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 >>
- The Impact of Bariatric Surgery on Type 2 Diabetes Mellitus and the Management of Hypoglycemic Events
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- Metabolic surgery for treating type 2 diabetes mellitus: Now supported by the world's leading diabetes organizations
Insulin Resistance And The Use Of Metformin: Effects On Body Weight
by Ruchi Mathur, MD, FRCPC Dr. Mathur is Assistant Professor of Medicine, Cedars Sinai Medical Center, University of California, Los Angeles, California. Bariatric Times. 2011;8(1):10–12 Abstract Metformin is a widely perscribed drug for the treatment of diabetes and is often used off label for the treatment of prediabetes and insulin resistance. In addition to its primary use, metformin has often been cited as having weight loss benefits. This article reviews the concept of insulin resistance as it pertains to body weight and the effects of meformin on body weight in subgroups of patients with and without diabetes. Introduction Insulin is an anabolic storage hormone produced by the beta cells in both a basal and a pulsatile fashion in response to food intake. Insulin is fundamental in allowing cells to uptake and use glucose. Insulin also regulates gluconeogenesis along with processes, such as protein synthesis and lipogenesis. When we were evolving, the theory is that insulin was necessary because we lived a life of feast and famine. Those who could store calories had a survival benefit, thus insulin had a significant evolutionary role. So, where and when did insulin become a bad thing? Likely, at the same time our evolutionary environment took a bit of a turn. These days, it is usual to go three hours without eating, and certainly not three days! Thus, what was once adaptive is now maladaptive as we continue to store as our ancestors did. Our environment has changed faster than our genetics. Insulin resistance is an impaired response to endogenous or exogenous insulin in cells, tissues (especially skeletal muscle and adipose tissue), the liver, or the whole body.[1,2] Many investigators believe that insulin resistance is an important factor in the development of th Continue reading >>
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 >>
Insulin Resistance And The Sleeve?
Said " Welcome to Gastric Sleeve " 0 Times I have insulin resistance and I'm looking for more people's experience with it and the sleeve. How did your weight loss go? Was it slow? What has worked for you to reduce your insulin resistance? I currently take Metformin and my fasting glucose has been in the 80s for the past couple years (I am already low carb, weight has been stable for a while now, just difficult to lose) but I am looking to maximize my results so I'd like to hear your experiences! I read online that everyone is recommending the bypass to people with insulin resistance. But I don't think I can cope with the stomach issues and deficiencies. I am already on vitamins because women in my family have Swiss cheese bones!! I was taking Metformin 1000mg two times a day, Cycloset 2.5mg 3 per morning and Byduren injection once a week before my surgery in May. On top of this I was also taking Lovaza for high chlorestoral. Today I am down only 52lbs but I take NO medication for diabetes. I had an A1c in April of a 10.7 and they were talking about putting me on insulin. My last Checkup in October my A1c was down to 6.5 with NO medicines. That is considered to be normal. I chose to have the sleeve because of mal-absorbsion related to the by-pass. I like the idea that my body works as it was intended to with the sleeve but I have portion control that I NEVER was able to achieve on my own. Good luck and Godspeed on your journey. Surgical weight ---266 lbs 5/10/13 Said " Welcome to Gastric Sleeve " 0 Times Do you have diabetes as well? Cause I don't have diabetes. Just the IR. Congrats on your loss! I had surgery almost three weeks ago. I did have the bypass and am doing great. Have five incisions like those with the sleeve. I took my physicians advice; however, I respect Continue reading >>
Metformin After Gastric Bypass Surgery 691701
Metformin After Gastric Bypass Surgery 691701 Este tpico contm resposta, possui 1 voz e foi atualizado pela ltima vez por This amazing site, which includes experienced business for 9 years, is one of the leading pharmacies on the Internet. They are available 24 hours each day, 7 days per week, through email, online chat or by mobile. Everything we do at this amazing site is 100% legal. 24/7 Customer Support. Free Consultation! Effect of Gastric Bypass Surgery on the Absorption and OBJECTIVE Use of gastric bypass surgery is common and increasing. Over 40 of patients in diabetes remission after gastric bypass surgery generic cialis tadalafil best buys may redevelop Gastric Bypass Surgery Can Affect Metformin Treatment Gastric bypass surgery seems to increase the body s ability to absorb metformin. This means that patients taking metformin and similar drugs may need Effect of Gastric Bypass Surgery on the Absorption and Gastric bypass may reduce the absorption and bioavailability of metformin. Over 40 of patients in diabetes remission after gastric bypass surgery may Effect of Gastric Bypass on the Absorption of Metformin Effect of Gastric Bypass on the Absorption of Metformin surgery, has dramatically is significantly reduced after gastric bypass. Modelling the Absorption of Metformin with Patients Post Modelling the Absorption of Metformin with Patients Post Gastric Bypass Surgery. drug absorption patterns after gastric bypass surgery are Metformin after surgery DailyStrengthGastric Bypass Surgery can you buy viagra without a prescription Support Group. Gastric bypass (GBP) is any of a group of similar operative procedures used to treat morbid obesity, a condition which arises PCOS after Gastric Bypass Socialize Thinner Times ForumI was diagnosed with PCOS about 5 years Continue reading >>
Pcos After Gastric Bypass
My heart goes out to all the stories I have read thus far. I have a similar yet different story than some. I didn't see anyone mention Gastric Bypass Surgery as a resort and now again fighting PCOS. I most likely had PCOS since I hit puberty and have many family members who do too but it was not diagnosed. I always knew there was something wrong with my body but no one would really listen. Fast forward to age 19 was put on BC for first time (Norplant) and gained 30 lbs before I even knew what hit me. Didn't change my symptoms of PCOS at all and once I tried to get it removed a couple of capsules broke. I feel with that and the new weight that set more of the weight gain component into motion and I started gaining (literally) 10 lbs a week. Despite my eating "Atkins and Zone" and starting my new-found love affair with protein drinks (LOL) AND exercising with my husband for 60 minutes a day I continued to gain quickly. I lost only self-esteem and dignity and the patience of my new husband. I gained 140 lbs in a year. I was tossed around to many doctors for a year before finding one who said, "You have PCOS, eat more protein and drink less water and take this spironolactone." I didn't understand what I had; I was exhausted physically and mentally with the whole process and just beat down from all the issues. I didn't know he was trying to tell me I had PCOS and how to manage it...he didn't really say that, he just brushed me off like saying I have high blood pressure. I lost 90 lbs and became pregnant with my first child. I still didn't understand PCOS so I gained the 90 lbs. back during pregnancy and continued to gain after giving birth. My hormones were whacked out and my self esteem was gone. I hadn't really changed my lifestyle and just yo-yo dieted out of frustration Continue reading >>
The Case For Bariatric Surgery
Earlier this year, we featured a guest post by Dr. Nicholas Yphantides, a family physician who underwent dramatic weight loss, that was highly critical of bariatric (weight-loss) surgery. This surgery has recently been touted not just as a way to shed pounds, but also as a potential remedy for Type 2 diabetes . For a different perspective, Diabetes Self-Managements Quinn Phillips interviewed bariatric surgeon Dr. Michael Bilof. Quinn Phillips: What led you to become a bariatric surgeon? Michael Bilof: I used to do vascular surgery ; Im a board-certified vascular surgeon. About five years ago, I left my vascular practice and started doing bariatrics. The reason I switched was that most diabetics have, if theyre diabetic long enough, some sort of vascular problems either in their eyes or their kidneys or their peripheral circulation and end up needing the services of a vascular surgeon, either for extremity bypass, for dialysis access, or if it really gets bad, for amputation. And it was not the most satisfying practice for me. The analogy I always use is, its like closing the barn door after the cow got out. By the time they got to me, my job was not so much to reverse the process but simply to slow the rate of decline. Personally, thats not what I got into medicine for. Bariatrics gave me a chance to close the barn door before the cow got out, to see patients 20 years before they would end up seeing a vascular surgeon. QP: What proportion of your patients have diabetes? MB: Id say its anywhere from a third to 40%. I make an effort to attract diabetic patients. MB: I do two types: gastric bypass , which is sort of becoming the gold standard for bariatric procedures, and gastric banding . QP: How successful is gastric bypass in reversing Type 2 diabetes? MB: The best pub 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 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 >>
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
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 >>
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 >>
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 >>
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 >>
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
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 >>
