am I the only one who found plateau harder than the injections
am I the only one who found plateau harder than the injections. I would rather ask a basic question now than get this wrong quietly for two months.
Kept a log from week one and the single most useful column turned out to be waist, not weight.
nausea made the first fortnight rough at each step up, then flattened out. Predictable enough that I started planning around it.
Sat at 1.0mg for four months because it was doing the job. Everyone told me to go up. The one time I did, the only thing that changed was the sulphur burps.
Happy to answer the boring questions. Those are usually the ones worth asking.
best — the order this archive was captured in
Steady state after a dose change takes four to five half-lives, so the fair judgement point on a new step is about a month, not four days.
The escalation schedule in the trials existed to keep people on the drug. It is a tolerability ramp, and it is why the label reads the way it does.
sema is weekly for a reason, the half-life does the smoothing
sema is weekly for a reason, the half-life does the smoothing
This is the part I would underline for anyone skimming. Everything else in the thread is downstream of it.
staying at 1.7mg for an extra month is a legitimate plan
Leaving this up. It is a check-in, it has numbers, and it is honest about being one person.
staying at 1.7mg for an extra month is a legitimate plan
endpoint_creep is describing the standard shape here and it matches the trial data better than most anecdotes do.
How long was the stall before you decided it was a stall?
How long was the stall before you decided it was a stall?
Right, and the timescale is the bit that keeps getting lost. Judge a step at a month, not at a weekend.
Delayed gastric emptying is most pronounced early and attenuates with continued dosing, which is why the early fullness usually fades at a stable dose.
First month I lost almost nothing and nearly quit. Month two and three were where it all happened.
Not convinced. You changed the dose and the week at the same time, so you cannot attribute the change to either.
Did protein intake change in the same window?
Does fatigue track the day after the shot, or is it there all week?
The appetite thing was the surprise. I expected to feel full. What I got was simply not thinking about food between meals.
What dose and how many weeks at it before this started?
My stall was eleven weeks. Eleven. Then it moved again without me changing anything at all.
Same injection day each week, or has it drifted?
Week 61: 25kg down, injection-site soreness basically gone since about week 7, and the honest headline is that nothing dramatic happened. It was boring and it worked.
Dropped my injection day by two days once because of travel. Nothing happened. The panic was worse than the effect.
stalling at 1.0mg is information, not a verdict
STEP-1 ran 68 weeks and landed just under 15% mean body weight change on 2.4mg. It is an average of a wide distribution, not a target you have missed.
The weekly interval comes out of the half-life — roughly a week — so you are on a smooth curve rather than a series of spikes. That is also why moving your day slightly does very little.
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Minor fix — the half-life is about a week, not about a day. The rest of your point stands.
The weekly interval comes out of the half-life — roughly a week — so you are on a smooth curve rather than a series of spikes.
Disagree with this specific line. A pause at 0.5mg is not evidence that 0.5mg has stopped working.
The mental model that finally made this click for me: there are two curves, and people watch the wrong one.
The first is exposure, which is set by the dose and smoothed by a week-long half-life. It changes when you change the dose and then settles over about a month. The second is body weight, which is exposure filtered through appetite, food, water, sleep, training and the scale itself, and which moves in steps rather than a line.
Almost every "it stopped working" post is somebody watching curve two over a fortnight and drawing conclusions about curve one. If the appetite effect is still there, exposure is fine. Wait the month.
Sceptical of the mechanism you are proposing. Gastric emptying slows, it does not stop, and the timings you describe do not follow from it.
I would push back gently. Going up because the scale paused is the single most common mistake described on this board.
the appetite signal and the scale move on different clocks
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