My Beginning: From Itch to Diagnosis
Last summer, my skin began to itch. I did not have a rash, or an insect bite, which meant the cause remained a mystery and lotion didn't help me for long. I scratched my legs, my ankles, my feet, my scalp, my neck. Sometimes I found blood on my sheets after I scratched myself while falling asleep. In fact, I slept most of the time. I went to bed when I finished work in the evenings and stayed there most weekends. If I did go out in the heat I wanted to vomit, and I could no longer keep up with my friends or my husband on walks. Instead I sat indoors and watched a spider build a web in my bedroom. I mostly thought about eating, because I had never been so hungry in my life, but nothing I ate ever satisfied me. The hunger was so commanding, so pitiless, that I wondered if it could be supernatural.
I learned early that autumn that I needed medicine, not an exorcism. An endocrinologist diagnosed type 2 diabetes. High blood sugar had dried out my skin, making me itch; it had stolen my energy, sickened me in the heat, and caused my relentless hunger. I started a high dose of metformin along with a GLP-1, Mounjaro, which I injected near my belly button once a week.
Drug Debate: The Gap Between Perception and Reality
To me, Mounjaro is medicine. To others, it is more symbolic. I've read that GLP-1's are a magic elixir — or a shortcut, even a symptom of cultural decline. Not long after my diagnosis, I saw photos of Ariana Grande and Cynthia Erivo on the red carpet, collarbones jutting; posters said they must be on GLP-1's. Meghan Trainor took Mounjaro and Lizzo tried Ozempic and low-rise jeans were popular again. It is a strange moment to watch myself shrink and a stranger moment to be ill.
Mounjaro, and drugs like it, have become another way to moralize. The GLP-1 discourse is so frenzied and detached from reality that it complicates my life and, lately, infuriates me. When I first started taking the drug, I was reluctant to mention it to anyone; I didn't want to be judged, or turned into an object lesson, while I was trying not to die.
Real Challenges: Side Effects and Healthcare System Obstacles
Diabetes is complicated enough by itself, and the American health-care system is one more obstacle to good health. In my case, Cigna refused to cover Mounjaro at the lowest dose, which forced me to increase it on corporate timing, not my own or my doctor's. I hoped it would be all right. The endocrinologist's nurse told me I might have gastrointestinal symptoms, but the drug was good for my blood sugar and the side effects usually got easier over time. She was right, for a while. My blood sugar fell, I no longer itched, and the hunger left me alone at last.
Then my progress seemed to stall. Six weeks into treatment, I'd lost over 20 pounds and I was still too sick to leave the house. While strangers debated GLP-1's on the internet, I slept most of the time and my brain deserted me all over again. In November, I was startled to realize I felt almost no emotion at all. I had diarrhea every day, so I drank electrolytes. I ate ginger chews, which came in a bag with an anthropomorphic root on it that the company called Mr. Knobs. I tried gummy multivitamins — no sugar — and psyllium-husk capsules and ate when I could, which wasn't often. My blood sugar kept getting too low. To correct it, I bought glucose gel in various flavors, each more disgusting than the last.
Emergency Room Visit: A Warning of Severe Dehydration
In December, I woke up, took a sip of water, and started vomiting on my bed and the floor, which frightened my cat and brought my husband running. He took me to the emergency room. The vomit was mostly water, which I had been trying to drink in large quantities, along with the food I'd eaten 12 hours earlier and still hadn't been able to digest. Mounjaro slows gastric emptying, suppresses the appetite, and makes the body more receptive to insulin, which is why it's such a powerful treatment for type 2 diabetes. Alas for me, it can also lead to a host of second-order side effects. I spent the night under observation in the emergency department for severe dehydration and low hemoglobin. After four bags of fluid, the physician told me that she'd seen a lot of patients who'd gotten sick on Mounjaro.
“You might not be able to tolerate it,” she told me. Later I asked for an appointment with my endocrinologist and instead got one with the nurse, who spoke to me for ten minutes, took me off metformin, and told me to eat fiber and drink water. She said that if that didn't help, there was always Ozempic. I lost nearly 30 pounds in two months.
Without metformin, which causes its own side effects, my diarrhea turned into chronic constipation. I ordered Miralax and glycerin suppositories. My hair started to fall out, my nails kept breaking off, and my bowels cramped every time I ate. That didn't seem good or normal, but I wasn't sure, and I never heard much from the endocrinologist, so I scrolled the Mounjaro sub-Reddit instead.
People showed off dramatic transformations, and I was surprised by how often they left their faces unblurred. They wanted us to see them as if we alone could understand the way they'd changed. Sometimes a user would ask for advice, or sympathy, and they didn't always get it. “Mounjaro put me in the hospital,” someone posted. “Sorry your going through it but as with anything we put into our body there is a chance for complications as others have stated make sure you read!! ” read a reply from a poster who said they took fen-phen in the '90s despite all the deaths. “It's always someone else's fault,” another said. “I read the guide front to back twice before I started. ” Mounjaro can be so effective for blood-sugar control and weight management that some users seemed willing to try anything to stay on the drug. I clicked on “Constipation problems solved!”
Every day, the poster takes one teaspoon of Sunfiber Partially Hydrolyzed Guar Gum, dissolved in an eight- to 12-ounce glass of room-temperature water, plus a cap of Miralax in warm water. They drink eight to 12 ounces of water every 90 minutes and consume a tablespoon of olive oil with each meal. At night, they finish everything off with 200 to 300 milligrams of magnesium glycinate. “Best of luck to each of you on your Mounjaro journey. It's a miracle drug! ” they wrote. I thought about dying.
If I stopped taking Mounjaro, it would leave my body eventually and my corpse might have a full head of hair. Instead I kept injecting the drug, because my blood sugar was healthy again and I had never really wanted to die. Now I would have to figure out how to live, and the internet has never been helpful for this.
In time, the algorithm figured out I was miserable and started showing me Instagram posts from body-positivity influencers. One called GLP-1's “prescribed anorexia,” which pissed me off because I have diabetes, not body dysmorphia. I learned about a workshop on the “necropolitics” of my medicine. A British fat-liberation group posted a list of different weight…