RE: Diabetes/bariatric surgery

[Guest guest]

Janice,

1) I write a letter to the PCP informing he/she about the pre-op diet and the need for medication/insulin adjustment. Sometimes our PCP's don't like to refer to endos.

2) I assist the client with meeting BG goals with diet modification; I focus on carb consistency considering it is usually easier to modify insulin when meals are equal.

3) Since this patient is on U-500 he will most likely still require insulin after surgery and should be placed on an insulin drip during surgery.Grace L. RD, Diabetes Educator

St 's Diabetes Treatment CenterWork: (804) 287-7079Mobile: (740) 707-5997

From: Janice Baker <jbaker9@...>Subject: Diabetes/bariatric surgery , dce@...Date: Sunday, June 28, 2009, 1:59 PM

Any suggestions on this scenario?

50 year old male with DM for 30 years on metformin and u500 insulin and humalog sliding scale, BMI 48 (wt 315#) will be having gastric bypass in a few weeks. He also has cardiomypathy, high lipids and hypertension. Does not currently see an endocrinologist. Will have surgery in a location several hours from his home so follow up support groups will be unlikely. Because of his likely very significant change in needed insulin dosing, I suggested that he consult with an endo in his area before surgery for evaluation and post op monitoring. Any experience with such a situation and changes that you see in insulin needs post op?

(has never heard of or tried Symlin or Byetta before-) thanks!!

Janice Baker, M.B.A., R.D., CDE

Registered Dietitian

Certified Diabetes Educator

Medical Nutrition Therapist

(619)742-0145

www.BakerNutrition. com

[Guest guest]

Thank you so much Grace- great info! You are right about the

PCPs!

Janice Baker, M.B.A., R.D., CDE

Registered Dietitian

Certified Diabetes Educator

Medical Nutrition Therapist

(619)742-0145

www.BakerNutrition.com

From:

[mailto: ] On Behalf Of Grace

Sent: Sunday, June 28, 2009 7:03 PM

Subject: Re: Diabetes/bariatric surgery

Janice,

1) I write a letter to the PCP informing he/she about the

pre-op diet and the need for medication/insulin adjustment. Sometimes our

PCP's don't like to refer to endos.

2) I assist the client with meeting BG goals with diet

modification; I focus on carb consistency considering it is usually easier to

modify insulin when meals are equal.

3) Since this patient is on U-500 he will most likely

still require insulin after surgery and should be placed on an insulin drip

during surgery.

Grace L. RD, Diabetes Educator

St 's Diabetes Treatment Center

Work: (804) 287-7079

Mobile: (740) 707-5997

From: Janice Baker <jbaker9@...>

Subject: Diabetes/bariatric surgery

, dce@...

Date: Sunday, June 28, 2009, 1:59 PM

Any

suggestions on this scenario?

50

year old male with DM for 30 years on metformin and u500 insulin and humalog

sliding scale, BMI 48 (wt 315#) will be having gastric bypass in a few

weeks. He also has cardiomypathy, high lipids and hypertension.

Does not currently see an endocrinologist. Will have surgery in a

location several hours from his home so follow up support groups will

be unlikely. Because of his likely very significant change in needed

insulin dosing, I suggested that he consult with an endo in his area before

surgery for evaluation and post op monitoring. Any

experience with such a situation and changes that you see in insulin

needs post op?

(has

never heard of or tried Symlin or Byetta before-) thanks!!

Janice

Baker, M.B.A., R.D., CDE

Registered

Dietitian

Certified

Diabetes Educator

Medical

Nutrition Therapist

(619)742-0145

www.BakerNutrition.

com