Monday , October 23 2017
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Helping Patients to Achieve Behavior Change


Man, 76 years of age, type 2 diabetes, obesity, SP right total hip replacement one year out. When preparing for hip surgery, was on basal and bolus insulin, metformin. Had been on a GLP-1 but had diarrhea so he stopped. Was able to, for the most part, follow a lower carbohydrate meal plan but was not active. When he first started coming to us for weight loss to prepare for his surgery, his weight was 304 pounds, BMI 45, A1c 9.9%, Cr 1.87, eGFR 34. We decreased his metformin from 2,000mg/day to 1,000mg day and referred to nephrology. With this change and being motivated for surgery, he lost weight and in 6 months went into surgery having lost 25 pounds with an A1c of 6.9%. Note, due to eating less carbs, he could take less insulin, which seemed to help his appetite. Surgery was performed and he did well.

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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #83: Measuring Insulin Action In Vivo


The heralded isolation of insulin in Toronto in 1921 was followed immediately by treatment of diabetes. It soon became clear that while insulin was effective in regulating the blood glucose levels in most patients, there were some subjects in whom insulin appeared to be ineffective. This lack of insulin effect was termed “insulin resistance” as early as 1925.

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