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Reposted by David W (aka Flex NP)

David W (aka Flex NP) @rnflex.bsky.social · 6h

These 24 hours will go down in medical history. A 4 act play. What's more incredible is ONE company did all of this in the last 5 years! 3 purposely designed drugs and suddenly we've solved essentially our oldest self inflicted ailment.

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David W (aka Flex NP) @rnflex.bsky.social · 6h

Add liver cirrhosis and by extension liver transplant to this in the next few years as well with the rise of multi agonist GLP1/GIP and/or glucagon drugs. Obesity related cancers as well over the longer term(20 years)

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Reposted by David W (aka Flex NP)

David W (aka Flex NP) @rnflex.bsky.social · 8h

In 24 hours we've seen one company, Eli Lilly, show us they've essentially solved obesity from a pharmacology standpoint. Take your pick it'll work. From a diabetic and obesity standpoint, bariatric surgery isn't the only option anymore. We can do it with pharmacology.

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David W (aka Flex NP) @rnflex.bsky.social · 8h

It has been a remarkable 24 hours in the world of diabetes and obesity medicine. First we saw the full readout of retatrutide for obesity. Then this morning retatrutide for type 2 diabetes. Both with historic weight loss. Now we can add Eloralintide+Tirzepatide combo to that list.

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David W (aka Flex NP) @rnflex.bsky.social · 13h

Oh my God. Eli Lilly just presented Eloralintide+Tirzepatide for Type 2 diabetes and it's even better than retatrutide for A1c and weight loss. Slides soon. This was my actual reaction in my office:

Reposted by David W (aka Flex NP)

Nephrology Journal Club @nephjc.bsky.social · 30/09/2026

1/10 #NephJC #TenPosts #NephSly 🫘💊 START your steroids! A question we ask constantly but adult RCT data rarely answers after remission in steroid-sensitive MCD/FSGS, how long should the prednisolone taper actually be? 🧵 www.sciencedirect.com/science/arti...

sciencedirect.com

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David W (aka Flex NP) @rnflex.bsky.social · 30/09/2026

And on cue. Diabetes data that'll get presented tomorrow. 21% Weight loss. 20% reduction in non HDL cholesterol, 40% of patients returned to A1c<5.7% aka diabetic remission. absurd drug. investor.lilly.com/news-release...

investor.lilly.com

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David W (aka Flex NP) @rnflex.bsky.social · 30/09/2026

And on cue. Diabetes data that'll get presented tomorrow. 21% Weight loss. 20% reduction in non HDL cholesterol, 40% of patients returned to A1c<5.7% absurd drug.

investor.lilly.com

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David W (aka Flex NP) @rnflex.bsky.social · 29/09/2026

Also This is in non-diabetics. Basically people who don't have a dysfunctional pancreas and it still makes it better!! Like this is hard to even explain how wild this is.

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David W (aka Flex NP) @rnflex.bsky.social · 29/09/2026

Full Retatrutide phase 3 obesity data published today. It's gonna take a minute to fill dissect this. The appendix alone has 70 pages of data. Long story short we created a drug that's almost too good. Huge chunks of people stopped or reduced doses from excess weight reductions.

nejm.org

Retatrutide, a Triple Hormone Receptor Agonist, for Treatment of Obesity | NEJM

Retatrutide is a triple-receptor agonist of glucose-dependent insulinotropic polypeptide, glucagon-like peptide-1, and glucagon receptors. In this phase 3, randomized, double-blind trial, we assign...

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David W (aka Flex NP) @rnflex.bsky.social · 29/09/2026

Part two of Insulin Sensitivity Training just as EASD kicks off this week! I cover a couple more advanced topics and look at 3 different clinical trials that weave a story of how Eli Lilly proved the insulin sensitivity benefits of GIP agonism in humans and why GIP is the real hero.

the-incretins.beehiiv.com

Advancing Insulin Sensitivity Training

Or how tirzepatide became king and GIP is why

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David W (aka Flex NP) @rnflex.bsky.social · 29/09/2026

At risk of sounding like a homer for Eli Lilly but this is an awesome initiative. Expanded access for GLP1 meds to low and middle income countries + medical training + treatment for obesity and diabetes. They plan to use their new oral GLP-1 medicine orforglipron heavily for this.

investor.lilly.com

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Reposted by David W (aka Flex NP)

Nephrology Journal Club @nephjc.bsky.social · 28/09/2026

Steroids are useful (and have bad side effects) in patients with podocytopathies. Starting is easy, but stopping can be challenging. Are longer courses of steroids better for longer remissions? How quickly do you taper? 🐇🐢 #NephSky #NephJC www.nephjc.com/news/startsteroidtaper

nephjc.com

Why Can’t I Quit You: Steroid Tapering in Adults with Podocytopathies (START) — NephJC

This week, we will discuss the best schedule for tapering steroids in adult patients with podocytopathies (MCD/FSGS).

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Reposted by David W (aka Flex NP)

Nephrology Journal Club @nephjc.bsky.social · 28/09/2026

Hey #NephJC 👋 Checkout the VA by @divyaveerssneph.bsky.social This week we're looking at steroid weaning strategies in adults with podocytopathies (MCD/FSGS). 💊Steroids: easy to start🟢 but hard to stop 🛑. #NephSky www.nephjc.com/news/starttrial

nephjc.com

START: The Visual Abstract — NephJC

Can steroid tapering be shorter after remission in adults with sensitive podocytopathy?

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David W (aka Flex NP) @rnflex.bsky.social · 27/09/2026

With Farxiga now generic, and GLP1 meds becoming more common in DKD/CKD it feels like thiazide diuretics have started to fade a bit in terms of prescribing? Use case just isn't as strong given current options

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David W (aka Flex NP) @rnflex.bsky.social · 26/09/2026

3 years and one day since my first injection in my retatrutide trial. Gave myself that first shot in the trial and donated 19 vials(120ml!) of blood. Life altering day for me!

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David W (aka Flex NP) @rnflex.bsky.social · 26/09/2026

Coonie can't be bothered after a day of chasing rabbits and squirrels in the backyard.

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David W (aka Flex NP) @rnflex.bsky.social · 25/09/2026

Happy Friday morning. Dang beautiful sunrise.

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David W (aka Flex NP) @rnflex.bsky.social · 25/09/2026

Thinking as a PCP 1 month again I saw a patient with very concerning symptoms to warrant an urgent referral and imaging. Last week the imaging came back. Today they saw the specialist. Next week urgent surgery. Feels good to be able to get appropriate life saving care so fast.

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Reposted by David W (aka Flex NP)

David W (aka Flex NP) @rnflex.bsky.social · 24/09/2026

We're at a point now with GLP1 meds where weight loss seems like a given at this point, both VK2735 and Enicepatide posted very impressive weight loss numbers this week. But Brenipatide, is the real treat. It's been studying for substance use disorder, MENTAL HEALTH and respiratory diseases.

the-incretins.beehiiv.com

Brenipatide, VK2735 and Enicepatide

All hail the current and future GIP kings

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David W (aka Flex NP) @rnflex.bsky.social · 24/09/2026

the-incretins.beehiiv.com

Brenipatide, VK2735 and Enicepatide

All hail the current and future GIP kings

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David W (aka Flex NP) @rnflex.bsky.social · 23/09/2026

Almost a trope at this point. Insurance company was supposed to call me for a peer to peer urgent appeal. They didnt call me as scheduled I called. Asked for claim escalation to resolve. Wait on hold 20 minutes. Connect with escalation team who then puts me back on hold, then disconnects the call

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David W (aka Flex NP) @rnflex.bsky.social · 22/09/2026

Fighting the insurance industry is so so exhausting today. Denying coverage for AAA surveillance. Refusing to cover CGM for a Type 1 diabetes. Trying to tell me I don't have a right to a peer to peer review. Some days it's just too much.

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David W (aka Flex NP) @rnflex.bsky.social · 22/09/2026

Had written 800 words for my next article on insulin sensitivity and GLP1 drugs and then Lilly very quietly released some fun new data. So after 15 clinic patients today I'm now 500 words into a different blog post! More to come soon!

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Reposted by David W (aka Flex NP)

David W (aka Flex NP) @rnflex.bsky.social · 20/09/2026

We're in a revolution not only with GLP-1 meds, but also drugs that are kidney protective. It appears we can add orforglipron an oral GLP-1 small molecule to the list of kidney protective in diabetes. This data will be presented in full at EASD in 10 days. This is an eye opening graph #NephJC

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David W (aka Flex NP) @rnflex.bsky.social · 20/09/2026

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David W (aka Flex NP) @rnflex.bsky.social · 19/09/2026

How you find me on a rainy Saturday morning. 4 hour clinic shift! But I'm excited for my new work keyboard!

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David W (aka Flex NP) @rnflex.bsky.social · 15/09/2026

The satisfaction I get with removing "hypertension" from a patient's chart and stopping their blood pressure meds. Or changing alcohol use disorder to alcohol use disorder in full remission. The joy they feel is palpable. The only change was to add a GLP1 medication. Miracle drugs.

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David W (aka Flex NP) @rnflex.bsky.social · 15/09/2026

2 weeks until we get this full data readout and full phase 2 data for Eloralintide+Tirzepatide in diabetics. Results are going to be wild. Even this data in obese patients is crazy. 17% weight loss in 4 months is better than retatrutide in the same time frame! And these are the low dose results!

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Reposted by David W (aka Flex NP)

David W (aka Flex NP) @rnflex.bsky.social · 14/09/2026

Why is insulin resistance such a big deal? Because it's a canary in a coal mine for health! And why are all the latest GLP1 drugs focusing on it? This one is basically part one to explain everything. Part 2(and 3?) will be examining upcoming clinical trial results regarding exactly this topic.

the-incretins.beehiiv.com

(Insulin) Sensitivity Training

An intro guide to a misunderstood metric of diabetic and cardiometabolic risk

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David W (aka Flex NP) @rnflex.bsky.social · 14/09/2026

the-incretins.beehiiv.com

(Insulin) Sensitivity Training

An intro guide to a misunderstood metric of diabetic and cardiometabolic risk

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David W (aka Flex NP) @rnflex.bsky.social · 13/09/2026

I'm putting the finishing touches on my newest blog article about insulin sensitivity. Why does it matter? How are GLP1 drugs involved? What the heck is an M-value and what's this graph all about? Find out tomorrow!

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David W (aka Flex NP) @rnflex.bsky.social · 09/09/2026

Last July I started a blog about GLP1 meds to just get my thoughts to a wider audience and fight disinformation/provide education about these remarkable drugs. Today I accepted a pharmaceutical advisory role, advising on GLP-1 meds. Funny that a passion project has turned into this. I'm excited! 😊

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Reposted by David W (aka Flex NP)

David W (aka Flex NP) @rnflex.bsky.social · 09/09/2026

This data is preclinical but it is actually something I discussed in my blog almost a year ago. This natriuretic/diuretic effect of glucagon that conserves free water has some very interesting beneficial implications for renal disease and heart failure. Something to keep an eye on going forward!

the-incretins.beehiiv.com

GLP-1 and the kidneys

Incretins are changing the narrative of chronic kidney disease

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David W (aka Flex NP) @rnflex.bsky.social · 09/09/2026

the-incretins.beehiiv.com

GLP-1 and the kidneys

Incretins are changing the narrative of chronic kidney disease

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David W (aka Flex NP) @rnflex.bsky.social · 08/09/2026

Oh look another Lilly trial for Brenipatide for an oddball indication, moderate to severe COPD! (not that odd, respiratory diseases are worsened by obesity, same drug also being studied for asthma!) GLP1 expressed in lung tissue + GIP antiinflammatory effect should show significant benefits.

clinicaltrials.gov

ClinicalTrials.gov

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David W (aka Flex NP) @rnflex.bsky.social · 06/09/2026

Garmin watch: You've had an easy day! Consider some light yoga before bed! My day actually: Teething 18month old screaming at 3:30am Got 5 hours of sleep Packed up and flew 1200 miles cross country with a 5yr old and 18 month old Now unpacking with my wife and trying to entertain kids. "Easy day"

static.klipy.com

WandaVision: Elizabeth Olsen's 'I'm Fine'

ALT: WandaVision: Elizabeth Olsen's 'I'm Fine'

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David W (aka Flex NP) @rnflex.bsky.social · 06/09/2026

Also medicine requires us to convince people of risks that are rare or uncommon. Vaccine preventable diseases they've never seen. Heart disease they don't have yet but can prevent with lipid lowering therapies Mis- and dis-information thrive in that space because humans are bad at long term risks!

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David W (aka Flex NP) @rnflex.bsky.social · 06/09/2026

Ahh the thing Michigan never did last night.

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David W (aka Flex NP) @rnflex.bsky.social · 06/09/2026

I literally fell off the couch with that Hail Mary. Completely undeserved win.

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David W (aka Flex NP) @rnflex.bsky.social · 05/09/2026

Ok DTE how did we lose power on a sunny, clear sky, barely a breath of wind day. Jesus lord have mercy this company is absolutely terrible.

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David W (aka Flex NP) @rnflex.bsky.social · 05/09/2026

My rescue Smokey just can't be bothered on GameDay. (Also her name is Dolly Parton) Also also Go Blue tonight!

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David W (aka Flex NP) @rnflex.bsky.social · 05/09/2026

Glucagon itself stimulates insulin secretion directly in beta cells. Also chronic glucagon agonism significantly improves insulin sensitivity better than essentially any other pharmacological agent currently available.

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David W (aka Flex NP) @rnflex.bsky.social · 04/09/2026

Bit shocking but they recruited relatively lower Lp(a) levels + maximum other LLT may have confounded results/couldn't add any extra benefit. Also pelacarsen was the "weakest" drug of those being developed so far. Really curious to see this full trial data!

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David W (aka Flex NP) @rnflex.bsky.social · 04/09/2026

Florida in summer is brutal. But get out early enough into some of the preserved woodlands for a trail run and you can find some magic.

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David W (aka Flex NP) @rnflex.bsky.social · 03/09/2026

*taps my own slide on women's health* Listen and believe women. Listen and believe women. Listen and believe women.

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