular assumptions around diabetes care, obesity, and the impact of modern medicine—using lived experience and emerging evidence to push for a more empathetic, flexible, and science-forward approach. If GLP-1 meds are new to you or you’re considering them, this is a must-listen—approachable, comprehensive, and grounded in what real patients want and need.

Reminder: Do not make changes to your medical regimen based on podcasts—bring questions and ideas from this episode to your medical provider for individualized advice.

Transcript

[A]

Friends, we're all back together for the next episode of the Juice Box Podcast. Welcome.

[B]

I'm Dave Knapp. I'm the founder of the on the Pen podcast. It is a weekly podcast all about the news around these new medications that I'm sure that you've heard about. The Ozempics of the world, the Manjaros of the world. Maybe you've heard it as the fat shot from the Oval Office, but however you've heard of it, you've heard of it by now. These medications are taking the world by storm and I, as a type 2 diabetic diagnosed in the fall of 2021, ended up on these medications after trying everything in my own power and my own might, and even looking down the barrel of a metabolic surgery that would have rearranged my anatomy. And my doctor introduced me to these medications and I thought, you know what? There's no one that is giving this information from the patient perspective. Everything that's out there is for a doctor. It's for an investor. But nothing exists for the patients and that's where on the Pen came in. So Scott, I'm super excited to be sharing with you a little bit today about what we talk about over at on the Pen. My favorite subject, GLP1 medications.

[A]

Nothing you hear on the Juice Box Podcast should be considered advice, medical or otherwise. Always consult a physician before making any changes to your health care plan. Foreign.

Just in time for the holidays, Cozy Earth is back with a great offer for Juice Box Podcast listeners. That's right, Black Friday has come [e-mail] and right now you can stack my code Juicebox on top of their site wide sale, giving you up to 40% off in savings. These deals will not last, so start your holiday shopping today by going to cozyearth.com and using the offer code Juicebox at checkout. The podcast is also sponsored today by Omnipod5. Omnipod5 is a tube free automated insulin delivery system that's been shown to significantly improve A1C and time and range for people with type 1 diabetes when they've switched from daily injections. Learn more and get started today@ omnipod.com juicebox at my link. You can get a free starter kit right now. Terms and conditions apply and eligibility may vary. Full terms and conditions can be found@ omnipod.com juicebox today's episode is also sponsored by usmed usmed.com juicebox or call 888-721-1514. Get your supplies the same way we do from us Med.

[B]

I'm Dave Knapp. I'm the founder of the on the Pen podcast. It is a weekly podcast all about the news around these new medications that I'm sure that you've heard about. The Ozempics of the world, the Manjaros of the world. Maybe you've heard it as the fat shot, too, from the Oval Office, but however you've heard of it, you've heard of it by now. These medications are taking the world by storm. And I, as a type 2 diabetic, diagnosed in the fall of 2021, ended up on these medications after trying everything in my own power and my own might, and even looking down the barrel of a metabolic surgery that would have rearranged my anatomy. And my doctor introduced me to these medications, and I thought, you know what? There's no one that is giving this information from the patient perspective. Everything that's out there is for a doctor. It's for an investor. But nothing exists for the patients, and that's where on the Pen came in. So, Scott, I'm super excited to be sharing with you a little bit today about what we talk about over at on the Pen. My favorite subject, GLP1 medications.

[A]

Dave, I can't thank you enough for doing this. Also, I'm super amused. Not amused, but, like, kind of delighted watching you because you're accustomed to being on video and I'm not. I'm watching, watching you be effusive and move around and smile and everything, like a maniac. And I realized that normally what would happen here is you and I wouldn't be looking at each other. I would spin 180 degrees, put my feet up over here, and bring this microphone over, and I would chat like that. Yeah, yeah. So it's really awesome. Well, listen, man, I. I appreciate you doing this. I wanted to do it for a couple of reasons, but mainly I'm most interested maybe in a guy like you, who's not a doctor, right. Who does not have a medical background, who just found himself flung into this, who started making content and then realized that it was a business. And because of that, I think that you're steeped in it in a different way. You don't get an opportunity often to talk to people who are paying a crazy amount of attention to one focused idea. And when I realized that you're out there making, like, you know, news clips about, like, hey, there's a pill coming. There's this, like, that stuff we talk about here. Like, oh, I heard there's a pill Coming. I heard it's going to be as effective as the injectable, maybe. But I heard that from a doctor I had on, like, six months ago, you know.

[B]

Yeah.

[A]

Who just said to me, like, it's coming in an oral form. And, like. And it's kind of how he put it. And I was like, what do you mean? He goes, it's coming fast. I want to know what that means, but I don't have the time to dig through it. I'm digging through type 1 diabetes and. And this podcast. So I'm. I'm here to pick your brain and. And everything, but I do want to get a little background first. So you said you're. You have type 2?

[B]

Yeah. So I was diagnosed with type 2 diabetes back in the fall of 2021. This was after a year of experiencing what I called, like, narcolepsy level sleepiness. I just knew something was wrong. I thought maybe it. And I went into my doctor's office and I said, I knew that something's wrong. What's going on? And I was having kidney stones and just kind of a host of, I don't know, ailments that I just knew something was wrong. I said to my wife, I said, either I have cancer, I'm dying, or I have some sort of chronic disease. The way I'm feeling is not normal. And I went in, and the doctor checked my blood sugar. He goes, the way that you're feeling is because you're type 2 diabetic. And I said, what, like, record scratch? Like, hey, I didn't have the typical, like, trajectory to type 2 diabetes that you hear about where your A1C is creeping up, man. Stay off the Twizzlers, whatever. You know, I went from 0 to 100. It had never sort of crept up on me. Never had any warning other than the fact that I have been overweight my entire adult life. And we have this thing, this type 2 diabetes in my family. I sort of skeptical that the coronavirus maybe kicked some people who were metabolically predisposed, based upon the virus going through your body, that it had a metabolic effect on some people. But that's definitely a conversation for a different day. But, yeah, I was diagnosed with type 2 back in the fall of 2021. And it was definitely a journey of, I want to try everything in my own, within my own willpower to sort of will this disease away.

[A]

How would you describe, like, you know, I'm so. I'm sure you've probably shared this a million times. I always end up apologizing to people first. But like, what was your height and weight at your diagnosis and how would you describe your heat, your eating habits at that time?

[B]

Yeah, so my, my height is 510 and my weight at that time was 319 pounds. So we're talking a bit about a BMI in the upper 40s, which is very, very high, morbidly obese. What I was eating. It's kind of hard to explain for somebody who's never lived with the disease of obesity. Right. Because obesity is a disease, it has profound metabolic effect that make it very difficult to, to get your weight down. But when we talk about what I was eating, well, I had actually yo yoed on the ketogenic diet from the time I was about 18, which is when I started really putting on noticeable weight. Like I, even from an adolescent I could tell I was a little chubby, you know, carried a little bit around my midsection that friends or family members didn't. But then it wasn't until high school that I really started to see that there was kind of a separation in the way that my body was handling the foods I ate, etc. I discovered this diet that everybody was kind of doing back then. It's kind of like the GLP1 of today. It was the Atkins diet, it was the low carb diet. And so I started this journey where I, I would get on the low carb diet and it would work really, really well for me for about six months. Like, I think the first time I went on it, I was, I had got up to 220 pounds. And the first time I went on it, within about six months, I think I was down to 170. But you know, I had the metabolism of an 18, 19 year old kid, not a 40 year old man. But I sort of chased that because I could maintain it for about six months out of the year. And then for the other six months I'd fall off the wagon hard. So the way I kind of describe it when I tell this story, Scott, is I'd be up or I would be down £40 and then I'd be up £50 and I'd be down £40 and up £50. And there were different variations of that. Yo yo. But every time on the upswing, it was up. And so first of all, just imagine what that does to your body metabolically like that swing back and forth and back and forth and back and forth for essentially like 17, 18 years.

[A]

Wow.

[B]

And so like that year when I was diagnosed with diabetes, it wasn't really that much different than any other year. I had just come off of six months of being very strict with my ketogenic diet, which is actually why I thought that I was experiencing kidney stones, because I had had that happen before, but, you know, I was minding my P's and Q's now. I've never been a real sugar consumer like you may think of somebody who becomes diabetic at that age. I wasn't a candy eater. Still not a candy eater. Wasn't a sugary soda drinker, although I've always been a diet soda drinker, you know, so I wasn't kind of like, in my mind, even though I was overweight, I didn't really fit the bill. For somebody who was going to go in at 36 and get a type 2 diabetes diagnosis. I mean, you might. The average person might go, well, you're a BMI of 45. What do you expect? Well, I've been doing this podcast now for three years. I've met people who are 6 or 700 pounds that aren't type 2 diabetic. You know, it was just. It was weird for me. It was. It was definitely a scary thing to get that diagnosis young because, you know, the implications in terms of what that does to somebody's expected lifespan. And so the only thing I could think about, Scott, was my kids. Like, what am I going to do? Like, how. How am I going to whip this thing into shape so that I can be around with for my kids? Because my dad, own dad, died of a massive heart attack at 54.

[A]

Did he?

[B]

Yeah.

[A]

So no kidding. My story is not much different than yours. To be perfectly honest, I never thought of myself as an incredibly poor eater. I do look back now, in hindsight, and realize I grew up pretty broke, and we ate some trashy food that I wouldn't eat now. But at the same time, it wasn't a massive amount. It wasn't like, constantly sugar or constantly this. And as an adult, a young adult, my wife and I did the same thing. We were like, oh, we'll try the Atkins diet. And it did work. Like, I was like, I lost, like, 40 pounds. I was like, oh, magic. Until one day you just wake up and you're like, I can't eat another chicken wing. I've run out of things to eat.

[B]

You know, I've eaten enough stacks of hamburgers. It's just, give me a bun.

[A]

I think when you realize you're in trouble is when you're like, you're out for the day, driving around and you're hungry, and you end up in like, a drive through at a fast food restaurant, like, pulling the patties off, and you're realizing, I don't even think this is meat. You're like, well, at least there's no carbs in it.

[B]

Right?

[A]

And. Yeah. So it just didn't work for me. And then I slowly began. I never had a type 2 diagnosis, and I don't think I was ever actually near one. Luckily though, like, I just think it's random because I was. I'm five nine, and I was 236 pounds when I started using GLP. You know, I know my body at that point. Like, I can't imagine what you were dealing with over £300 at that height. Like, it must have been really just difficult on you and your body. And even psychologically, I. I imagine it was not pleasant.

[B]

Yeah, the.

[A]

The.

[B]

Definitely The. The upswing and the downswing. And then you get used to this kind of cycle of positive reinforcement from the people around you, because when you're on the downswing, people like, you look great. And then you're kind of like, oh, you know, what are these people thinking of me when I'm on the upswing? And then you. You start to worry about all the people you're letting down and. Yeah.

[A]

Oh, man. When. The first time I went into. Where did it happen to me first? Maybe it was a friend I bumped into. Then it was a post office that I only go to yearly. Like, there post office. I used to mail my taxes and like, so I don't see this lady very often, but it's a small post office. And I walked in and she made eye contact. She recognized it was me. Then she looked horrified. Then she got quiet, and then she didn't know what to say. And I realized, because I had been through it now twice before, I put my hand out, I went, I don't have cancer. She goes, oh, thank God. She's like, you lost so much weight. I just thought maybe you had cancer. And I was like, I know. And I said, I'm. It's okay that you feel that way. You're like maybe the fourth person that this has happened to me with.

[B]

Yeah.

[A]

And that, to your point, what in the hell did I look like before? It's like.

Right, that, like, standing in front of her at a reasonable weight, she was like, oh, this one's on his way out. So anyway, it is. It's been very transformational for me, but I kind of want to, like, jump ahead a little bit.

[B]

Yeah.

[A]

Because you start making your thing. You started on YouTube, I guess, right? Yeah. Yeah.

[B]

Yep.

[A]

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[B]

Yeah, I mean, I was really, really wanting to learn more about these medications and how they worked and what they did in your body, and I just, I wasn't eager to take a drug, to be honest with you, which I think has really set me up great to lead this community, because I think there's a lot of people who are reticent to take a drug, especially for obesity. But I wanted to learn everything there was to learn about these medications. And so when I went to YouTube or like any good millennial is, that's where we learn things, right? So when I went there, there was a lot of really amazing stories about, hey, I lost £100 with Ozempic. There is nobody saying this is how it worked. And these were the side effects that I had. And this is how they discovered these medications. Like, all the things that I would want to know about these medications didn't exist there. And so while it started as like a, hey, this is me taking my first shot.

[A]

Look at me go, woo.

[B]

It very quickly developed into. As I was reading clinical trial data, as I. And I started following the Eli Lilly earnings calls almost immediately, too. And I started sharing because I was like, well, you know, you talked earlier about the pills, right? Yeah, I've actually been talking about these pills now for two and a half years because they were being talked about on these earnings calls where they were saying, you know, hey, we're. We're in, you know, phase one development for, like, Eli Lilly has this one called or Forglipron, which is coming out in a couple of months here, you know, and so we were talking about or Forglipron two years ago, because I started to see, not only are these medications that appear to be changing so many people's lives, the ones that are here, there's medicines down the pike that are really going to help people who have advanced metabolic disease. And I've been somebody who's kind of struggled to lose a ton of weight on these. Although I'm right where you would expect a diabetic to be based upon the diabetic clinical trials for weight loss, you know, there's hope down the pike, too, for people who are more seriously sick. And so really just wanted to start sharing that side of it, which is really sort of what exploded the work that I'm doing. And then one of the crazy things, and we may see some more of this in the coming months with the expansion of these drugs to Medicare. But when I first started these medications and people were learning about them, it was the heyday of GLP1, because you could get Mounjaro without a type 2 diagnosis for $25 a month. In those early days, they had a.

[A]

Coupon really, how Long ago was that.

[B]

This was 2022. At the end of 2022, around the time I first started, you could literally download a coupon and it didn't matter if you had it covered on your insurance. It didn't matter if you had diabetes. You could just take that to the pharmacy and get Manjaro for 25 bucks. And then of course, they cut that off like a sieve. Once the word started to get out about how powerful tirzepatide, the active ingredient in Manjaro is at getting people's weight down, they had to pull back on the savings card because it became so popular so fast. With, mind you, zero advertising, it was all word of mouth. These drugs went into shortage. And so very quickly, you being in the type one world, like, I know these companies manufacture insulin all day in little single dose or multi dose vials. Why can't they just do that? And so I actually started a social media campaign that went viral and ended up getting covered by some of the major news outlets called Release the Vials, which ultimately, through conversations with Lilly, I actually had conversations with their CEO there. They ended up releasing zepbound in single dose vials and going direct to consumers with the cash pay price. And they were kind of the first ones to do that, even before this most favored nation stuff with the administration.

[A]

Yeah, that's really interesting, the things that I've seen it help people with. I really hope that we can get to a point like, I'm not, Listen, I'm not confused. I'll actually. Let me share this with you and I'll go backwards 15 years. My wife works in drug safety, so she does kind of like the behind the scenes pharma stuff where she makes sure that, you know, reporting's done correctly and that, you know, things are being done the way they're supposed to. That kind of stuff. Right. She came home to me 15 years ago and she goes, scott, one day people are going to take an injection and they're going to lose weight. And I was like, what do you mean? She goes, I saw some data. And she's like, we're working on this type two drug. And she was at Novo. But man, like, you should see the data on people losing weight. I really think one day people are gonna take a shot and lose weight. Three years ago, now, maybe, coming up on three years ago, I started doing it. I was like, oh my God, this is the thing Kelly was talking about. And just like that, it, it started happening. Now, of course, before, before that they. But they had other JLPs, right? Like rebelsis and there were like pills and stuff like that didn't really work quite as well. But now I'm seeing it help people in like, such varied ways. I mean, no kidding. All the different ways that you see it impacting lives, that I can see it impacting my life. You know, we talk so much about, like, trying to fix things for people, like they just ate better. You know, there's no factory farming. If. And you start piling up all these if, if, if, if, and you realize, like, we're not getting any of this straight. Right? Right. People keep suffering and they keep gaining weight and they keep being ill and they keep, you know, just not having the lives they can. I'm not a person who's like, put everybody on medication. I'm really not. But like, now that I've seen what it's done for me, I'm not down with just yelling like, you're cheating if you're doing this thing. Like, right. Like, I don't know why my body doesn't work the way it's supposed to, but it clearly doesn't. And you add this GLP to me and I'm better off. I don't like when people say to me like, are you gonna have to use it for the rest of your life? I'm like, whatever. I was like, because the other way I was gonna have a heart attack for sure. So, you know, whatever. And now you're talking about that pill. That pill might end up being more of a maintenance thing for someone like me. Right. I used to hate ordering my daughter's diabetes supplies. I never had a good experience and it was frustrating. But it hasn't been that way for a while. Actually for about three years now because that's how long we've been using us med usmed.com juicebox or call 888-721-1514. USMED is the number one distributor for Freestyle Libre systems nationwide. They are the number one specialty distributor for Omnipod Dash, the number one fastest growing tandem distributor nationwide. The number one rated distributor in Dexcom customer satisfaction surveys, they have served over 1 million people with diabetes since 1996. And they always provide 90 days worth of supplies and fast and free shipping. USMED carries everything from insulin pumps and diabetes testing supplies to the latest CGMs like the Libre 3 and Dexcom G7. They accept Medicare nationwide and over 800 private insurers. Find out why USMED has an A rating with a better business [e-mail] juicebox or just call them at 888-721.

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[B]

It sounds like the pills may be a great option for maintenance or people with, let's say, less severe metabolic disease. They're not going to be as potent to start with. They're not going to be as potent as the injectables. They kind of tout that these high doses of Rebel. So high dose Rubelsis, which is the oral semaglutide from Novo Nordisk for diabetes, is currently with the FDA for approval in high doses for what they're calling oral Wegovy, which is their injectable weight loss medication, their popular one. They are touting that those get up there. But still, I think most people are going to tolerate the shots once weekly shots better. But yeah, for maintenance. There's a whole lot of hosts and applications for these oral versions. And maintenance is definitely one big thing that they're looking at. But one of the things I want to touch on based upon kind of what you were just saying there, because I think you hit on something that I think is what needs to be understood when we talk about the discourse, the public discourse around GLP1 medications and this idea of taking a drug forever or cheating or taking the easy way out. I just want to kind of reframe that conversation for people and just kind of build on what you were saying. There is. We can all agree that there are likely contributing factors, confounding factors in this country specifically, that contribute to metabolic disease that are beyond just your own personal agency. Right. We don't know how what they're spraying on our crops affects our gut microbiome. We don't know really how much or how little the prescription drugs that we're taking, we're learning more, are screwing with our gut microbiome. We don't know how, how much, for instance, alcohol screws with our gut microbiome. What they're finding right now, we're going to get dated later this week, probably maybe early next week from Novo Nordisk. That's likely to show that rybelsis slows the progression of Alzheimer's. Why is that? Because they have found this gut brain connection that they're just now starting to unwind. But these GLP1 medications, all they are, are manufactured peptides that in Inovo's case, they actually make it from yeast. They're peptides that mimic hormones that are naturally made in your gut. But there's byproducts of gut bacteria there's byproducts of adipose tissue called DPP4 that literally is run amok in the guts of people who are diabetic and obese. They've done studies on this. It's this DPP4 enzyme that destroys GLP1, native GLP1 or endogenous GLP1 GIP, these incretin hormones. Right. And so a lot of what they're learning is this unique connection between the gut and the brain in terms of signaling satiety, signaling insulin release, and these hormones are integral to that. And you can imagine what's happening in the guts of people who have had their good bacteria destroyed or have high adiposity, where the environment there is working against your own native GLP1. That's one of the reasons that these medications work so well, is prior to GLP1 medications, there was a whole other class of type 2 diabetes medications called, called DPP4 inhibitors. So that culprit that attacks your endogenous GLP1, your endogenous, the Ozempic that your body makes naturally, essentially, they had a drug that tried to block that DPP4 so that your native GLP1 could shine through and do its job, signal satiety, signal insulin release, stimulate the beta cells in your pancreas to release insulin more efficiently, et cetera. And so these medications are literally. And this is sort of one of the more controversial things that I. I'll say is that I believe they are the antidote to whatever the culprit is. And it's probably many factors that are creating a hormonally dysregulated body for people who are metabolically sick.

[A]

Yeah. I don't know another way to explain it to you other than my body just works better now. And I mean, from, like, I used to have terrible reflux. Gone. Had it like most of my life, it's just gone. People will say, oh, it's because you lost weight. It was gone before I lost the weight. I used to be anemic all the time. Like, I'm telling you, Dave, like I would. I was in the last handful of years of my life. I was getting two and sometimes three iron infusions a year so that my ferritin wouldn't drop off the planet. And I. I couldn't. Like, I couldn't stand some days. Like, I was so anemic. I haven't been anemic in almost three years. What happened? My expectation is my digestion changed. My body is now picking up nutrients differently, and I'm not lacking in Iron anymore. That's a simple thing. That. To your bigger point about, like, I'm sure there's a million things happening that are impacting us that we don't know about. I wasn't going to unwind all that in my lifetime, right? And even if I could, what am I going to go live in a yurt? Like, you know what I mean? Like, grow a carrot in my own. Like, I don't know. What was I going to do? Exactly, right? You're like, like, I got a house, I got kids, I got to live my life. This is the world I'm in right now. If the world's doing this to me, then. And there's an anecdote, you know, quote unquote, to that, I'm in. Like, I'm in to take it. Because I wasn't going to live as long. I wasn't. My days were much less pleasant. I was never rested. The reflux gave me other issues that I'm hoping don't turn into bigger problems. Right? Like, there's a lot going on. And now all of a sudden, man, I'm full of energy. I got nothing but, like, clarity in my mind. Like, you know, I've worn a CGM a couple times. My glucose doesn't move. Like, you almost can't will it to move. Yeah. It's been so beneficial. And then we were able to, you know, like, I think I told you before we started talking, I used it. My wife used it. Awesome results. My brother has type two. I'm adopted, so not my brother by blood, but my brother, type 2 diabetes. He's lost, like 70 pounds. His A1C's dropped way down, like two points down. And still he was with a doctor the other day who said to him, if I was you, I wouldn't be using this GLP medication. Awesome, man. Thanks. How come? Muscle. He kind of waved his hand at him. Muscle wasting. And I was like, Brian, I'm like, GLPs don't magically make muscle go away. I'm like, they can give you, like, put you in situations that can cause that, and there's ways to counteract that. I was like, he's like, don't worry, I'm not gonna stop taking this. And I was like, oh, okay. But, like, it's amazing that, like, in 2025 now there's still a doctor who's just like, waving their hand, randomly saying muscle out loud and telling a guy whose A1C went from the sevens to the fives and lost 70 pounds. Hey, you probably shouldn't be taking that. So that guy doesn't understand this functionally at all.

[B]

No.

[A]

And he's out there giving advice. So in a world where there are doctors giving advice that they don't know about, that, like you said, something's getting sprayed on something, I'm eating it. Something in my stomach that medicine barely understands at this point.

[B]

Right.

[A]

Is getting dysregulated. Who cares, man? You know, I tell people I have a GLP deficiency. That's what I tell them, because it shuts them up. And. And I don't really know what else to say.

[B]

I love it.

[A]

So when you see it back into this world a little bit with type 1, I know this isn't, you know, what your focus is on, but I feel like you might have a lot of information that's gonna help otherwise. So if you don't have an answer, just say, scott, I don't know. This isn't my lane. But when people talk about GLPs reducing inflammation, for example, do you understand or does anyone understand how that happens? Or do we just know it does happen?

[B]

I believe they're trying to untangle, untangle all of that and why it works too, especially on that inflammation. I know that with tirzepatide, they're doing some studies that are looking at the C reactive protein, which is one of the biggest markers for inflammation in the body. They're seeing reduction in all of those. And in fact, the next sort of advent of where GLP1s can take us, because honestly, they're going to have the weight problem solved in the next 10 years. There's not going to be. There's going to be something for everyone, I firmly believe out there that's going to get you to your goal weight. More than likely. The question now becomes a, how do we improve the quality of weight? To the doctor's point of muscle wasting, which that happens when you lose weight dramatically. I mean, these medications, the ones that are on the market currently, essentially help bring down your weight by reducing the amount of energy you put into your body. And so if you're reducing the energy you put in, that's how you get weight loss. But unfortunately, with weight loss, you're losing a certain amount of muscle mass. So the quality of weight loss is what they're looking at in the future pipeline of these medications. But they're also looking at other indications because there's people like you who walk around and say, you know, actually, this is how it helped me. I, you know, I have rheumatoid arthritis. And all of a sudden I don't need my rheumatoid arthritis medication, or I have, you know, irritable bowel syndrome. And it's cleared up, like all these things that really at the heart of it, you know, are inflammatory drivers in the body. And then so they're looking at that and they're looking at combining these medications with other treatments for some of those autoimmune diseases. So autoimmune diseases are kind of the next frontier of where they're looking specifically with tirzepatide, because one of the things we call these medications GLP1 medications. But at the end of the day, everything up until Tirzepatide, which is Mounjaro and Zepbound was just a GLP Manjaro. Tirzepatide, the active ingredient is actually two hormones in the family of, they're called incretins. They're nutrient stimulated hormones. In other words, you eat food and your body releases these. When your gut starts to sense the nutrients, it releases these hormones naturally. GIP is another prominent one, is actually, I think they discovered GIP before they discovered GLP1, but it's a combination of both. And it's mostly a GIP medicine with just a little bit of GLP1 where lycozempic semaglutide is just straight GLP1, not super important. But for the purposes of what you're talking about with inflammation, what they're finding is that GIP has a profound effect on inflammation in maybe some ways that GLP1 doesn't. These molecules have protective properties in the body that they're just starting to understand. And these properties are independent of weight loss. So, for example, one of my favorite pieces of data on semaglutide, which is, you know, becoming kind of like an old school drug. And when you talk about Ozempic, they're like, hey, have you heard of Mounjaro? It's even better. But when you look at GLP1 receptor agonism in the biggest study for semaglutide, which was called the select trial in cardiac stuff, right? So it was looking at people with heart failure, and then it was looking at major cardiovascular outcomes. In this trial, there was some tens of thousands of people were enrolled in this trial and it lasted for four years. And what they found was it didn't matter what dose of semaglutide you took, and it didn't matter how much or if you lost weight. You experienced a 20% reduction in major cardiovascular events. A 20% reduction in deaths associated with major cardiovascular events. And so what they thought in that trial, or one of the things they were extrapolating, was there's something specifically protective in the heart about the GLP1 molecule. And so they, they spun off researchers, spun off a smaller study that just came out a couple weeks ago. And this is just in rodents. But what they did is they took the first GLP one that ever came out. It's called Byetta. Really cool story about how they discovered that one, because in the 1960s, and maybe it was the 70s, they discovered this thing called the incretin effect. We called these the incretin drugs. Right? They discovered that, hey, when you inject somebody with glucose and when you feed somebody with glucose, there's actually a quicker metabolic response when you feed it to people and they ingest it through their stomach and their gut rather than injecting it. And they called this the incretin effect. That's because these hormones, like I said, are nutrient stimulated, but they lack the ability to create duplicate peptides of ones that were already in your body. And so through research, these doctors were looking at the venom of Gila monsters because they found that it lowered blood sugar. And then they isolated a peptide in the venom of a Gila monster and found that it nearly mimicked exactly human GLP1, except instead of lasting for just a few minutes in the body and getting destroyed by DPP4, they could make it last for four hours. Right? So that's, that's how they came up with the first GLP1. So this study with the rodents actually looked at exenatide, which was the first GLP one. They basically gave it to these rodents and induced a heart attack. And there were two subsets of these rodents. There were the kind that got the GLP one, and then they were the kind that actually got a version of the actually blocks the GLP1 receptors. And so there's these cells on the hearts, they're called parasites. They found that the rodent population that got GLP1 receptor agonism injected into them along with the heart attack, it opened up the blood flow to the part of the heart that otherwise would have been damaged permanently. And conversely, in the rodents that didn't, that got the GLP1 blocker, that part of the heart stayed forever damaged. It never got the blood restored to it. So long way around saying that there's something that's protective about these molecules themselves, independent of the weight loss. And to our earlier points, there's something within our ecosystem here that has caused Dysregulation in these hormones. And I believe that's why you're seeing people that get on these medications, even ones that. That don't have a tremendous amount of weight to lose, and maybe even none. And they're just microdosing because they've read the studies and they want to get some of these benefits that they're saying, my psoriasis is going away, My arthritis is getting better. I mean, fill in the blank. There's so many things.

[A]

I haven't had an eczema flare in years.

[B]

Wow.

[A]

I used to have it every. It just occurred to me as you're saying it, like, this time of year, as it starts to get colder, I would get these red patches on the inside of my thighs and sometimes in the back of my arms, and I haven't had them in years. No. No kidding. Yeah. Yeah, yeah, yeah. I. I just heard you say I'm going to live forever. Dave, thank you. I appreciate.

[B]

Yeah, that is. That's what I was getting at.

[A]

I only had plans for the next 20 years. I'll figure something else out. It's interesting. You're younger than me, but. And it's really. Let me say, before I say this, it's really interesting talking to you. What did you do before this? Professionally?

[B]

I sold traffic signals.

[A]

That's amazing, man.

[B]

It's a natural transition.

[A]

I mean, I just. I love that when you talking about it. I'd be thrilled if my doctor understood this as well as you did. Like, you know what I mean? Like, it's so cool I brought this up in the beginning, but it so kind of mimics me a little bit. Like, I'm not perfect. I don't know everything, but I try learning all the time. And what this job allows me to do is it allows me to be steeped in it constantly. Yeah. And I think we need more people who just spend a lot of time in an idea absorbing it, you know? So very cool that you're doing this and that you can speak about it so well.

[B]

Appreciate that.

[A]

But what I was saying is, like, when I was growing up, I've said this before on here all the time. Like, the biggest problem people had was their weight. Like, oh, my God, if medicine would just figure out weight. If they would just figure out weight, like, the society just wanted it, they begged for it, and then we gave it to them. And people like, you're a cheater. And I'm like, oh, my God. People are fickle. Fascinating. But okay. We get past that. The other thing I've Been hearing weigh.

[B]

Down, but not that way.

[A]

Not like that. Do it the way you're supposed to.

[B]

Like, there's also, like, what drives me insane is there's also an assumption that people are just taking the medicine and they're not also going to the gym. They're not also watching what they eat. Like, these medicines don't just magically work for everyone. Most of the people. We have 160,000 people in the OTP community across the platforms. There are very few people, if any, that I've met that are like, I just let the drug do the work. They're all in the gym also.

[A]

I want to say, if that's what they did, like, God, like, it's their life. Like, you know what I mean? Like, if they're better off, let them be better off. My point about the weight is we talked all. That's all society talks about. We got to help people with their weight. And the other thing I hear people talking about my whole life is inflammation. Inflammation. Such a problem. It's such a problem. We can't. And I believe it, by the way. Like, you can't take an NSAID every five minutes, but, you know, you've had issues. You take an Advil, it reduces the inflammation in your body. Like, oh, this is better now, right? Some people have it more chronically. You know, I watch my daughter, who obviously has, you know, an autoimmune issue, but she also has, like, she has hypothyroidism. She has type 1 diabetes. She might have PCOS. And I'm telling you that when she's on this medication, things are better for her. Like, they. They just are. And I have a giant community of people who are reporting back very similar, you know, returns, and they're a little blocked because, of course, in the studies, they found that, you know, people with type 1 diabetes were going to DKA sometimes. And it's. But it's really. I think it turns out to be just because they eat less and they're using less insulin. And then they ended up in DKA because they Type one and they need insulin and they weren't using enough. They didn't have their settings changed. Because with my daughter, I've never had that problem when she's using the glp, you just have to titrate back or. Basil. You'd be surprised how much of her. How wide her settings can swing without a GLP. It could take one unit of insulin to move my daughter's blood sugar 34 points. But on a micro dose of GLP, one unit of insulin will move her blood sugar 95 points. That's insane, right? Like, she. She's in. Involved in some sort of insulin resistance or inflammation in her body. I don't even care. Like, I genuinely don't even care what you call it. It doesn't matter to me. Like, I see. I see what happens. Then I talk to other people who are having other, you know, issues, and then everybody that comes on here, you know, you didn't start this way, but if you came on and you had type one, I'd say, hey, do you have any other autoimmune issues? How about in your family? And people sit down, they go, oh, I got celiac. You know, there's vitiligo. I have a friend of mine's got eczema. There's a lot of. A lot of allergies. Hypothyroidism, like, it runs through their family lines. And I just imagine and believe that these people are experiencing a higher level of inflammation. Like, just generally speaking, like, so if. If this leads to, I don't know, 10 years from now, them coming out with something else, it just lowers people's inflammation a little bit. I think that. I think this is awesome. Like, what was I seeing the other day? My brother got. My brother was sick, I told you, and he's got a virus. It's just not passing quickly. And so they put him on a steroid pack. But by the way, like, he had to beat him over the head to even get the steroids. Like, that won't help you, like, you know, be arguing with him. He finally gets a steroid pack. He's on the steroids for a couple hours. He calls me, goes, scott, I feel so much better. Like, all the pain's going away, blah, blah, blah. And I said to him, did you know that in the 40s when steroids became, you know, when they figured them out and they started using them, for a split second, they thought they had literally fixed all the problems mankind had. And until you realize what happens if you stay on these steroid packs too long and you get rebound, and it's not great, right? There's a lot of problems if you stay on them too long. But still, when you're on them in that short window, I don't know if you've ever experienced this. I feel like Superman when I'm on a steroid pack. I'm almost excited when I'm sick, I'm like, oh, my God, they're gonna give me a steroid back next week of my Life's gonna be awesome, man. Imagine that. Like, imagine if this stuff leads to not just people losing weight, people's A1Cs dropping out of a diabetic range, type ones, hopefully needing less insulin, people with autoimmune having less impacts from their autoimmune issues. And what if they could get rid of like some of this inflammation for people? Absolutely.

[B]

I, I, one of the things that I've been saying for a couple years too that has been, you know, one of the more controversial things in terms of just the feedback that I get from people is I really believe these medications, these, these incretin nutrient stimulated hormones, however you want to couch them, we'll call them GLP1s because that's what everybody else does. But I believe they have the power to save our healthcare system in the United States. And when this new administration came in, there was a lot of people who were very nervous within our community about how they were going to treat GLP1s because there was a lot of like anti ozempic talk before they came in. And I was just like hoping beyond hope that once they got in and really looked at the data objectively and maybe, you know, took their political hats off and put on their, their data hats, that they would see what we have been seeing in this community for so long that, that these medications really have the power at the right price to transform the health in this country. Because again, you know, we have the, these drugs have been out for a long time. That's another like misnomer that people have is that they're brand new, they're not the Diana's been around for 20 years. And so we have lots of years of data with these drugs on the market that we can go back and comb. I don't know how much your audience gets in the weeds on like clinical trial data, but they have these, these studies called post marketing studies. So you have phase one to make sure that, you know, animals don't die when you inject them with something. And then they put them in phase two, like small human trials, and then phase three is the last one before it gets approved, the bigger trials to figure out dosing and et cetera. Well, they have these phase four trials once something comes to market where they're able to just aggregate data, right? All these patient records and say, here's these 20 million people that are on GLP1s. What they're seeing in almost every single major medicine journal has showed lower CRP, lower IL6, lower TNF alpha. What these are doing to Fatty liver disease and metabolic health directly by mechanisms of reducing liver fat and even reversing fibrosis stages. What they're showing is that can you imagine the downstream effects, Even just the 20% reduction of major cardiovascular events with semaglutide and the reduction in hospitalization. So I don't think it can be understated what just happened last week, or maybe it's a couple weeks now with the administration getting the pharmaceutical drug companies to the table and saying, hey, like let's work on volume here. Every almost my own personal held belief that almost everyone who lives in this country should be considering the idea of talking to their doctor about whether a medica one of these medications could benefit them in some way.

[A]

Dave, I gotta tell you, I think for a minute people thought like that Lily and and Nova were sending money over here because I was like, let's spray it out of airplanes. You're seeing like so many people. You know what I realized when I talk to people over and over again, this is interesting, right? Is that I don't think people think they're eating poorly. Like, I think when you really like, it's, it's easy to step back and like say, oh, like poo poo. People don't take good care of themselves or like, you know, you act like those bro podcasters, like, who's gonna row the boat? All that to stuff. Like, you know what I mean? Like, it's easy to say work harder, do better. Like, you know, the last thing I need is a guy making $20 million a year tell me I got a cold plunge in the morning. I'm like, I'm at work. Like I don't, you know, like, thanks, big help man. Thank you.

[B]

Right, right.

[A]

When I look at people, I don't think people are out there doing a poor job on purpose. And I think, moreover, I don't think they know they are if they are around nutrition, around other health issues. I talk to people all the time. They're not like, oh, you know, I know I'm making bad decisions all day long. You know, I have extra money to buy better food, but I just decided to buy crack with it instead. Like, like people are doing their best in the system that they have in the life that they have. No one wants to be unhealthy. Like, I find like calling people, there's a thing they do in type one is if you don't have the outcomes that the doctors want, they tell you that you're non compliant. Yeah, we told you what to do when you're not complying. I talk to people all the time. I don't find people to be non compliant at all. They're trying as hard as they can with their understanding and their tools and their finances and their insurance and all the other things that they have. And their time, by the way, Dave, because they get up in the morning and they got kids and they got a vacuum and they got to go to school and they got to go to work and like, nobody's got time to sit and talk about this. Like, we do. Like, right? Like, you know, so telling people, do better, and then when they don't do better, go, well, you must not be trying hard enough, I guess you deserve to die. What a bizarre thing to do to people. And we're out here saying there's not enough food for people. We can't do small farming because we have to make food for so many people. You know how much less food I eat now? I'm fine. You know what I mean? Like, I don't eat, like, in bulk the way I used to. You can't even. I mean, you ever go out. My wife and I go out together sometimes. We order a dish and we split it and we still. And we still don't fit it, and we're nice and full and healthy and everything's okay. My point is that if there's all this inflammation and all this autoimmune and all this weight and all the other things that are impacting people, I want those people to open their minds up more. Like, this is what I, you know, at the pharma level, at the doctor's level, like, look, listen to what people are saying and look at your patients and say, could I be helping them with this? Right? Like, do I want the world to be fixed another way? Like, should Monsanto not spray whatever they spray on my wheat? Like, yeah, awesome. I don't know how to impact that, you know, but on my side, I know what's working for me. And honestly, I don't even understand if. Trust me, I'm making this up right now. I wish they'd mix it into the insulin. I heard you talking.

[B]

They are, by the way. Yeah. Like Novo Nordisk and Eli Lilly, I think both have clinical trials combining GLP with insulin.

[A]

Dave, you don't know me well. I'm gonna cry. It's awesome, man. My daughter has a needle phobia. She's a lot of trouble taking the GLPs. I sit in here and I stare at it and I wonder, like, I would never. I want to be clear, I wouldn't do this, but, like, there's this little part of me that wants to just squirt some of the GLP into the insulin because it'll go into her pump and help her. And I know, I, trust me, don't do that. That's not what I'm saying. What I'm saying is, is that, like, I just. I'm like, God, why can't they just do that a little bit? Like, look what it does for her. Like, how much less insulin would she need? Because also, the dosing is all screwy.

[B]

Yeah.

[A]

Probably you can explain it to me better. But, like, the dosing, the way the pens are set up, right, like, it's just. It's what testing what told them would work. Right. If they spread it over the population, like, most people will have some success, but there are plenty of people who do two and a half, and they go, oh, it made me nauseous. I couldn't keep doing it. But one and a quarter might have been perfect for them. I'm saying, like, open up the dosing to people.

[B]

Oh, yeah, yeah.

[A]

Let them make their own decisions about how much they get.

[B]

Anyway, I think one of the cool things that has happened unintentionally, like an unintentional consequence of those really early shortages of these medications, was that it opened up the world of compound medications and personalized medication. I don't know how much you get into the compound world over here, but really, essentially a quick flyover is in this country, when a drug comes to market that's not a biologic if the manufacturer can't keep up. We have this system called compound pharmacies 503A and 503B compound pharmacies that can basically step in and make and sell to doctors who prescribe them to patients, drugs that are in shortage. So you sort of bypass the intellectual property at that point. One of the interesting things that's happened is it spurred this whole telehealth world where Doctors are prescribing GLPs on a personal level, and they're actually prescribing microdose versions of these drugs because, again, we're never going to get a trial. Clinical trials are designed by the pharmaceutical companies. They want you taking more of their drugs. So first of all, just know that about a clinical trial is that it's funded by the pharmaceutical companies that run them. But second of all, when you look at what they're trying to accomplish in a clinical trial, especially for obesity and diabetes, is they're in Diabetes, they're looking at A1C, type 2 diabetes, they're looking at A1C reduction and in obesity. And I'm talking about this because this is my world, though Type 1 world isn't the world that I live in. In obesity, they're just trying to slam you with as much medicine as possible to balance side effects and get the maximum amount of weight, because that's what Wall street wants. And so really, clinical trials are designed less. They're designed for regulators and they're designed for investors. They're not really designed for patients. And we're starting to see a shift in that. But because the shortages led to this world of compounding, you have now millions of people who have gotten benefits of the benefits of getting on a individualized dose of these medications and finding that 2.5 milligrams of tirzepatide is the starting dose commercially. But I, I just being a figurative random person, took 10% of that a week and got similar benefits, you know. And so we're seeing in real, in the real world this sort of situation play out where we're starting to see like a massive sort of non traditional clinical trial going on showing that these, these peptides specifically have benefit for a lot of people outside of the normal dosing that we got from the clinical trials, including, but not limited to microdosing.

[A]

The way I see with my daughter and with myself, so I first learned it with myself, is that I'm sure most people who use these drugs will tell you this. I'm on zepbound. I do 12 and a half, right? Okay. I shoot it usually on Saturdays or Sundays. By Thursday I start thinking about like, ah, maybe I should order a pizza tonight. Like, right. Like on Wednesday, I'd never think that on Friday I actually could get a pizza. I can only eat a slice of it or so. But like the whole process, like, I can feel it let go in my brain a little bit. Like, I don't know another way to put this unless you've been on these. Like, the best way I can explain it to people is that my brain doesn't tell me I'm hungry and my stomach doesn't tell me I'm hungry. Like if I don't, I need to remind myself to eat. It was tough to do in the beginning, by the way. I used to, I set alarms in the beginning, like, have breakfast now eat this, make sure you have protein, like that kind of stuff. But then I said, okay, so obviously the life of this drug in my body, it wanes it's not completely gone, but it wanes. Even I could see, like, weight loss, first four days. And it maybe drifts back a little bit in the last three days and everything. So I'm looking at my daughter, and again, the issue is with her not wanting to do the injections. But, you know, we started with a 2.5-manjaro pen for her. Because, by the way, my daughter has a dual diagnosis. She has a type 1 diagnosis and an insulin resistance diagnosis. So she gets Manjaro through her insurance. Two and a half's too much. She'll lose too much weight. She's never hungry. It's not. It's way too much for her. But you can't argue with the fact that her A1C is like 5.2 and her blood sugar won't spike over, like 150, like, no matter what she's eating. Right. Even if she can. You know, she talked herself into eating through not being hungry. And so one day I'm like, this is not sustainable. And so I learned about microdosing, bought some vials on Amazon, injected the pen into the vial. I basically. I didn't know how much was in there, so I drew it all out and I. And I converted it to insulin units, basically because I had insulin needles. And I'm like, all right, well, there's this many units in here. The whole of it is too much. I'll try giving her half, and then every week I'd try giving you like, an insulin unit less and trying to look for a sweet spot where she could get a weeks worth of coverage on our insulin resistance and our insulin usage. But the truth is it should probably be shot even less than that, like, every four or five days because of the life of it. Yeah, it's a struggle, man. You should see, like, it's. I know it's a weird thing to say that a type one is like, you know, has like a visceral fear of injections, but she does, Right?

[B]

That's unfortunate. Yeah.

[A]

And that's tough. Yeah. And so. But I know if she didn't, I know if somebody else was here and we could mess around with it a little bit. But I know there's an amount she should get. And I know we could figure out the pacing of it and it would be much less, maybe more frequently, and I think it would change your life. Yeah. Like, seriously.

[B]

So two things that I would just posit to you as something to muse on over the next week. The first thing is that with tirzepatide, if that's the molecule that she wants to stick with. There are compounding pharmacies who do make it in oral form that said they're not FDA approved, they're not FDA inspected for, you know, like it's, it's compounded medication. So it, it by nature is outside of the FDA system, but it's still a prescription you get from a doctor and take under doctor supervision. There are sublinguals. There are. And so that these compound pharmacies have found a way to protect these peptides and make them oral, orally, bioavailable. But the question is, we don't know how much because they've never gone through clinical trials. And frankly, the pharmaceutical companies pay billions of dollars for technology to make peptides orally bioavailable. But if you can set that aside and know that that is an option that you could explore and talk to her doctor about. The second is when we talk about tirzepatide specifically on the injectable side. The interesting thing about tirzepatide is the half life on tirzepatite is like five days on average, where semaglutide is seven. And so it's pretty normal for those effects to sort of fall off a cliff towards the end of that week when you're getting a couple days away from injection day. And I firmly believe to build on our earlier conversation about clinical trials, they chose seven days because seven days is easier for people to manage, not because it's ideal for the patient. And again, it's easier for the insurance companies, it's easier for the pharmacies, it's easier for the manufacturers to just. Four pens, one month, once a week. Yeah, but at the end of the day, it's probably not what's best for the patient every time.

[A]

Do you know there's an actual like human problem in that too, which is that when people feel better, one of the first things they do is stop doing the thing that helps them feel better.

[B]

100. Yeah, right.

[A]

That's very common. So, right. You're in a terrible conundrum. You'd start taking this injection, three months later, your whole life's different. Then, you know, you get to Saturday and you're like, you don't even remember. You don't feel well and you don't think about the pen. It's in the back of the refrigerator. And yeah, there, I mean, there's different issues there. So do you think that for. In my daughter's example, as I explained it, she'd be better off on Ozempic.

[B]

I don't know because the Mol Tirzepatide again is, is more GIP than it is GLP1. It's, it's, it's a different hormone that it's focused on although it's two, it's more so a gip. And so it's going to be a different experience on Semaglutide Ozempic than it is on Manjaro. And so I don't know the answer to that but I do know that she may experience if she gets similar effects on the blood sugar control side from semaglutide that theoretically it should last longer because the half life of the drug is longer. But it does seem to me like when you look at the studies I can't remember what they actually are in type 2 diabetics. So you can look at the surpass study for Manjaro and you can look at the, can't remember what the one for Wegovy or for Ozempic was off the top of my head but you can look at them and show, it'll show you that Manjaro is better at controlling a 1C and I think it's because of that GIP mechanism. But you may get a steadier peak and trough of the concentration of the drug with Ozempic just because of that seven day half life.

[A]

That sounds like maybe if I wait I can get Humalog with GLP and GIP in it.

[B]

I can't remember, I can look it up here but Insulin Novo Nordisk. It's Insulin Icodec. Does that sound right? Insulin ICON deck. There's, there's one that they're, that they're looking at for with Novo Nordisk and I, I don't know, it's, it's the Insulin Iodeck is a, is a once weekly. Right? Just like, like is. Oh, okay, right. So it's, it's supposed to give you know, a smoother experience for somebody taking it and less sort of variability in the peaks and troughs of that. And so they're looking at combining it with GLP1.

[A]

Listen, hopefully it gets there for people who could be helped. I'll say this too. I've seen people on type ones who use it and it doesn't touch their insulin needs at all. And that always makes me wonder are these people who have type 1 diabetes but don't have other metabolic issues.

[B]

I wonder too if it just really comes down to what level of beta cell function you have, if any, because in some really small clinical studies They've shown clinically that they can give type 1 diabetics GLP1 semaglutide. And they, they come, like 90% of them come off all of their insulin at the right doses. But this was a small trial, and you have to have some level of beta cell function in order to, to have that happen, because you have to be able to rely on your own insulin.

[A]

Yeah. It makes me think about this researcher I, I interviewed like, 15 years ago, who was, she was like, I sometimes feel like the beta cells aren't dead. They're, like, so inflamed that they can't work is how she put it. And I'm wondering, like, I mean, that's a very, like, layman's, like, remembrance of her conversation. But, like, I do wonder, like, somewhere in there there's a lot of things to be learned. Like, hopefully those companies are digging in labs on all of this stuff, right? Because. Oh, yeah, you know, I hear people all the time say, like, well, they'll put themselves out of business. I'm like, the truth is, if you took care of all the problems people had and that's what put you out of business, I think you'd have enough money to make it. There's that kind of cynical, like, they want to have some of the money forever. I think if you got all the money right now, they'd probably be happy to, you know, turn that money into a bank and stop being a pharma company and, and, and, and on your way. I also don't want them to go out of business. Obviously. It's a, it's a weird balance. Right. Like, to your point, like, you know, they're out there, they're doing this work, and they're also trying to maximize their profits. It's hard to argue that. I mean, I understand what they're doing. We don't want them, not out there. And, you know, you also want them making money and hiring good people. And it would also be nice if this stuff was affordable for people who were really, you know, in the trenches and needed it every day. I mean, honestly, you know, $500. It's down to 500amonth now for people, and people are like, oh, it's cheaper. I'm like, my God, that's still so expensive. Yeah, yeah.

[B]

But the, the good news is that with the addition of GLPs for obesity to Medicare, Medicare recipients are going to pay 50 bucks a month for it. The government arbitrated their price down to 250, and so Medicare patients will get it for a $50 copay, Medicaid is going to follow because they're going to get the same pricing. So most states will follow, and those folks won't even pay a copay. And then for the rest of the people, the deal with the most favored nations is that you'll be able to cash pay these things over the next 24 months to get these down. Both WeGovy, which is the obesity version of Oz Epic, and Zepbound, the obesity version of Manjaro, you'll be able to get those both for 250 bucks within the next 24 months. And the price just came down on the cash pay.

[A]

Well, then I'm thinking everybody should buy stocking companies that make clothes like bras and underwear and stuff that. Oh, yeah, because you have any idea how many times I've donated my clothes and had to rebuy stuff over the last two years? Like, it's.

[B]

Oh, yeah, yeah. It's a huge. There's a huge closed swap market that goes on within the community of people who use these drugs.

[A]

That's brilliant. Well, so, Dave, I. Thank you. I've taken up a lot of your time. I wondered, do you see it, I don't know, an avenue here where you and I could get back together and do this every once in a while?

[B]

I would. I mean, I, I. This is my world. I love talking about this stuff. I love talking to other people who are passionate about health. And I, frankly, I just like talking to other lay people that, you know, like you said, steeped in this stuff, immersed in it every day. We've learned about this stuff because we're passionate and we have skin in the game ourselves. And I just think it's. It helps a lot of people to hear from. From other people like us. So I would love to do more of this if you're willing to.

[A]

We're gonna have to find an overlap with my audience's needs and your skill set and, and your. And your knowledge and. And find a way to do. We can do that. We'll do that offline for sure.

[B]

Yeah. There's a lot of people in the on the pen community who are type one and they're pining for more information, just like you are on this stuff, because everything is so focused on type 2 and obesity. And they're saying, wait, you know, my husband went on Manjaro, and he's a type one, and he's off his insulin, or he was able to greatly reduce his insulin. What are they. What are the trials saying? And there's just been very little in terms of looking at GLP1s with type 1. But I think that's because it's such a spectrum of disease in terms of how severe it is for people. So it's hard to put together probably clinical trials for it.

[A]

Well, yeah, also, and it's scary to say out loud too, because you don't want to give people the idea that if they just took enough of this, their type 1 diabetes would stop needing insulin. Because I. That's not going to be the case for a great many people and obviously they would be impacted very poorly with their health for not taking their insulin. You don't want that to be confused and you also don't want people not to look into it.

[B]

Right.

[A]

There's something there. Like I think I told you before we started, I've had a gentleman on who's Type one and he's definitely type one. People are like, well, maybe he wasn't, but he's definitely type 1. He has auto antibodies. He's been using insulin for years. They put him on Manjaro or Zepbound for weight and he literally came off his insulin. Now he doesn't expect that's going to be forever, but it is for now. And no one knows why it's not. Because GLP cures type 1 diabetes, which is how late like simple black and white thinking ends up getting. You know, people get very reactive when you say stuff like that. But I've also had, you know, 15 year old girl, her mom came on to talk about how her insulin needs went down. She was using one unit of basil a day. She had to go off her pump. She's an injected unit of basil a day. She's back on a pump now, but it lasted her two years. Like two years where she wasn't taking a ton of insulin. Somebody needs to be asking, like, what happened there? Like, you know what I mean? Like, what was the functionality there? Like what? That's the stuff I want people looking into. I don't think that if you just gave a type 1 enough GLP they'd stop needing insulin. Like, no one's saying that. Like, I think you can hear there's a bigger conversation here about other impacts on your life. And even if it just, man, if it just makes something better for you, I just, I think it's really valuable to hear about more of it.

[B]

Right.

[A]

You know, and then there's the functional side of it, like actually implementing it. You can start shooting this into people who don't really understand their insulin. Like, you know, we've talked a lot today about, like, it would be nice if people could dose this themselves. Insulin's a thing that type ones dose themselves all day long. And trust me, Dave, between me and you, they're not great at it. The doctors aren't great at giving you the right doses, and you're. And people aren't great at making the adjustments they need to make for a lot of good reasons, and just flopping them on a GLP and reducing their needs right away, they might struggle to get their insulin, like, readjusted, which will cause them a lot of problems. And some of those problems could be, you know, a dangerous hypoglycemia, hyperglycemia, and obviously you don't want that too. And then you get into that more functional human problem of, like, how do you put this into practice? And, I mean, I don't have any answers for that, but for the people who can figure out how to do it on their own, and you feel like you're up to the task, I'd look into this if I was you.

[B]

So 100.

[A]

All right.

[B]

Everything I. I think you probably would echo this. Everything that I share as a LA person, hear about this stuff. We just want people to have better conversations with their doctor. And so that's always my hope. Whenever I share any of the information that I've learned is just, you heard about a study, you heard about a drug, you heard about something that might help. Go talk to your doctor about it, and if your doctor doesn't know about it, ask them to know about it or find somebody that does.

[A]

Dave, I don't think there's any doubt that shows like yours and shows like mine. I think they push innovation forward because people can find out about things sooner. Like, you know, 40 years ago, like, you'd be like, you know, do you have Pat? She lives, like, three doors down. She's taking the glp. That would take years for that to spread through the neighborhood, but it wouldn't help anybody, right? Like, you can yell it out loud now and have 10,000, 20,000, a million people hear it. And. And you're not trying to make them do something. You're trying to make them go home and quietly go, go. Huh? I wonder, what should I be asking for myself on this? You know, And I think that's why this podcast works for people with Type one, too, because I don't see a lot of difference between what we're talking about here and what ends up happening to people when they're diagnosed with type 1 or type 2 diabetes. Honestly, like he gets sent home with like, here, take Metformin. You'll be fine. That's it? That's what you're gonna tell me? So anyway, I appreciate this very much. Let me say goodbye to you and thank you very much for your time.

[B]

Thank you Scott. Appreciate it.

[A]

This episode of the Juice Box Podcast is sponsored by Omnipod5. Omnipod5 is a tube free automated insulin delivery system that's been shown to significantly improve A1C and time and range for people with type 1 diabetes when they've switched from daily injections. Learn more and get started today at@ omnipod.com juicebox at my link you can get a free starter kit right now. Terms and conditions apply. Eligibility may vary. Full terms and conditions can be found@ omnipod.com juicebox Today's episode is also sponsored by usmed.com juicebox or call 888-721-1514. Get started today and get your supplies from usmed. A huge thanks thanks to Cozy Earth for sponsoring this episode. Don't forget Black Friday has come [e-mail] right now you can stack my code Juice Box on top of their site wide sale. This is going to give you up to 40 off in savings and these deals are definitely not going to last. I'm talking about sheets, towels, clothing, everything they have. Get that holiday shopping going right now today. Do it. Do it, do it. Cozyearth.com use the offer code Juice Box Thanks. Thank you so much for listening. I'll be back very soon with another episode of the Juice Box Podcast. If you're not already subscribed or following the podcast in your favorite audio app like Spotify or Apple Podcasts, please do that now. Seriously, just to hit, follow or subscribe will really help the show. If you go a little further in Apple Podcasts and set it up so that it downloads all new episodes, I'll be your best friend. And if you leave a five star review, oh, I'll probably send you a Christmas card. Would you like a Christmas card?

Hey, I'm dropping in to tell you about a small change being made to the Juice Cruise 2026 schedule. This adjustment was made by Celebrity Cruise Lines, not by me. Anyway, we're still going out on the Celebrity beyond cruise ship, which is awesome. Check out the walkthrough [e-mail] JuiceCruise the ship is awesome. Still a seven night cruise. It still leaves out of Miami on June 21st. Actually, most of this is the same. We leave Miami June 21, head to CocoCay in the Bahamas, but then we're going to San Juan, Puerto rico instead of St. Thomas after that. Basteria. I think I'm saying that wrong. St. Kitts and Nevis. This place is gorgeous. Google it. I mean, you're probably gonna have to go to my link to get the correct spelling because my pronunciation is so bad. But once you get the St. Kitts and you Google it, you're gonna look and see a photo that says to you, oh, I want to go there. Come meet other people living with type 1 diabetes, from caregivers to children to adults. Last year we had a hundred people on our cruise and it was fabulous. You can see pictures again at my link juiceboxpodcast.com juicecruise you can see those pictures from last year there. The link also gives you an opportunity to register for the cruise or to contact Suzanne from Cruise Planners. She takes care of all the logistics. I'm just excited that I might see you there. It's a beautiful event for families, for singles, a wonderful opportunity to meet people, swap stories, make friendships and learn. If you're new to type 1 diabetes, begin with the Bold Beginnings series from the podcast. Don't take my word for it. Listen to what reviewers have said. Bold Beginnings is the best first step. I learned more in those episodes than anywhere else. This is when everything finally clicked. People say it takes the stress out of the early days and replaces it with clarity. They tell me this should come with the diagnosis packet that I got at the hospital. And after they listen, they recommend it to everyone who's struggling. It's straightforward, practical, and easy to listen to. Bold Beginnings gives you the basics in a way that actually makes sense. The Juice Box podcast is edited by wrong way recording wrongwayrecording.com if you'd like your podcast to sound as good as mine, check out [e-mail].