Exhibit F

Photo by Wonderlane

And now, another case report.

This is a patient I saw in the office today, a young female S/P Gastric Bypass with a history of Type 1 DM. Definitely not the majority of our Diabetes patients in general, as most are Type 2's, but an interesting look at the early changes that occur in a type 1 patient after a metabolic surgery such as the Bypass.

I saw this patient recently as a 1 mos post Bypass check up.

Demographic:  21 y/o F

Start Weight:  252   BMI:  46

Date of Surgery:  11/12  Laparoscopic Gastric Bypass

DM Hx:  DM 1 since 13 years old.  Note from Endocrinology stated she had gained 100# over the previous 6 years while under their care.  Glycohemoglobins in the past never below 10%, control consistently poor.  Poor compliance with self monitoring of BGs.  Regimen prior to surgery was 56 units of Lantus once daily, and Novolog 1 unit for every 4 CHO.

Current DM Hx:  Lost the prerequisite 20# prior to surgery with a mild improvement in insulin sensitivity.  Now, 1 mos after her Bypass, her Lantus dose is decreased to 38 units once daily, and Novolog 1 unit for every 10 CHO.  She describes an easier time with her Diabetic control now, and has gained some momentum with weight loss, with her weight at 219 today, down 40# since start of the pre-surgical process.  

Take Home Point:  An overweight type 1 patient, while not being the rule for that disease state as they are classically lean, can also benefit from weight loss and the metabolic effects of Bariatric Surgery.  Again, her improvement in insulin sensitivity was noted perioperatively, as she was able to be sent home on almost half of her previous basal Lantus dose.  Her insulin sensitivity was also significantly improved as measured by her meal time dosing ratio that went from 1 unit of Novolog for every 4 CHO to 1 unit for every 10 CHO.  

Her new found consistent blood glucose control on an advancing "regular" diet (from post op liquids and pureed foods) in conjunction with steady weight loss has her on a 'health high'.  She is now taking much better care of herself, eating right, exercising, and enjoying her new appearance- a slimming version of her previous self.  Good stuff.

On another note, this patient was being seen by Endocrinology, who had mentioned the need for weight loss on numerous previous visits, mentioned surgical possibilities, and was ready to refer her for weight loss surgery when she was ready.  As mentioned in other places in this blog, given the necessary component that behavior enables to determine a successful outcome, a patient "talked into" surgery, even when indications are strong, often fares sub-optimally   Timing really is everything.  

Again, nice to see that in this case, a somewhat uncommon case of an obese type 1 patient in need of much better glucose control, not to mention comorbidities of asthma and intermittent low back pain, was introduced to the concept of surgery for weight loss, the referring MD had the additional metabolic benefits in mind, and she is now well on her way to healthier living.  Awesome!