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Metformin Post Bariatric Surgery

Pcos, Metformin Use After Being Sleeved

Pcos, Metformin Use After Being Sleeved

Hi guys... I am currently 4 months post-op and on no medications. I have lost a total of 45 pounds. I still cant believe it. I am so thankful for my sleeve. Yet, I have PCOS and have not noticed my period regulating just yet. I was on metformin prior to having surgery but after surgery i was told to stop the medication. My surgeon informed me it is too soon to tell if my period will regulate since i am only 4 months post op. Yet, I was wondering if anyone was in my situation and if you had to start taking metformin again? Also, will this medication hurt my sleeve? I had really aweful side effects from it the first 3 months after taking it. I would appreciate any advice from anyone who experienced this problem. I am currently on day five of my period and it is extremely heavy which worries me because I am anemic due to my heavy periods and feel very weak. I was hoping surgery would correct this problem bit i havent noticed a change in my cycles and this really worries me. Give it more time. Be sure to get your Protein , fluids and Vitamins and if you still have irregular periods talk to both your surgeon and GYN. So I have been out for about 7 weeks and getting my period ever since the 3rd week. Prior to the surgery, my periods were missing for over a year.. I started taking metformin 3 days ago and ever since, I have been feeling very mild pain in my stomach. It's mild pain but it's there.. Is it too soon to be taking metformin?? English is my 6th language so forgive me if my sentences don't make any sense at times! I was also on metformin prior to my bypass. I have also been taking 2 Zovia per day for the past 9 mths just to keep me from having a heavy period constantly. I stopped the metformin but have not been able to wean off of the birth control. I am 11 weeks out Continue reading >>

Modelling The Absorption Of Metformin With Patients Post Gastric Bypass Surgery

Modelling The Absorption Of Metformin With Patients Post Gastric Bypass Surgery

Received date: February 13, 2014; Accepted date: March 27, 2014; Published date: March 31, 2014 Citation: Almukainzi M, Lukacova V, Lbenberg R (2014) Modelling the Absorption of Metformin with Patients Post Gastric Bypass Surgery. J Diabetes Metab 5:353. doi: 10.4172/2155-6156.1000353 Copyright: 2014 Almukainzi M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Purpose: Gastric bypass surgery in obesity shortens the length of the small intestine, which can have a significant impact on drug absorption . Literature reports that the observed drug absorption patterns after gastric bypass surgery are sometimes unexpected. One report states that the absorption of Metformin was higher after gastric bypass surgery. The purpose of this study was to investigate the mechanistic background of the reported data using Advanced Compartmental Absorption and Transit (ACAT) model and apply it to patient data with post gastric bypass surgery. Methods: GastroPlus 8 (Simulations Plus, Inc.) was used to develop a model that describes the observed absorption of an immediate release (IR) metformin tablet in healthy subjects. The data was taken from a published article that compared the absorption of metformin between a control group and post gastric bypass surgery patients. The model was fitted against the data for the control group and then used to predict the drug absorption in post gastric bypass surgery patients by changing the related GI parameters. All assumptions to explain the observed data, suggested in the literature, were tested by changing the appropriate parameters in the software. Result Continue reading >>

Metformin After Surgery

Metformin After Surgery

I was diagnosed with PCOS and insulin resistance over 5 years ago. I am having surgery on Tuesday and because it is complicated to get a liquid version of metformin I have decided not to take it for the month I'm on liquids. We all know that PCOS can be treated (to some degree) by weight loss. I did the glucose tolerance test to find out I had PCOS. After surgery there is no way that I can do that test again. I was just thinking about this myself. My surgeon actually told me that Icould stop the metformin. I had surgery on 4/18 and have not taken it since two days before that. Italked to him again yesterday and told him my concerns about stopping it right now. He was ok with that and told me to go ahead and keep taking it.I think I will wait until I get down to a healthy BMIbefore I stop taking it...and then see how it goes. Mainly, Itake it to have regular periods and a few other minor symptoms. I was taking 2000mg metformin daily and my surgeon told me to discontinue after surgery. I've never had issues with blood sugar, just insulin resistance, so I also question discontinuing it. My gyn told me that PCOS won't go away -- it's hormone related -- but that weight loss will help the insulin resistance. So I guess I don't have anything of value to add except I'm with you on the question!! I am a little rusty in my knowledge of PCOS and IR as I did do ALOTof reading in 2006 when I was first diagnosed but that was 6 years ago :) PCOS can go away. It's a hormone imbalance and losing weight can cause your hormones to become balanced. The issue with PCOS is that it's sort of a negative diagnosis - if you have certain symptoms with no other reason then you are told you have PCOS. My nurse in the hospital gave me a study that showed that almost all the symptoms of PCOS (hair g Continue reading >>

Medication And Nutritional Supplement Use Before And After Bariatric Surgery

Medication And Nutritional Supplement Use Before And After Bariatric Surgery

Medication and nutritional supplement use before and after bariatric surgery Utilizao de medicamentos e suplementos nutricionais antes e aps a cirurgia baritrica IMaster's Student in the Postgraduate Pharmaceutical Sciences Program, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil. IIPhD. Pharmacist, School of Public Health, Health Department of the State of Rio Grande do Sul, Porto Alegre, RS, Brazil. IIIMD. Coordinator of the Health Technology Assessment Center, Grupo Hospitalar Conceio; Head Professor of Public Health, Universidade Federal de Cincias da Sade de Porto Alegre (UFCSPA); Associate Professor of Public Health, Universidade Luterana do Brasil (ULBRA); and Contributing Professor in the Postgraduate Epidemiology Program, Department of Social Medicine, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil. IVPhD. Associate Professor, Postgraduate Pharmaceutical Sciences Program and Postgraduate Pharmaceutical Services, School of Pharmacy, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil. Bariatric surgery has been an effective alternative treatment for morbid obesity and has resulted in decreased mortality, better control over comorbidities and reduced use of drugs. The objective of this study was to analyze the impact of bariatric surgery on medication drug and nutritional supplement use. Longitudinal study of before-and-after type, on 69 morbidly obese patients in a public hospital in Porto Alegre. Through interviews, the presence of comorbidities and use of drugs with and without prescription were evaluated. Among the 69 patients interviewed, 85.5% had comorbidities in the preoperative period, with an average of 2.3 ( 1.5) per patient. The main comorbidities rep Continue reading >>

Effect Of Gastric Bypass On The Absorption Of Metformin (absorb-met)

Effect Of Gastric Bypass On The Absorption Of Metformin (absorb-met)

Study Description Study Design Groups and Cohorts Outcome Measures Eligibility Criteria Contacts and Locations More Information Background: Gastric bypass is the most commonly performed type of bariatric (obesity) surgery, has dramatically increased in popularity and is now considered to be preferred treatments in severely obese patients that fail non-surgical therapy - particularly in patients with type 2 diabetes. Drug malabsorption is a potential concern post-gastric bypass because intestinal length is reduced. Purpose: The purpose of this controlled, pharmacokinetic study is to determine whether the absorption of a single dose of metformin, the first line drug treatment in patients with type 2 diabetes, is significantly reduced after gastric bypass. Methods: A single dose of standard release metformin 1000 mg will be administered to patients who have undergone gastric bypass and to patients who have not received surgery but are on the wait list (wait-listed controls). Blood sampling and urine sampling will occur in standardized fashion over the ensuing 24 hours to measure and compare the absorption of metformin between study arms. 34 patients total will be recruited. Significance: Following completion of this study, we will better understand how gastric bypass affects metformin absorption. Ultimately, this information will help to ensure that this patient population is receiving optimal doses of this important drug treatment. AUC glucose (0-8h) [TimeFrame:cross-sectional] bioavailability of metformin (urine metformin concentration from 0-infinity) [TimeFrame:cross-sectional] Study Description Study Design Groups and Cohorts Outcome Measures Eligibility Criteria Contacts and Locations More Information Information from the National Library of Medicine Choosing to par Continue reading >>

Diabetes Remission After Gastric Bypass Determined By Beta Cell Function Not Weight Loss

Diabetes Remission After Gastric Bypass Determined By Beta Cell Function Not Weight Loss

Home / Specialties / Gastroenterology / Diabetes Remission after Gastric Bypass Determined by Beta Cell Function Not Weight Loss Diabetes Remission after Gastric Bypass Determined by Beta Cell Function Not Weight Loss Remission of type2 diabetes in severely obese people after bariatric surgery hinges on baseline beta cell function, not weight loss. The study by Richard Perugini, MD, and colleagues from the University of Massachusetts Medical Center in Worcester, involved 137 people with diabetes who were severely obese (body mass index ranged from 33 to 75kg/m). All patients required medication for glycemic control and had achieved HbA1c levels under 7.5% prior to undergoing Roux-en-Y gastric bypass surgery. In 46% of patients, diabetes had remitted at 40 days (remission was defined by the researchers as the withdrawal of diabetic medications). That rose to 57% at 180 days and 70% at 1 year. For all subjects (those who were no longer on medication and those who were), mean HbA1c level was 5.9% at 40 days, 6.0% at 180 days, and 6.1% at 1 year, Dr. Perugini reported. At 1 year, subjects no longer taking medication had a better mean HbA1c level than those taking medication (5.7% vs 6.3%). Weight loss was similar in those who experienced remission and those who did not (23% to 27% at 6 weeks and 58% to 60% at 1 year), suggesting that the remission of diabetes is independent of weight loss, said Dr. Perugini. Dr. Perugini noted that, "The majority of patients who went off their medications were off by 6 weeks." At that point, the only phenomena at play were independent of weight loss, such as the incretin response, he explained. The researchers compared the remission and nonremission groups and found that the 2 strongest predictors of postsurgical remission were baseline in Continue reading >>

Gastric Bypass Increases Metformin Bioavailability

Gastric Bypass Increases Metformin Bioavailability

Home blog Gastric Bypass Increases Metformin Bioavailability Gastric Bypass Increases Metformin Bioavailability One of the concerns of undergoing gastric bypass surgery is the impact on gut absorption of essential nutrients. Although, with modern gastric bypass surgery, the length of gut that is bypassed is rather limited (around 80-120 cms) and all known nutritional deficiencies are generally manageable with dietary monitoring and supplementation, the impact of this surgery on medications is less well known. Thus, although most patients undergoing gastric bypass surgery will experience substantial improvement or even remission of many obesity related comorbidities, they may still require to take medications for conditions that persist, reoccur with subsequent weight regain, or are unrelated to excess weight in the first place. This is also true for diabetes medications. While most patients can often discontinue their diabetes medications after gastric bypass surgery, this is not true for all patients and some, despite experiencing marked improvement in the first few years after surgery, may find diabetes creeping back (which is why it is fairer to use the term remission rather than cure in this context). This means that there will always be patients who have undergone gastric bypass surgery who may require to continue on or restart their diabetes medications over time. One of the most widely used oral medications for type 2 diabetes is metformin, a drug that activates the enzyme AMP-kinase and primarily acts by reducing sugar production in the liver (gluconeogensis). In addition, metformin has positive effects on insulin sensitivity, glucose uptake and fatty acid oxidation. Unfortunately, however, metformin also has rather low bioavailability and slow, incomplete gast Continue reading >>

Post Bariatric Surgery Questions

Post Bariatric Surgery Questions

Posted on October 7, 2010 at 1:37 PM in Bariatric Surgery , Weight Loss Surgery After pondering about potential topics for this month, I decided to focus on post op follow up concerns. I have tried to compile the most important questions patients have regarding follow up, medications and treatments after surgery and my responses to them. First off, it is important to remember to never stop a medication abruptly unless advised to do so by the hospital, the primary provider, a specialist or our office. Surgery is not a miracle pill. A surgery does not warrant stopping needed medications. Initially, some may be stopped (such as some diabetic and blood pressure medications) but not all. The patient and his, her primary care provider and specialist must work together to decide when and if medications can be stopped SAFELY. After Bariatric surgery, hypertensive medications may need to be adjusted. The patient must first monitor his, her blood pressure twice daily in assessment of lower (or higher) blood pressure. Initially patients are told to hold medication if BP is <140/90. This is for a good reason. If borderline on this number and a medication is inadvertently dosed, it could unsafely lower blood pressure causing untoward side effects such as dizziness, lightheadedness or even syncope (passing out). I will add that beta blocker (medications ending in an OLOL) dosages may need to be reduced but the patient must be careful about stopping these without a doctors supervision as this type of medication has other functions besides lowering BP. If a patient is in doubt about what medications to take or not take, he or she is advised to consult the primary care provider or specialist who manages the medications. With diabetic medications, the patient is initially told to monito Continue reading >>

Metformin After Sleeve?

Metformin After Sleeve?

So I've been on the forums lately about not losing any weight since my sleeve - in fact I've gained 2 pounds. Well I think I may have an idea. My surgeon discontinued my Metformin which I have been on for years cold turkey the day before my surgery. As an RN I wasn't comfortable with this but followed his orders. I questioned him about it at my 2 week post op visit and he asked me if I had been checking my sugars. I reminded him AGAIN that I don't even own a glucometer because my HbA1C has been 5.8% on Metformin. He just laughed and said see I cured you - he hasn'd done any labs or glucometer checks of my sugar. My PCP prescribed my Metformin. So I've put in a call requsting to restart my Metformin. I don't feel well , my metabolism is out if whack and frankly I have no confidence in him at all. He was the only Bariatric surgeon in my area on Lynne insurance plan. My NUT just trys to sell me Vitamins and Protein Powder when I go that's it. I think I may just follow up with my PCP The surgeon only wants to see me one more time at 3 months anyway. Can you believe he didn't even examine my wound's until I insisted!! sorry you've haven't lost weight since WLS not that this helps much, but there are other people in similar situations might take longer than you like, but hopefully you will see improvement sooner than later "God GIVE ME PATIENCE, JUST HURRY UP ABOUT IT!!" YOU are the RN, so what i say is from a laymen who is 3+ years WLS. 2+ years GOAL maintaining 105 lb weight loss (little fluctuation) "don't feel well , metabolism out if whack and no confidence in him at all (surgeon)" I'm not the RN like you, (not being sarcastic) but i don't think the metformin in this case is the culprit of how you feel your tummy has gone through major surgery surgery also would/can eff Continue reading >>

Diabetes / Metformin Pills

Diabetes / Metformin Pills

I am one week post op and was told to decrease my diabetes meds from 2000 mg of Metformin and a one a day dosage of Glyburide in the morning, to 1000 mg of Metformin and no Glyburide. My problem is that after I take my Metformin, I have noticed it in solid form in the toilet after a BM. I am having serious doubts to its effectiveness from that location! How do I get it to absorb?? Did I drink too much when taking them and flush them too quickly through my pouchie? I break them up into 4 small sizes so that I can tolerate swallowing them. I'd be checking with the pharmacy to see if they are crushable pills. If they are, crush them. Otherwise, you'll likely not get much use out of them. In time, hopefully you'll be off all the meds. It took me about 3 months to be able to fully wean off insulin, cholesterol and blood pressure meds .. SO happy not to have to take those! if they are safe to crush, yes. Check with the pharmacy. I don't remember if they are okay to crush or not. I used to use those tiny medicine cups the hospital gave to me.. crushed my pills (I was not allowed ANY whole pills at all for six months post op, everything had to be crushed).. I would take my crushed pills.. add a tablespoon or two of flavored water.. stir quickly and drink. Other people crush them in applesauce. I just wanted it done & over with. In the hospital they crushed mine and mixed it with jello and it was horrible. I gaged to get it down..Yucky!! Then they said I could crush it into tiny piece's and take it that way. 2 days after being home from surgery I was completely off metformin I called the pharmacy and they told me that if its the ER version of Metformin (extended release) then its not to be crushed. But that the non ER version should be fine to crush and take. So right now I am Continue reading >>

Metformin After Bariatric Surgery - An Acid Problem

Metformin After Bariatric Surgery - An Acid Problem

Metformin is the oral drug of first choice in type 2 diabetes. Therefore a large number of patients undergoing bariatric surgery will be on Metformin treatment. However, use of Metformin has been associated with lactate acidosis. Weight loss following bariatric surgery is most pronounced during the first weeks after the operation and this creates a phase of negative energy balance with ketone body formation. To shed more light on this situation we measured ketone bodies in 90 patients 5 days-18 months after bariatric surgery. Ketone bodies were markedly elevated during the first 3-4 months. Metformin use should therefore be critically reconsidered after bariatric operations. Do you want to read the rest of this article? ... Therefore, higher levels of 3-HB at the early days after the bariatric surgery in the improved group in our study might have induced similar enhancement in insulin signaling leading to better glycemic control. With a recent report suggesting that early high levels of 3-HB after metabolic surgery return to normal levels after several months, [30] it seems that 3- HB values before, not after, significant weight loss might be mechanistically related to the diabetic improvement. With this mechanistic relevance and our data showing the correlation with the prognosis at 3 months, the [3-HB]/[glucose] ratio might be a useful prognostic marker for future glycemic control, if our results are reproduced in larger studies. ... Continue reading >>

Effect Of Gastric Bypass Surgery On The Absorption And Bioavailability Of Metformin

Effect Of Gastric Bypass Surgery On The Absorption And Bioavailability Of Metformin

Effect of Gastric Bypass Surgery on the Absorption and Bioavailability of Metformin Raj S. Padwal, MD, MSC; Raniah Q. Gabr, MSC; Arya M. Sharma, MD, PHD; Lee-Ann Langkaas, LPN; Dan W. Birch, MD; Shahzeer Karmali, MD; Dion R. Brocks, PHD ObjectiveUse of gastric bypass surgery is common and increasing. Over 40% of patients in diabetes remission after gastric bypass surgery may redevelop diabetes within 5 years. Metformin, the first-line drug for diabetes, has low bioavailability and slow, incomplete gastrointestinal absorption. We hypothesized that gastric bypass would further reduce the absorption and bioavailability of metformin. Research Design and MethodsIn a nonblinded, single-dose pharmacokinetic study, 16 nondiabetic postgastric bypass patients and 16 sex- and BMI-matched control subjects (mean age 40 years and BMI 39.2 kg/m2) were administered two 500-mg metformin tablets. Plasma metformin levels were sampled at 0.5, 1, 1.5, 2, 3, 4, 6, 8, and 24 h. Metformin absorption, estimated by the area under the curve (AUC) of the plasma drug concentrations from time 0 to infinity (AUC0-), was the primary outcome, and metformin bioavailability, assessed by measuring 24-h urine metformin levels, was a secondary outcome. ResultsCompared with control subjects, metformin AUC0 was increased in gastric bypass subjects by 21% (13.7 vs. 11.4 g/mL/h; mean difference 2.3 [95% CI 1.3 to 5.9]) and bioavailability was increased by 50% (41.8 vs. 27.8%; 14.0 [4.123.9]). Gastric bypass patients had significantly lower AUC glucose levels over 8 h compared with control subjects (35.8 vs. 41.7 g/mL/h; 5.9 [3.18.8]), but this was likely a result of differences in baseline fasting glucose and not metformin absorption. ConclusionsMetformin absorption and bioavailability seem to be higher after Continue reading >>

Metformin After Bypass

Metformin After Bypass

Take a look around and read through the conversations our members are having. If you would like to participate, it is easy to join the Streamline Surgical family: simply click here to register. Once you are a member of our online family, you can talk about whatever you want, from considering weight loss surgery to life post surgery. Simply browse the conversations to join one or start your own if you prefer. Viewing 11 posts - 1 through 11 (of 11 total) Got a quick question, I have got to see my GP next week for my post bypass medication review. Before my bypass I was a type 2 diabetic on Metformin, I was told thatbasmsoon as I have had my bypass I will no longer need to take the Metformin, so I stopped it. I have been monitoring my BG levels and they have never been higher than 6 so it looks like all is well. So when I go to my GP I was going to ask him to stop the metformin, trouble is I have now been told by a diabetic nurse on another wls forum that the latest advice is to not stop taking the metformin as it has been proven to offer good cardiovascular protection, or at most cut the dose to half but defiantly stay on it. So anyone here post opp and been told to stay on it. Or anyone got any links to published data saying I should stay on them. Sorry it was not quite as quick as I thought it would be. Almost everyone I know who was on Metformin pre surgery is now no longer taking it. Listen to what your team say as they will have your full medical history in front of them with which to decide what is best for YOU. Bugger, I was hoping I would be kept on it, as my medication bill is going to get very expensive, especially after the recent prescription price rise, I will still be on 6 items at 7.65 an item, if they had kept me on Metformin I would have got them for fr Continue reading >>

Type 2 Diabetes Management In A Post-bariatric Surgery Patient

Type 2 Diabetes Management In A Post-bariatric Surgery Patient

Type 2 diabetes management in a post-bariatric surgery patient Type 2 diabetes management in a post-bariatric surgery patient A patient, aged 57 years, was admitted to the hospital to undergo gastric bypass surgery. He had a history of type 2 diabetes for ten years. Diabetes management in a pre-, post-bariatric surgery patient A patient, aged 57 years, was admitted to the hospital to undergo gastric bypass surgery. He had a history of type 2 diabetes for ten years. Pre-admission diabetes therapy included metformin 1000 mg at morning and bedtime, insulin glargine ( Lantus ) 70 units every day in the afternoon or evening, insulin aspart ( NovoLog ) 30 units plus sliding scale three times per day. The day prior to surgery, the patient reported taking metformin 1000 mg, insulin glargine 70 units, and insulin aspart 30 units with his evening meal. His hemoglobin A1c value was 8%, and it was taken just prior to surgery. The patient's blood glucose value on admission was 204 mg/dL. Throughout the surgery, blood glucose values ranged from 208 to 214 mg/dL. Throughout the day, the patient received a total of 8 units of insulin aspart in correction doses for noted hyperglycemia. The patient was instructed to take nothing by mouth on the day of surgery, and then was advised to start a bariatric clear liquid diet on post-operative day one, advancing as tolerated. This meal plan consisted of six small, liquid meals provided throughout the day with the goal of staying hydrated. On post-operative day two, blood glucose values ranged from 90 to 103 mg/dL. The patient continued to tolerate six small meals per day via a bariatric surgery diet.He was approved to dismiss from the hospital on post-operative day two. The patient was recommended to take a multivitamin with minerals daily aft Continue reading >>

Effect Of Gastric Bypass Surgery On The Absorption And Bioavailability Of Metformin

Effect Of Gastric Bypass Surgery On The Absorption And Bioavailability Of Metformin

Effect of Gastric Bypass Surgery on the Absorption and Bioavailability of Metformin We are experimenting with display styles that make it easier to read articles in PMC. The ePub format uses eBook readers, which have several "ease of reading" features already built in. The ePub format is best viewed in the iBooks reader. You may notice problems with the display of certain parts of an article in other eReaders. Generating an ePub file may take a long time, please be patient. Effect of Gastric Bypass Surgery on the Absorption and Bioavailability of Metformin Raj S. Padwal, MD, MSC, Raniah Q. Gabr, MSC, [...], and Dion R. Brocks, PHD Use of gastric bypass surgery is common and increasing. Over 40% of patients in diabetes remission after gastric bypass surgery may redevelop diabetes within 5 years. Metformin, the first-line drug for diabetes, has low bioavailability and slow, incomplete gastrointestinal absorption. We hypothesized that gastric bypass would further reduce the absorption and bioavailability of metformin. In a nonblinded, single-dose pharmacokinetic study, 16 nondiabetic postgastric bypass patients and 16 sex- and BMI-matched control subjects (mean age 40 years and BMI 39.2 kg/m2) were administered two 500-mg metformin tablets. Plasma metformin levels were sampled at 0.5, 1, 1.5, 2, 3, 4, 6, 8, and 24 h. Metformin absorption, estimated by the area under the curve (AUC) of the plasma drug concentrations from time 0 to infinity (AUC0-), was the primary outcome, and metformin bioavailability, assessed by measuring 24-h urine metformin levels, was a secondary outcome. Compared with control subjects, metformin AUC0 was increased in gastric bypass subjects by 21% (13.7 vs. 11.4 g/mL/h; mean difference 2.3 [95% CI 1.3 to 5.9]) and bioavailability was increased by 50 Continue reading >>

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