Mounjaro fatigue

Also, all my blood work and tests—-thyroid, testosterone, cortisol, ACTH, kidney ultrasound, eGFR have come back normal. A1c 6.3

I am the same age, taking the same meds, and feel like the walking dead.
I have decided to take the holistic route in order enjoy some realistic venues of life.
Taking several medications for various ailments create severe complications. At our age, we should seek balance
utilizing common sense, and paying close attention to what our bodies are telling us. For me life has been
fulfilling, and, I am finding diet, exercise, and natural herbs a beautiful alternative to uncharted medicine.

I am not a doctor or anything.
The fact that his thyroid, testosterone, cortisol, ACTH, and kidney function tests are all normal is excellent. It rules out the most common endocrine and renal causes of fatigue. However, this makes the fatigue a more urgent signal, not a less urgent one.

1. Cardiovascular Issues (Highest Concern)
For an older male with diabetes, severe, debilitating fatigue and a new inability to handle exertion can be a "red flag" for a heart problem. This symptom, when it replaces traditional chest pain, is known as an "anginal equivalent."

Why it's a concern: Diabetes can damage the nerves that would normally send a "chest pain" signal to the brain. Instead, the signal of heart distress (ischemia, or lack of oxygen) is expressed as profound fatigue, shortness of breath, or weakness.
What this means:His fatigue could be a sign of a blocked artery or worsening heart failure. This must be the first thing to rule out.

2. Hypoglycemia Unawareness (High Possibility)
Randy's A1c of 6.3 is outstanding, but because he takes insulin, it may be *too* tight. An A1c this low suggests he might be having episodes of low blood sugar (hypoglycemia) that he is no longer feeling.
Why it's a concern: After many years of diabetes, or in older adults, the body can stop giving the usual warning signs of a low (shaking, sweating, anxiety). This is "hypoglycemia unawareness."
What this means: He could be experiencing lows, especially at night, and the "symptom" he feels hours later is the debilitating fatigue and "washout" feeling. The body is exhausted from the event. He should check his blood sugar immediately when he feels this fatigue.

3. Medication Side Effects (Still Possible)
You are correct to question the medications, though the order of suspicion may be different.
Mounjaro (Tirzepatide): As you noted, it takes about a month for it to clear the system. Since the fatigue has not improved, Mounjaro is *unlikely* to be the primary cause.
Pravastatin (Statin): It is *possible* for statin-induced muscle fatigue (myopathy) to appear after long-term use, though it is less common than it appearing early. Research suggests this side effect is more common in women, which makes it a slightly less likely (but not impossible) cause for Randy.

His situation has moved beyond simple side effects. He needs to see his doctor immediately to report that the fatigue persists despite stopping Mounjaro. The doctor needs to investigate two urgent possibilities:

1. A full cardiac workup(like a stress test or echocardiogram) to rule out heart disease.
2. A review of his blood sugar logs to check for hypoglycemia. He may need to raise his A1c target (e.g., to 7.0-7.5%) by reducing his insulin to be safer.
3. A simple blood test (a CBC) to check for anemia, which was not on your list of normal tests and is a very common cause of fatigue.

Some very interesting replies above.

I am a 74 YO male. I have been fatigued for the last 4 years. And no one really could tell me why or how to cure it. I have stopped taken certain meds to see if they are the cause but they were not.

I finally went to an endocrinologist since I had all the symptoms of Addison's disease. One big side effect was chronic fatigue. I just started taking the med for Addison's. So I shall see if that will help my fatigue.

Good morning, I am T2D and have been for 10+ years. I am currently on 12.5mg of Mounjaro, Rosuvastatin, Fenofibrate, Insulin, and Crestor. The only side effect from Mounjaro has been nausea on day 2. And for that, I use Zofran. Mounjaro has helped with my weight loss of 35 pounds over 1.5 years. As well as working with my insulin to keep things in check. At one point, I was taking 200+ units a day of insulin. All of the above with the addition of a pump and CGM have dropped that to between 90 and 100 units daily.
I have not had any fatigue issues with any of my diabetic meds.

Severe fatigue is the ONLY symptom I had causing problems. I went to cardiologist and two week heart monitor and echo were fairly normal. Next was a nuclear stress test. It was showing possible minor issues so cardiac Cath was ordered. Turned out to be 95% blockages in the LAD and required two stents!
Make an appointment with a cardiologist ASAP!
Now in Cardiac rehab and feeling 120% better! best of luck to you!

I have been on tirzepatide compounded for 4 months. Somewhere around 90 days, severe fatigue set in. I had just started moving up from 7.5 mg to 10 mg per week in 1 mg increments (advantage of compounded vials). I also had blood work done by my PA at that time. It showed low free T3, but still within limits. And it showed low ALP, but not far from the bottom.
I have tried the following with the support of my PA and ChatGPT (who queued me to ask some of the questions).
1) Low ALP can signal malnutrition - in the form of not enough protein, magnesium and/or zinc. As I was on a high protein diet (cannot eat anymore), with my PA's agreement we looked at my magnesium and zinc intake. We are now adding both magnesium and zinc to my daily vitamin schedule in accordance with the recommended daily allowance,
2) Despite twice a week weight lifting, I had noticed a drop in the amount of weight I could lift for each muscle group. Since the body composition scale did not indicate a significant loss of muscle (10 percent), the presumption is I did not have the needed ATP for energy to use the muscle. With my PA's agreement, we added 5 gm of creatine monohydrate per day to provided the needed precursor for ATP (energy source). I have had some improvement in lifting weight, but still a bit below my original capacity.
3) Since I had done well at 7.5 mg/week of tirzepatide and was fatigued at 9.5 mg/week, she suggested move back to 8.5 mg/week for 2 weeks (a test) but to split the dose - ie take 1/2 the units twice a week.
At week 2 things were getting better, so I stuck with the plan above. At week 4, all is well.
Not saying it will work for you, but considering how little I am eating (vs the past), it seems reasonable that there were nutritional deficiencies... You might want to discuss with your medical provider and get their input on the proper dosages of any vitamins/supplements?
PS I am 67 years old and at this point have lost more than 10 percent of my body weight in 12 weeks. My BMI is now below 30.
PPSS She also added selenium to support the conversion of T4 to T3. I do not know how to evaluate if that helped, but my feet and hands are less cold.

Hello,
I'm also 72 and been on Ozempic first that did nothing for me. My physician changed me to Mournjaro 10 MG. The new medication has really helped with my apatite suppression. However, Like you I have been exhausted. I have heard through the grapevine that it may effect the protein levels in the blood. I just had my Albumin check and the kidneys are producing the normal ranges.

I spoke to my Physician who informed me try vitamin B-12 and additional protein. I already take a B-Complex so I can rule that out. What was the name of the blood test to verify if the patient is mal nutritional?

Just a friendly reminder that we here at Mayo Clinic Connect shouldn’t be diagnosing or prescribing. We may know a lot and may have experienced a lot too throughout our own health journeys. But our main purpose is to encourage each other and give hope.

It is important to remember that all meds have potential side effects. It is important to be aware of what those could be. If you are taking medications for several conditions there can be the added risk of drug interactions.

If something doesn’t feel right (for example fatigue) bring it to the attention of your provider. Perhaps a dose adjustment will help or even a change to an alternate medication may be possible. Thankfully there are usually other options. Your pharmacist can be a good source of information too.