3 ms·

'an appetite suppressant' is really underselling liraglutide. It also corrects insulin resistance, which accounts for some degree of it's effectiveness as a we

'an appetite suppressant' is really underselling liraglutide. It also corrects insulin resistance, which accounts for some degree of it's effectiveness as a weight loss aid beyond it's effects on slowing the GI tract. GLP-1 agonists are truly an amazing class of drugs. It's absolutely absurd that they're generally not covered by insurance for non-diabetics, even when they yield such obvious benefits for obese people.

omginternets 4y ago
>It also corrects insulin resistance Is liraglutide doing that directly, or is it mediated by people eating less sugar?
- sithadmin 4y ago
  Directly. It stimulates insulin release from the pacreas.
  - omginternets 4y ago
    Eesh… that doesn’t seem great. How does this not cause further habituation?
    - sithadmin 4y ago
      Human and animal studies demonstrate that it doesn't seem to worsen insulin resistance if treatment is ceased, but probably doesn't significantly improve it either.
      - omginternets 4y ago
        Weird. That's quite intriguing.
psychphysic 4y ago
Within the UK they remain restricted too. However, more and more at target populations i.e. obesity + diabetes/obesity related secondary condition or even at risk for diabetes i.e. ethnicity based. Are being offered these treatments. It really will be a new age for obese patients. The first and exercise tactic is a lost battle, ideally we'd be bringing up a generation that can manage their weight but we've failed at that. This is a really good option. Metformin is similarly excellent drug even in absence of diabetes.
- sithadmin 4y ago
  As a non-diabetic (though demonstrably insulin resistant and leptin resistant), I've found metformin's gastro side effects and impact on blood glucose levels to be annoyingly unpredictable. Metformin also causes a noticeable drop in testosterone that can be especially counterproductive for men if weight loss/maintenance is a goal and one already has relatively low baseline testosterone levels.
  - psychphysic 4y ago
    Definitely heard that the gastro side effects are unacceptable to many and can even impact social life. I'd heard a bit about the testosterone, i.e. that you don't get the testosterone rise associated with successful management for diabetes. And perhaps Metformin short circuits that. Also that it might correlate with the life expectancy improvement and it does make sense since Metformin is also used for PCOS with wide ranging benefits not limited to insulin resistance but actually reducing androgenic effects of the condition. Do you think you'll continue with Metformin? I've genuinely was close to starting on it some years back (despite having no (pre) diabetes.).
    - sithadmin 4y ago
      Metformin never really yielded noticeable benefits for me (neither in terms of fat loss nor any bloodwork metrics) above and beyond other lifestyle changes I had already made, so I discontinued it after a trial period of about 4 months. The MD I was working with argued that I could have seen a impact on weight loss if taking a more extreme approach to dieting (basically an extremely high protein, moderate fat, moderate carb diet with 300-400 calories of intake every ~4 hours from sunrise to sunset) in conjunction with the metformin, but that approach didn't really fit my lifestyle at the time. If done correctly, this ostensibly maximizes the gluconeogenesis inhibition effect of metformin in conjunction with minimizing fatty acid synthesis by keeping blood levels at a consistent glucose deficit (thus encouraging lipolysis). I was also unconvinced that this isn't a just-so story, and thus I preferred to take a traditional 'keto' diet route (which has a lot more evidence backing it).

omginternets 4y ago

>It also corrects insulin resistance Is liraglutide doing that directly, or is it mediated by people eating less sugar?

sithadmin 4y ago
Directly. It stimulates insulin release from the pacreas.
- omginternets 4y ago
  Eesh… that doesn’t seem great. How does this not cause further habituation?
  - sithadmin 4y ago
    Human and animal studies demonstrate that it doesn't seem to worsen insulin resistance if treatment is ceased, but probably doesn't significantly improve it either.
    - omginternets 4y ago
      Weird. That's quite intriguing.

psychphysic 4y ago

Within the UK they remain restricted too. However, more and more at target populations i.e. obesity + diabetes/obesity related secondary condition or even at risk for diabetes i.e. ethnicity based. Are being offered these treatments. It really will be a new age for obese patients. The first and exercise tactic is a lost battle, ideally we'd be bringing up a generation that can manage their weight but we've failed at that. This is a really good option. Metformin is similarly excellent drug even in absence of diabetes.

sithadmin 4y ago
As a non-diabetic (though demonstrably insulin resistant and leptin resistant), I've found metformin's gastro side effects and impact on blood glucose levels to be annoyingly unpredictable. Metformin also causes a noticeable drop in testosterone that can be especially counterproductive for men if weight loss/maintenance is a goal and one already has relatively low baseline testosterone levels.
- psychphysic 4y ago
  Definitely heard that the gastro side effects are unacceptable to many and can even impact social life. I'd heard a bit about the testosterone, i.e. that you don't get the testosterone rise associated with successful management for diabetes. And perhaps Metformin short circuits that. Also that it might correlate with the life expectancy improvement and it does make sense since Metformin is also used for PCOS with wide ranging benefits not limited to insulin resistance but actually reducing androgenic effects of the condition. Do you think you'll continue with Metformin? I've genuinely was close to starting on it some years back (despite having no (pre) diabetes.).
  - sithadmin 4y ago
    Metformin never really yielded noticeable benefits for me (neither in terms of fat loss nor any bloodwork metrics) above and beyond other lifestyle changes I had already made, so I discontinued it after a trial period of about 4 months. The MD I was working with argued that I could have seen a impact on weight loss if taking a more extreme approach to dieting (basically an extremely high protein, moderate fat, moderate carb diet with 300-400 calories of intake every ~4 hours from sunrise to sunset) in conjunction with the metformin, but that approach didn't really fit my lifestyle at the time. If done correctly, this ostensibly maximizes the gluconeogenesis inhibition effect of metformin in conjunction with minimizing fatty acid synthesis by keeping blood levels at a consistent glucose deficit (thus encouraging lipolysis). I was also unconvinced that this isn't a just-so story, and thus I preferred to take a traditional 'keto' diet route (which has a lot more evidence backing it).