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
Well this is fun. I get to stop my statin because I nearly ended up in rhabdo from it. Checked CPK this week and it was 684u/l 🙃🙈
Nearly 4x the upper limit of normal!
In late January I noticed some increased muscle aches but figured it was just from my increase in running and lifting 🧵
Nearly 4x the upper limit of normal!
In late January I noticed some increased muscle aches but figured it was just from my increase in running and lifting 🧵
February 12, 2026 at 11:51 PM
Well this is fun. I get to stop my statin because I nearly ended up in rhabdo from it. Checked CPK this week and it was 684u/l 🙃🙈
Nearly 4x the upper limit of normal!
In late January I noticed some increased muscle aches but figured it was just from my increase in running and lifting 🧵
Nearly 4x the upper limit of normal!
In late January I noticed some increased muscle aches but figured it was just from my increase in running and lifting 🧵
Fascinating preclinical work on my favorite topic, glucagon.
This study suggests glucagon is doing a lot more than just futile cycling glucose substrates and inducing ketogenesis & lipolysis for weight loss.
This study suggests glucagon is doing a lot more than just futile cycling glucose substrates and inducing ketogenesis & lipolysis for weight loss.
GCGR agonism requires GABAergic signaling in the Medial Basal Hypothalamus to Promote Weight Loss in Obese Mice - PubMed
Glucagon receptor (GCGR)-mediated thermogenesis is a key component for the next-generation of obesity therapeutics. Herein, we investigated the central and peripheral mechanism by which activation of the GCGR augments metabolic rate to promote weight loss. Chronic treatment of obese mice with a long …
pubmed.ncbi.nlm.nih.gov
February 12, 2026 at 1:05 PM
Fascinating preclinical work on my favorite topic, glucagon.
This study suggests glucagon is doing a lot more than just futile cycling glucose substrates and inducing ketogenesis & lipolysis for weight loss.
This study suggests glucagon is doing a lot more than just futile cycling glucose substrates and inducing ketogenesis & lipolysis for weight loss.
I know everything is crazy but let's celebrate some wins. I diagnosed a patient with new onset diabetes and heart failure last June, initial A1c 14% EF 21%
As of last week, EF has improved to 35% A1c is 6.2% (!!!!) and patient has lost about 40lbs to a near normal BMI. (Tirzepatide + flozins!)
As of last week, EF has improved to 35% A1c is 6.2% (!!!!) and patient has lost about 40lbs to a near normal BMI. (Tirzepatide + flozins!)
February 11, 2026 at 12:58 PM
I know everything is crazy but let's celebrate some wins. I diagnosed a patient with new onset diabetes and heart failure last June, initial A1c 14% EF 21%
As of last week, EF has improved to 35% A1c is 6.2% (!!!!) and patient has lost about 40lbs to a near normal BMI. (Tirzepatide + flozins!)
As of last week, EF has improved to 35% A1c is 6.2% (!!!!) and patient has lost about 40lbs to a near normal BMI. (Tirzepatide + flozins!)
Reposted by FlexNP
Moreover, the most critical advantage of the mRNA tech is the speed at which it can be produced. Under a properly functioning regulatory apparatus, when we got surprised with H3N2 subclade K, we could have had an updated vaccine within ~2 months.
February 11, 2026 at 12:15 AM
Moreover, the most critical advantage of the mRNA tech is the speed at which it can be produced. Under a properly functioning regulatory apparatus, when we got surprised with H3N2 subclade K, we could have had an updated vaccine within ~2 months.
Reposted by FlexNP
Patient to me today about their cancer care:
'They cured my cancer but didn't care about my humanity afterwards'
That has stuck with me all dang day.
We cannot just treat the disease and forget the human.
'They cured my cancer but didn't care about my humanity afterwards'
That has stuck with me all dang day.
We cannot just treat the disease and forget the human.
February 10, 2026 at 1:44 AM
Patient to me today about their cancer care:
'They cured my cancer but didn't care about my humanity afterwards'
That has stuck with me all dang day.
We cannot just treat the disease and forget the human.
'They cured my cancer but didn't care about my humanity afterwards'
That has stuck with me all dang day.
We cannot just treat the disease and forget the human.
Patient to me today about their cancer care:
'They cured my cancer but didn't care about my humanity afterwards'
That has stuck with me all dang day.
We cannot just treat the disease and forget the human.
'They cured my cancer but didn't care about my humanity afterwards'
That has stuck with me all dang day.
We cannot just treat the disease and forget the human.
February 10, 2026 at 1:44 AM
Patient to me today about their cancer care:
'They cured my cancer but didn't care about my humanity afterwards'
That has stuck with me all dang day.
We cannot just treat the disease and forget the human.
'They cured my cancer but didn't care about my humanity afterwards'
That has stuck with me all dang day.
We cannot just treat the disease and forget the human.
Reposted by FlexNP
In continuing the theme of GLP-1s are overpowered Mary Sue drugs, we have our first glimmer they may actually rebuild cartilage in knee osteoarthritis. This tracks with some real life anecdotes I've seen here and in clinic @eecklund.bsky.social @stresshoop.bsky.social
www.cell.com/cell-metabol...
www.cell.com/cell-metabol...
February 9, 2026 at 8:32 PM
In continuing the theme of GLP-1s are overpowered Mary Sue drugs, we have our first glimmer they may actually rebuild cartilage in knee osteoarthritis. This tracks with some real life anecdotes I've seen here and in clinic @eecklund.bsky.social @stresshoop.bsky.social
www.cell.com/cell-metabol...
www.cell.com/cell-metabol...
In continuing the theme of GLP-1s are overpowered Mary Sue drugs, we have our first glimmer they may actually rebuild cartilage in knee osteoarthritis. This tracks with some real life anecdotes I've seen here and in clinic @eecklund.bsky.social @stresshoop.bsky.social
www.cell.com/cell-metabol...
www.cell.com/cell-metabol...
February 9, 2026 at 8:32 PM
In continuing the theme of GLP-1s are overpowered Mary Sue drugs, we have our first glimmer they may actually rebuild cartilage in knee osteoarthritis. This tracks with some real life anecdotes I've seen here and in clinic @eecklund.bsky.social @stresshoop.bsky.social
www.cell.com/cell-metabol...
www.cell.com/cell-metabol...
Lemme tap these two slides from obesity week 2025. Our bodies regulate our weight almost down a couple calories to maintain weight.
And yet at the same time we've created such a world of excess in terms of food AND reduced energy expenditure it's basically a given that obesity is so prevalent.
And yet at the same time we've created such a world of excess in terms of food AND reduced energy expenditure it's basically a given that obesity is so prevalent.
February 9, 2026 at 8:17 PM
Lemme tap these two slides from obesity week 2025. Our bodies regulate our weight almost down a couple calories to maintain weight.
And yet at the same time we've created such a world of excess in terms of food AND reduced energy expenditure it's basically a given that obesity is so prevalent.
And yet at the same time we've created such a world of excess in terms of food AND reduced energy expenditure it's basically a given that obesity is so prevalent.
Eli Lilly is already on that. They're also looking at smoking cessation as well for this dual GIP/GLP-1 agonist.
I can mirror your experience. I had 2 beers for Super Bowl Sunday. That's dramatically less than it used to be.
clinicaltrials.gov/study/NCT072...
I can mirror your experience. I had 2 beers for Super Bowl Sunday. That's dramatically less than it used to be.
clinicaltrials.gov/study/NCT072...
February 9, 2026 at 5:27 PM
Eli Lilly is already on that. They're also looking at smoking cessation as well for this dual GIP/GLP-1 agonist.
I can mirror your experience. I had 2 beers for Super Bowl Sunday. That's dramatically less than it used to be.
clinicaltrials.gov/study/NCT072...
I can mirror your experience. I had 2 beers for Super Bowl Sunday. That's dramatically less than it used to be.
clinicaltrials.gov/study/NCT072...
I've been predicting this would happen. I suspect they'll get banned in certain sports where weight matters, biking, rowing, etc.
Even more so when glucagon agonists come around(that requires more than 300 letters to explain)
Even more so when glucagon agonists come around(that requires more than 300 letters to explain)
Use of GLP-1 Drugs Under Scrutiny at Winter Olympics
Anti-doping group includes novel diabetes, weight-loss drugs in its monitoring program
www.medpagetoday.com
February 9, 2026 at 3:49 PM
I've been predicting this would happen. I suspect they'll get banned in certain sports where weight matters, biking, rowing, etc.
Even more so when glucagon agonists come around(that requires more than 300 letters to explain)
Even more so when glucagon agonists come around(that requires more than 300 letters to explain)
That's the 3rd GLP1 ad
(Also I appreciate that commercial not being a bunch of white people! Minorities in the USA have high rates of obesity too!)
(Also I appreciate that commercial not being a bunch of white people! Minorities in the USA have high rates of obesity too!)
February 9, 2026 at 2:56 AM
That's the 3rd GLP1 ad
(Also I appreciate that commercial not being a bunch of white people! Minorities in the USA have high rates of obesity too!)
(Also I appreciate that commercial not being a bunch of white people! Minorities in the USA have high rates of obesity too!)
Superb Owl beverage. Coconut rum barrel aged stout. SO. DAMN. GREAT.
February 9, 2026 at 12:46 AM
Superb Owl beverage. Coconut rum barrel aged stout. SO. DAMN. GREAT.
GLP1 commercial count for the Super Bowl: 1
February 8, 2026 at 11:12 PM
GLP1 commercial count for the Super Bowl: 1
The ice is over a foot thick on the river. It was a bright and sunny morning. So I did some exploring, almost to the Canadian border on the frozen river. Magnificent ice and snow formations!!
February 8, 2026 at 3:19 PM
The ice is over a foot thick on the river. It was a bright and sunny morning. So I did some exploring, almost to the Canadian border on the frozen river. Magnificent ice and snow formations!!
Seeds! There might be snow on the ground but it's time to start tomatoes, peppers, leeks and cabbage indoors!
February 7, 2026 at 9:14 PM
Seeds! There might be snow on the ground but it's time to start tomatoes, peppers, leeks and cabbage indoors!
9.3 miles of running this morning. Goal was 11-12 miles. Except the windchill was -10F and my water bottle froze nearly solid at mile 8 and I couldn't feel my toes so I suppose that was the sign I should stop a little early today. 🤷
Training for ultra marathons, not for the faint of heart 😂
Training for ultra marathons, not for the faint of heart 😂
February 7, 2026 at 7:07 PM
9.3 miles of running this morning. Goal was 11-12 miles. Except the windchill was -10F and my water bottle froze nearly solid at mile 8 and I couldn't feel my toes so I suppose that was the sign I should stop a little early today. 🤷
Training for ultra marathons, not for the faint of heart 😂
Training for ultra marathons, not for the faint of heart 😂
Get a coonhound they said. Watch them just be weird. Like where is that paw even coming from?
How can she breathe??!!
How can she breathe??!!
February 7, 2026 at 1:03 AM
Get a coonhound they said. Watch them just be weird. Like where is that paw even coming from?
How can she breathe??!!
How can she breathe??!!
February 6, 2026 at 2:47 PM
And there's Novo's response. They're gonna sue HIMS into oblivion with this(or at least try to)
February 5, 2026 at 4:01 PM
And there's Novo's response. They're gonna sue HIMS into oblivion with this(or at least try to)
I have some immediate questions on the legality of this and expect some lawsuits to start flying. Oral Wegovy isn't in shortage and it uses a patented absorption enhancer to even work. Is HIMS violating multiple patents here? Cuz it feels like yes.
#$HIMS launching $49 WeGovy knock-off. #$NVO -8% pre-market, if it closes here would be the lowest in almost 5 years.
www.reuters.com/business/hea...
www.reuters.com/business/hea...
February 5, 2026 at 2:41 PM
I have some immediate questions on the legality of this and expect some lawsuits to start flying. Oral Wegovy isn't in shortage and it uses a patented absorption enhancer to even work. Is HIMS violating multiple patents here? Cuz it feels like yes.
Reposted by FlexNP
Wanted to do a quick GLP-1 update based on Eli Lilly and Novo Nordisk's earning calls today. It really highlights how one company has become overtly aggressive in the development of these medications while the other has stagnated. First Novo's pipeline update...which is sparse
February 4, 2026 at 8:25 PM
Wanted to do a quick GLP-1 update based on Eli Lilly and Novo Nordisk's earning calls today. It really highlights how one company has become overtly aggressive in the development of these medications while the other has stagnated. First Novo's pipeline update...which is sparse
Wanted to do a quick GLP-1 update based on Eli Lilly and Novo Nordisk's earning calls today. It really highlights how one company has become overtly aggressive in the development of these medications while the other has stagnated. First Novo's pipeline update...which is sparse
February 4, 2026 at 8:25 PM
Wanted to do a quick GLP-1 update based on Eli Lilly and Novo Nordisk's earning calls today. It really highlights how one company has become overtly aggressive in the development of these medications while the other has stagnated. First Novo's pipeline update...which is sparse