CJC-1295+Ipamorelin and Insulin Resistance

[Mitchell Fleisher, M.D., D.Ht., D.A.B.F.M.]

Dear SSRP colleagues,

I have four, 60+ y.o, male patients who were doing very well on testosterone cypionate IM therapy.  Their total T levels were in the 600 range.  CJC-1295+Ipamorelin  0.1 ml (100 mcg) SQ QHS 5 days/week (M-F) was added for anti-aging.

Lab testing performed about 3 months after initiation of the CJC-1295+Ipamorelin revealed significant insulin resistance, i.e., HOMA-IR ovder 4.0, which did not exist prior to the CJC-1295+Ipamorelin therapy.  Their pre-treatment HOMA-IR values were in the 0.7 to 1.2 range, which is WNL.  They all have healthy diets, good quality supplementation, and regular exercise regimens.

I am requesting input on the best clinical course of action:

1. Decrease dosage of CJC-1295+Ipamorelin to 0.05 ml (50 mcg) SQ QHS 5 days/week (M-F)?
2. Discontinue 0.1 ml (100 mcg) SQ QHS 5 days/week (M-F)?
3. Add GLP1-RA therapy, i.e. Exenatide 0.05-0.10 ml (5-10 units) QAM?
4. Add GLP1-RA therapy, i.e. Exenatide 0.05-0.10 ml (5-10 units) BID?

Thank you for sharing your insights.

Mitch Fleisher, M.D., D.Ht., D.A.B.F.M.

[Leonard Pastrana]

Dr. Fleisher

3 months of cjc/ipa is a good time to take a break and rotate anyway.  My vote would be to discontinue the cjc/ipa.

I would look to start something like MOTS-C due to its effects on insulin sensitivity.

I would base the GLP dosing on how well it is being tolerated. Start low and slow.

I would focus on timing and type of exercise to help with glucose uptake. ie focus on resistance training.

I like using a continuous glucose monitor for 2-4 weeks in this scenario as well. See when we are getting glucose spikes. Use the information to tweak nutrition and exercise for optimal levels.

[Mitchell Fleisher, M.D., D.Ht., D.A.B.F.M.]

Leonard,

I’ve prescribed a trial of CJC+Ipamorelin 0.05 ml SQ QHS (5 days/wk) for a month, as well as Exenatide 1.0 ml SQ QAM, and MOTS-c 10 mg SQ Q1week for 4 weeks, and then will recheck fasting lab work. 

Thus far, the Exenatide has been well tolerated.

We’ll see what happens.

Dr. Fleisher

[Khanh Nguyen, MD]

where do you get exenatide?

[Mitchell Fleisher, M.D., D.Ht., D.A.B.F.M.]

From Pure Pharmacy

[Arash Esmaili]

Dr. Fleisher, any updates on these four patients with insulin resistance?

[Mitchell Fleisher, M.D., D.Ht., D.A.B.F.M.]

Yes, they’re doing well now with a regimen of CJC+Ipam. cycllng 3 months on and 1 month off, and Gly-Control 2-3 capsules BID (from PGL, 800-527-9512, order #7876).

[Author]

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