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Insulin sensitivity

Post-op insulin sensitivity affected by pre-op changes

Pre-op the patients lost 40 lbs (8.9% of his initial body weight) and his insulin requirements decreased to a total of 55 units of U-500 per day

Bariatric surgery has immediate effect on insulin sensitivity and the effect is more pronounced if associated with pre-operative lifestyle interventions and weight loss, according to a case study (‘Reversal of severe insulin resistance immediately after bariatric surgery’, abstract No. 255) presented at the American Association of Clinical Endocrinologists’ annual meeting in Las Vegas.

The case report concerned a 49 year old male with a longstanding history of morbid obesity (BMI 59), T2DM (more than five years), obstructive sleep apnoea and hypertension. The patient was insulin dependent for at least three years with severe insulin resistance requiring a total of 300 units of insulin U-500 per day and Metformin 1000mg BID.

Prior to surgery he was placed on a medical weight management programme (dietician supervised calorie count and regular exercise) for six months. He lost 40 lbs (8.9% of his initial body weight) and his insulin requirements decreased to a total of 55 units of U-500 per day.

The patient then had a sleeve gastrectomy and at one hour postoperatively required only 2 units of regular insulin subcutaneously. His fasting blood glucose, fasting insulin level and C-peptide were measured at 24, 48 and 72 hours postop and HOMA-IR was calculated and the results were 18.82, 11.43 and 5.84 respectively.

He required no further insulin and was discharged home with no diabetic medications. At 2 week follow-up and following a liquid diet, his fasting glucose was 113mg/dl with a simultaneous insulin level of 16.5 (uIU/ml), his HOMA was 4.6. The patient was off his diabetic medications.

The researchers from St Vincent Medical Center, Cleveland, OH, said that the case illustrates the effect of lifestyle changes can have on insulin sensitivity and ”demonstrates the effect of bariatric surgery on insulin resistance in the immediate postop as reflected by the dramatic improvement of his HOMA score and his null postop insulin needs.”

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