A 65-year-old man with type 2 diabetes was referred by his primary care physician to the weight center for an evaluation of his obesity and recommendations for treatment options, including weight-loss surgery. Pertinent medical history. Current medications include 30 to 70 units of NPH insulin before breakfast and before or after dinner, respectively. 850 mg of metformin twice daily, atorvastatin, lisinopril, nifedipine, allopurinol, aspirin, and an over-the-counter vitamin B12 supplement.
He reports that his morning blood glucose levels are 100–130 mg/dl , his hemoglobin A 1c (A1C) level is 6.1%, which is within normal limits, his triglyceride level is 201 mg/dl, and serum insulin is 19 ulU/ml. He weighs 343 lb and is 72 inches tall , giving him a BMI of 46.6 kg/m 2 . Weight history. Patient developed obesity as a child and reports having gained weight every decade His family…
