To answer nick_SD_fit's question specifically:

From a clinical standpoint, VPN usage when ordering is well-supported by the literature.

The short answer: follow the standard titration protocol and reassess at 4-6 weeks.

The longer answer involves pharmacokinetic considerations around steady-state concentrations, which I am happy to elaborate on if helpful.

Slightly tangential to VPN usage when ordering but wei_SG reminded me — has the insurance landscape changed recently?

I know it is not exactly on-topic but it seems related enough to ask here rather than starting a new thread. Apologies if this has been covered — I did search first.

OP here — wow, did not expect this much response! Thank you all for the thoughtful replies on VPN usage when ordering.

To answer MaxMetOK: I get my labs done through Quest every 3 months.

Quick update: my latest labs came back even better. Thanks again for the evidence-based discussion — this is exactly why I posted in a science-based community. 🙏

Slightly tangential to VPN usage when ordering but wei_SG reminded me — does anyone have experience combining this with metformin?

I know it is not exactly on-topic but it seems related enough to ask here rather than starting a new thread. Apologies if this has been covered — I did search first.

Bookmarked 📌 The VPN usage when info in this thread is essential. Coming back to this for sure.