Taming the Glucose Monster — Again

By Howard Wolinsky, Editor, The Active Surveillor

When I first wrote in 2018 about taming the glucose monster, I was celebrating a victory that felt almost improbable. I had dropped 35 pounds, normalized my A1C, and assembled an enthusiastic team — a family physician, dietitian, nurse practitioners, a diabetologist, and fellow diabetics — who helped me wrestle my metabolism back into line.

I even ventured into the then‑new world of microbiome testing, hoping the trillions of microbes in my gut could be coaxed into helping me. For a while, it all worked. My numbers were steady, my weight was down, and my continuous glucose monitor showed the kind of calm, predictable curves that make clinicians smile.

But the monster never really leaves. It waits.

Over time, the careful routines I’d built began to fray. The Israeli company whose algorithm helped me pair foods for better glucose control folded, taking my personalized microbiome plan with it. But the truth is, it wasn’t just them. Life crept in — travel, stress, aging, and the slow drift back toward familiar habits. My A1C rose. Not to the danger zone, but enough to remind me that metabolic control isn’t a one‑time achievement. It’s a practice. And I had slipped. I regained weight.

My clinical pharmacist at UChicago, who now manages my Mounjaro journey, says I need to lose 25 pounds. The good news: before starting anything new, I clawed my way back to an A1C of 6.5 through exercise alone. That number was mine — earned.

Only then did I begin Mounjaro (tirzepatide), which, alongside exercise and diet, lowers blood sugar by prompting the release of natural insulin and reducing the liver’s glucose output. My family doctor had been urging me for the past year or so to take the leap; his patients were seeing excellent results.

Still, I hesitated.

After decades of reporting on medicine, I’ve seen enough “miracle therapies” to know they all come with fine print. And metformin had been my dependable companion for 15 years. When my doctor told me I could stop it because it might be nudging my kidneys in the wrong direction, I felt both relief and unease — relief at letting go of a twice‑daily ritual, unease at stepping into something new.

I’ll admit something else: I dreaded the needle. A weekly shot felt like crossing a line. But when the moment came, it was nothing. I felt nothing. The anticipation was far worse than the reality.

I’ve only been on Mounjaro for a few weeks, but the changes are already noticeable. My daily blood sugar readings are lower and steadier, as if someone smoothed out the rough edges.

In the first three weeks, I dropped eight pounds — about the heft of a bowling ball, a large watermelon, or a newborn — the weight just slipped off in the night. I just hope no unsuspecting soul mysteriously gained them in some cosmic conservation-of-mass fat‑exchange program.

No side effects so far.

My family doctor looked at the numbers and said that, at this pace, normal readings aren’t far off. My eating patterns have always been improvisational rather than three‑meals‑a‑day, but even within that rhythm, something has shifted.

Sated. Full comes sooner now — not heavy, just complete. A quiet, unmistakable signal.

And I’m aware this is a fast‑moving field. GLP‑1 medications are the hottest area in metabolic research, with new forms already in development — more effective, longer‑acting, more targeted. I may not be on this exact drug forever. The landscape is changing too quickly for that. But right now, it feels like the right tool at the right moment.

It’s early days. I’m just getting started. But there’s a familiar feeling returning — the sense that the monster is once again losing ground. Not because of a single strategy or a single diet or a single microbiome tweak, but because I’m back in the fight with new tools and a clearer understanding of how the pieces connect.

The microbiome still matters. Exercise still matters. Prostate cancer vigilance still matters. Heart health still matters — especially for someone who survived a widowmaker twenty years ago. And now Mounjaro is part of that constellation, a new ally in a long, complicated story.

Will the drug affect my PSA or PHI readings, or prostate cancer progression? No one knows. There are tantalizing theories, but no answers yet. It’s also expected to boost testosterone levels — another variable to watch.

Meanwhile, the glucose monster isn’t gone. It never will be. Some say if you live long enough, you’ll become a diabetic — but maybe GLP‑1s and their future iterations will help us postpone the inevitable.

For now, my situation is quieter. I’m learning new patterns. This time, I’m not aiming for a dramatic victory. I’m aiming for steadiness — the kind that lasts.

By Howard Wolinsky, Editor, The Active Scrveillor

A major new study led by Dr. Kosj Yamoah of Moffitt Cancer Center delivers one of the clearest messages yet for men with early prostate cancer: genomic testing can reliably identify aggressive disease early—and it performs especially well in Black men.

The research, published as “A Prospective Validation of the Decipher Genomic Classifier in Men With Early Localized Prostate Cancer: The VANDAAM Study” in the Journal of the National Comprehensive Cancer Network, followed more than 200 men for two years after treatment. The goal was simple but long overdue: test whether the Decipher genomic classifier—a 22‑gene test—can predict early biochemical recurrence, a warning sign that a cancer is more aggressive than it first appears.

Yamoah et al. explain why this work is urgently needed: “African American men experience a disproportionately higher disease burden… with a 1.7× higher incidence rate and a 2× higher mortality rate.”

They also highlight a long‑standing gap in prostate cancer research: “Few prospective studies have specifically targeted minority populations to investigate the genomic landscape of prostate tumors.”

This study finally does—and the results are striking. Every Black man in the study who experienced a recurrence within two years had a high‑risk genomic score. The test didn’t miss any early aggressive cancers in this group. As the authors put it,

The researchers said: “Our study demonstrates that the genomic classifier is an independent predictor of early 2‑year recurrence in African American men.”

For men on Active Surveillance, this matters. Many worry that their cancer might be more dangerous than it looks. This study shows that genomic testing can offer a clearer picture of true risk. A low genomic score provides reassurance that surveillance is safe. A high score signals that treatment may be needed sooner. And for Black men, the test appears especially reliable.

The study also uncovered a practical issue familiar to many patients: tumors located in the front of the prostate—anterior tumors—are harder to sample and more likely to be under‑graded.

When researchers compared biopsy genomic scores with scores from the prostate removed during surgery, anterior tumors were 23 times more likely to be upgraded to high‑risk. For men on surveillance, especially those with anterior tumors on MRI, genomic testing becomes even more important.

Another intriguing finding: Black men in the study who received radiation therapy had better recurrence‑free outcomes than those who underwent surgery. Their tumors showed higher immune activity and lower DNA‑repair activity—biological features that may make radiation more effective. This doesn’t mean radiation is universally better, but it reinforces the idea that treatment should be personalized, and genomics can help guide that personalization.

Biomarkers remain controversial. Some clinicians argue that PSA, Gleason score, and MRI provide enough information. Other experts believe genomic tests add a layer of precision that traditional tools cannot match. The VANDAAM study moves that debate forward by showing that genomics can reveal biological differences that routine clinical measures simply do not capture. As the authors note,

Researchers said: “Clinicopathologic variables… do not fully capture the genomic diversity of prostate tumors.”

For readers of The Active Surveillor, the takeaway is clear: genomic testing—especially Decipher—can help men make safer, more confident decisions about Active Surveillance. It can identify who is truly safe to watch and who may need treatment sooner. And it offers hope that better tools can help close long‑standing racial gaps in prostate cancer outcomes.

h/t P. Ball

A fast‑moving area of prostate cancer research is gaining attention: the gut microbiome and its potential connection to prostate cancer. Early studies suggest gut bacteria may influence inflammation, metabolism, immune activity — even patterns seen in prostate cancer itself.

Join ASPI for a look at what researchers actually know — and what remains speculation — with urologic oncologist Dr. Michael Liss of UC San Diego, a leading voice in microbiome research and prostate cancer innovation.

Webinar: Saturday, August 22, 2026 • 12 PM Eastern
Where: Zoom — Register here: https://aspatients.org/event/gut-microbiome-prostate-cancer/

Tip The Surveillor

Check out how surgical micro-moves make a difference in prostate surgery. See my Substack Prostate Cores.

Also, see This Guy’s Guide on aging with Obama, Eastwood, and the rest of us.