Exhibit B

Photo by Wonderlane

Here's another case study, a patient who had surgery last week.  Before I put up another report, I will put together a post detailing the pathophysiologic mechanisms at work that make Bariatric Surgery so beneficial for Diabetes.

Demographic  66 y/o WF

Start Weight  278 /  BMI 42

Date Of Surgery  9/12  Laparoscopic Gastric Bypass

Diabetes Hx  Glimepiride 4 mg QD, Victoza, Metformin 500 QD, Actos 30 mg QD.  Controlled pretty well per the patient, had started meds for Diabetes 12 years ago.

In Hospital  We put her on Novolog sliding scale immediately post op, and let her settle out over the next 24 hrs to see what she would need.  The stress response to surgery sometimes causes a transient rise in BGs, and seems to quiet down in most patients by POD 1.  First reading after surgery was 244, then 157 next AM on no other maintenance coverage. On POD 2, the last 2 readings before she was D/C were 98 then 78, again requiring no insulin, PO meds, or Victoza.  She was sent home on no meds, and we will see her in the office in 1 week for follow up.

Take Home Point  Again, a fairly typical, yet profound, improvement in restoration of euglycemia after surgery, and sent home off all antidiabetic meds. 

A couple of interesting points.  She had DM2 for 12 years, on a good mix of medicines, and sometimes that duration of disease alone is enough to diminish the favorable metabolic effect of the surgery. Add to that her age, and it was a little surprising she did so well after surgery.  She will have to be watched long term for the slight chance of the return of her Diabetes, but with additive weight loss as expected from the surgery, she should do well for quite a while after surgery at a minimum.

Also, she said she lost 30# preoperatively on a Lean and Green diet, exceeding our requirement of 10% loss required to get to surgery.  That is usually enough to make a dent in DM2 meds needed, as often evidenced by patients getting hypoglycemic on their usual meds for DM2 as they lose weight in our preoperative phase, prepping for surgery.  She told me there was no change in her meds despite the significant weight loss preop, and that makes you think about significant insulin resistance, or the start of an insulinopenic state potentially brought on by prolonged DM2.  

In any event, she's through the surgery, did well, "Sugar-Free", and we'll recheck her next week.