25 years old, always sick, and I'm terrified.

I'm 25 years old, female, 5'1" and 225 pounds. I take 10mg Abilify for borderline personality disorder (have taken for 7 years), 10mg cetirizine for allergies (have taken for over a decade), 1000mg metformin XR for insulin resistance, vitamin D supplement for low but not technically deficient vitamin D levels, Zepbound 15mg weekly, and I have a Nexplanon implant.

I feel like my body is just falling apart and I don't know what I can do at this point to improve my symptoms and quality of life. Diagnoses include: moderate sleep apnea (used to be severe at 45 events/hour PRIOR TO having nasal turbinate reduction, now closer to 30 events/hour), fatty infiltration of the liver, severe insulin resistance (last fasting insulin was 56, fasting glucose measured at the same time was 103, A1C was 5.2), and atherosclerosis of the heart (I have seen a cardiologist and my echo was normal, so in combo with my age they weren't concerned other than a diagnosis of supraventricular tachycardia, have not done calcium scoring to determine severity). I used to be 235 pounds but have lost 10 pounds with Zepbound over 8 months of being on it. The lack of weight loss on the GLP-1 is another concern of mine. My fasting insulin prior to starting Zepbound was 49, now is 56 8 months into taking Zepbound, as mentioned. In my opinion, I also have very high levels of stress and struggle to manage it day-to-day.

Note that in the last year, I did go to the ER for chest pain and my d-dimer was 0.54 mcg/mL. They found nothing else wrong other than an abnormal T-wave on an EKG and they released me. I was told there was not much beyond that they could do.

I don't want to live like this, but I don't know where to go next. I'm seeing a dietitian soon to make some (probably drastic) improvements to my diet. But I'm afraid to exercise because I'm afraid of the atherosclerosis. Sometimes when my heart pounds, I get chest pain, hence the history of ER and cardiology visits. I just don't want to give myself a heart attack.

I'm terrified and I'm ready to make changes, but my primary care provider has been less than helpful to say the least. I will not consider bariatric surgery at this time because I have a history of traumatic experiences with food and as helpful as surgery might be on paper, I think it would at best be unsuccessful for me long term. I'm willing to consider any solutions outside of bariatric surgery.