FlexNP
@rnflex.bsky.social
Jack of all trades nurse practitioner, trail runner photographer, coonhound rescuer, lover of glucagon agonism in the liver, kidney and pancreas, fascinated by obesity medicine, retatrutide fan boy
The NNT for tirzepatide to prevent 1 case of diabetes is 9. The HR for preventing diabetes was 0.07(which lol what?!) In percents, 1.3 of tirzepatide patients vs 13.3 of placebo patients developed diabetes on trial.
December 28, 2025 at 7:21 PM
The NNT for tirzepatide to prevent 1 case of diabetes is 9. The HR for preventing diabetes was 0.07(which lol what?!) In percents, 1.3 of tirzepatide patients vs 13.3 of placebo patients developed diabetes on trial.
I tell my patients this all the time. Exercise actually sucks for weight loss and research backs this up. If you want to lose weight 1.) calorie deficit. 2.) high satiety foods(protein + fiber) 3.) eating protein first in a meal then waiting a few minutes helps satiety + insulin response
YMMV. For me, trying to use cardio for weight loss was a frustrating and counter-productive experience (it just made me hungrier and did not make a meaningful dent in energy balance). Weight loss happened when I started cooking every meal and doubled my protein and fiber intake.
Fitness gurus are always knocking cardio. Well, the elliptical is super effectively for weight loss. It’s low impact so you can do it for long time periods, every day. I can burn 800-1000 calories in an hour. I can do it daily. I lost 100 lbs once doing nothing but that damned boring elliptical.
December 28, 2025 at 6:19 PM
I tell my patients this all the time. Exercise actually sucks for weight loss and research backs this up. If you want to lose weight 1.) calorie deficit. 2.) high satiety foods(protein + fiber) 3.) eating protein first in a meal then waiting a few minutes helps satiety + insulin response
Tater tot breakfast casserole this morning. Can also do this with tortilla chips.
December 28, 2025 at 4:49 PM
Tater tot breakfast casserole this morning. Can also do this with tortilla chips.
4 year old woke up this morning and immediately said to me "Dad I want red bell pepper cut into big strips" and promptly got the red bell peppers from the fridge and handed it to me.
She ate an entire bell pepper raw for breakfast.
Kids and their food preferences man 🤷
She ate an entire bell pepper raw for breakfast.
Kids and their food preferences man 🤷
Oh man. Our 3 year old was GREAT about trying new foods.
Now she's 4 and has some serious opinions about foods she used to eat 😂 enjoy it and hope your 3 year old keeps it up
Now she's 4 and has some serious opinions about foods she used to eat 😂 enjoy it and hope your 3 year old keeps it up
December 28, 2025 at 1:00 PM
4 year old woke up this morning and immediately said to me "Dad I want red bell pepper cut into big strips" and promptly got the red bell peppers from the fridge and handed it to me.
She ate an entire bell pepper raw for breakfast.
Kids and their food preferences man 🤷
She ate an entire bell pepper raw for breakfast.
Kids and their food preferences man 🤷
You'll hear A LOT about heart rate and glucagon in 2026. But keep this in mind, glucagon is seemingly far more important to rodent hearts than human hearts. In humans it does cause a modest rise in heart rate but some of it may also be blood pressure mediated.
Glucagon exerts a positive chronotropic effect in the isolated mouse heart via GCGR & via HCN channels in the sinus node. Glucagon-containing GLP-1 medicines are on the way, reminding us of the species-specific differences in cardiac GCGR expression 🧪#Obesity #MASH www.mdpi.com/1422-0067/27...
December 27, 2025 at 5:50 PM
You'll hear A LOT about heart rate and glucagon in 2026. But keep this in mind, glucagon is seemingly far more important to rodent hearts than human hearts. In humans it does cause a modest rise in heart rate but some of it may also be blood pressure mediated.
What is fun about this published data is that Lilly focused almost entirely on the cardiovascular outcomes in this paper. I think they're going to write up the renal outcomes in a separate paper just based on lack of renal mentions in this paper. #NephSky #CardioSky
In patients with type 2 diabetes and atherosclerotic cardiovascular disease, tirzepatide was noninferior to dulaglutide with respect to major cardiovascular events. Full SURPASS-CVOT trial results and Research Summary: nej.md/4qd5rLx
#MedSky #EndoSky #CardioSky
#MedSky #EndoSky #CardioSky
December 27, 2025 at 3:12 PM
What is fun about this published data is that Lilly focused almost entirely on the cardiovascular outcomes in this paper. I think they're going to write up the renal outcomes in a separate paper just based on lack of renal mentions in this paper. #NephSky #CardioSky
French toast bake, beer aged in port wine barrels, joyous morning for our children and us.
December 25, 2025 at 4:18 PM
French toast bake, beer aged in port wine barrels, joyous morning for our children and us.
Merry Christmas from Dolly Parton, our blue tick coonhound who never met a blanket she didn't love to hide under especially after the kids went wild with their presents today.
December 25, 2025 at 1:58 PM
Merry Christmas from Dolly Parton, our blue tick coonhound who never met a blanket she didn't love to hide under especially after the kids went wild with their presents today.
Good Christmas Eve morning from my little corner of our beautiful planet.
December 24, 2025 at 1:43 PM
Good Christmas Eve morning from my little corner of our beautiful planet.
bsky.app/profile/rnfl...
Literally pointed out this morning the lack of research on iron deficiency because it affects mostly....women and minorities!
Literally pointed out this morning the lack of research on iron deficiency because it affects mostly....women and minorities!
Will say, I think historical lack of research into women's health plays a role in all of this due to many of these conditions disproprionately impacting women.
December 23, 2025 at 9:54 PM
bsky.app/profile/rnfl...
Literally pointed out this morning the lack of research on iron deficiency because it affects mostly....women and minorities!
Literally pointed out this morning the lack of research on iron deficiency because it affects mostly....women and minorities!
If you can feel the systolic murmur/probable severe aortic stenosis vibrate your fingers while checking a carotid pulse that's usually a bad thing right? Because whoa 😳😳
December 23, 2025 at 7:39 PM
If you can feel the systolic murmur/probable severe aortic stenosis vibrate your fingers while checking a carotid pulse that's usually a bad thing right? Because whoa 😳😳
Reposted by FlexNP
And we start 2026 off with a bang. Oral Wegovy is now approved in the United States for obesity. Now will the demand be there? Will it be priced cheap enough? Will insurance cover it(Probably not...)
Will patients follow the weird dosing regimen?
Things are heating up again in the GLP1 world.
Will patients follow the weird dosing regimen?
Things are heating up again in the GLP1 world.
The GLP-1 medicine field continues to evolve, offering new effective options for people living with #obesity coming to US distribution channels in January 2026 Higher dose oral semaglutide for weight management now FDA approved #weightloss @novonordisk.bsky.social
www.novonordisk.com/content/nnco...
www.novonordisk.com/content/nnco...
December 23, 2025 at 12:00 AM
And we start 2026 off with a bang. Oral Wegovy is now approved in the United States for obesity. Now will the demand be there? Will it be priced cheap enough? Will insurance cover it(Probably not...)
Will patients follow the weird dosing regimen?
Things are heating up again in the GLP1 world.
Will patients follow the weird dosing regimen?
Things are heating up again in the GLP1 world.
New Years goals:
1.) Continue my personal crusade against losartan, prescribe more telmisartan and irbesartan.
2.) Hopefully get my health system to fund a pilot study of telmisartan and tirzepatide to see if it provides synergistic benefits for weight loss & A1c control.
1.) Continue my personal crusade against losartan, prescribe more telmisartan and irbesartan.
2.) Hopefully get my health system to fund a pilot study of telmisartan and tirzepatide to see if it provides synergistic benefits for weight loss & A1c control.
New Years goals:
1. Remove all abbreviations/acronyms from my documentation. Patient's can read and should read our notes. Why should they have to figure out our abbreviations?
2. Remove pointless words to save everyone time in their reading.
#medsky
1. Remove all abbreviations/acronyms from my documentation. Patient's can read and should read our notes. Why should they have to figure out our abbreviations?
2. Remove pointless words to save everyone time in their reading.
#medsky
December 23, 2025 at 12:44 PM
New Years goals:
1.) Continue my personal crusade against losartan, prescribe more telmisartan and irbesartan.
2.) Hopefully get my health system to fund a pilot study of telmisartan and tirzepatide to see if it provides synergistic benefits for weight loss & A1c control.
1.) Continue my personal crusade against losartan, prescribe more telmisartan and irbesartan.
2.) Hopefully get my health system to fund a pilot study of telmisartan and tirzepatide to see if it provides synergistic benefits for weight loss & A1c control.
And we start 2026 off with a bang. Oral Wegovy is now approved in the United States for obesity. Now will the demand be there? Will it be priced cheap enough? Will insurance cover it(Probably not...)
Will patients follow the weird dosing regimen?
Things are heating up again in the GLP1 world.
Will patients follow the weird dosing regimen?
Things are heating up again in the GLP1 world.
The GLP-1 medicine field continues to evolve, offering new effective options for people living with #obesity coming to US distribution channels in January 2026 Higher dose oral semaglutide for weight management now FDA approved #weightloss @novonordisk.bsky.social
www.novonordisk.com/content/nnco...
www.novonordisk.com/content/nnco...
December 23, 2025 at 12:00 AM
And we start 2026 off with a bang. Oral Wegovy is now approved in the United States for obesity. Now will the demand be there? Will it be priced cheap enough? Will insurance cover it(Probably not...)
Will patients follow the weird dosing regimen?
Things are heating up again in the GLP1 world.
Will patients follow the weird dosing regimen?
Things are heating up again in the GLP1 world.
That's a frigate. Or a destroyer at best. Did none of them happen to even look at what a battleship is *supposed* to look like??
The stupid burns so badly....what the hell is wrong with these people.
The stupid burns so badly....what the hell is wrong with these people.
Trump Class battleship illustration, as released by the White House.
December 22, 2025 at 11:29 PM
That's a frigate. Or a destroyer at best. Did none of them happen to even look at what a battleship is *supposed* to look like??
The stupid burns so badly....what the hell is wrong with these people.
The stupid burns so badly....what the hell is wrong with these people.
Reposted by FlexNP
Eli Lilly in summer of 2025: We will trial GLP1 medications for any indication we believe it will provide benefit to the patient.
Me at the time: Yeah, ok. 🙄
Eli Lilly today how about a GIP/GLP1 medication as adjunct to standard of care for bipolar disorder type 1 or 2
Me at the time: Yeah, ok. 🙄
Eli Lilly today how about a GIP/GLP1 medication as adjunct to standard of care for bipolar disorder type 1 or 2
December 22, 2025 at 5:29 PM
Eli Lilly in summer of 2025: We will trial GLP1 medications for any indication we believe it will provide benefit to the patient.
Me at the time: Yeah, ok. 🙄
Eli Lilly today how about a GIP/GLP1 medication as adjunct to standard of care for bipolar disorder type 1 or 2
Me at the time: Yeah, ok. 🙄
Eli Lilly today how about a GIP/GLP1 medication as adjunct to standard of care for bipolar disorder type 1 or 2
Eli Lilly in summer of 2025: We will trial GLP1 medications for any indication we believe it will provide benefit to the patient.
Me at the time: Yeah, ok. 🙄
Eli Lilly today how about a GIP/GLP1 medication as adjunct to standard of care for bipolar disorder type 1 or 2
Me at the time: Yeah, ok. 🙄
Eli Lilly today how about a GIP/GLP1 medication as adjunct to standard of care for bipolar disorder type 1 or 2
December 22, 2025 at 5:29 PM
Eli Lilly in summer of 2025: We will trial GLP1 medications for any indication we believe it will provide benefit to the patient.
Me at the time: Yeah, ok. 🙄
Eli Lilly today how about a GIP/GLP1 medication as adjunct to standard of care for bipolar disorder type 1 or 2
Me at the time: Yeah, ok. 🙄
Eli Lilly today how about a GIP/GLP1 medication as adjunct to standard of care for bipolar disorder type 1 or 2
Wife: Why are you making latkes?! We don't celebrate Hanukkah??
Me: Do I ever need a reason to make fried potatoes?!
Her: ......*grabs 3 of them to eat*
Me: Yeah exactly 😅
Me: Do I ever need a reason to make fried potatoes?!
Her: ......*grabs 3 of them to eat*
Me: Yeah exactly 😅
December 21, 2025 at 11:48 PM
Wife: Why are you making latkes?! We don't celebrate Hanukkah??
Me: Do I ever need a reason to make fried potatoes?!
Her: ......*grabs 3 of them to eat*
Me: Yeah exactly 😅
Me: Do I ever need a reason to make fried potatoes?!
Her: ......*grabs 3 of them to eat*
Me: Yeah exactly 😅
Oh look it's me, my wife and 2 kids. Make more money than my parents ever did. But our mortgage in a great school district + daycare is 44% of our take home pay.
Daycare *alone* is 26% of our paychecks.
We owe 60k in student loans. Then groceries, utilities, insurance and a car payment.
Daycare *alone* is 26% of our paychecks.
We owe 60k in student loans. Then groceries, utilities, insurance and a car payment.
It's unquestionable that young people today are richer than their 1960s counterparts, but the big difference in precarity. A good job requires living in a metro area with a housing shortage. A child requires an even more expensive home in a functional school district. A college degree requires debt.
These Young Adults Make Good Money. But Life, They Say, Is Unaffordable.
www.nytimes.com
December 21, 2025 at 9:28 PM
Oh look it's me, my wife and 2 kids. Make more money than my parents ever did. But our mortgage in a great school district + daycare is 44% of our take home pay.
Daycare *alone* is 26% of our paychecks.
We owe 60k in student loans. Then groceries, utilities, insurance and a car payment.
Daycare *alone* is 26% of our paychecks.
We owe 60k in student loans. Then groceries, utilities, insurance and a car payment.
Why did we study the angelfish equivalent of a pancreas in the 80s? Same with gila monster venom in the late 80s/early 90s? Oh I dunno just a little thing now called GLP-1.
It's always "why did we spend $10m to study grass flu?" and you do 2 minutes of digging and it turns out grass flu destroys $75 billion in crops every year and now we have a new vaccine for that that costs $3 to apply.
December 21, 2025 at 7:30 PM
Why did we study the angelfish equivalent of a pancreas in the 80s? Same with gila monster venom in the late 80s/early 90s? Oh I dunno just a little thing now called GLP-1.
Not to be that person but Christmas this year sucks. Not only are we financially stretched but my family is just being not great/not cool. *Sigh*
December 21, 2025 at 4:18 PM
Not to be that person but Christmas this year sucks. Not only are we financially stretched but my family is just being not great/not cool. *Sigh*
Homemade Mac and cheese night! Sharp cheddar + Gouda + Havarti
December 20, 2025 at 11:14 PM
Homemade Mac and cheese night! Sharp cheddar + Gouda + Havarti
Reposted by FlexNP
rfk will not rest until your kid is dead wapo.st/4s2l2zn
U.S. plans to stop recommending most childhood vaccines, defer to doctors
The plan, which is not finalized, suggests children get fewer shots and shifts to a model telling parents to consult doctors to make their own vaccine choices.
wapo.st
December 20, 2025 at 12:25 AM
rfk will not rest until your kid is dead wapo.st/4s2l2zn
Some form of plague has infected my household so time for some instant ramen with pork belly and onions.
December 19, 2025 at 8:29 PM
Some form of plague has infected my household so time for some instant ramen with pork belly and onions.
*Me routinely ordering lipid profile on patient with high cholesterol on statins...*
Insurance company: Lipid profiles are only a covered benefit every 1825 days and it's only been 385 days.
Me:
Insurance company: Lipid profiles are only a covered benefit every 1825 days and it's only been 385 days.
Me:
a man wearing glasses and a suit is making a face
ALT: a man wearing glasses and a suit is making a face
media.tenor.com
December 18, 2025 at 7:27 PM
*Me routinely ordering lipid profile on patient with high cholesterol on statins...*
Insurance company: Lipid profiles are only a covered benefit every 1825 days and it's only been 385 days.
Me:
Insurance company: Lipid profiles are only a covered benefit every 1825 days and it's only been 385 days.
Me: