Mr. McKinley has had type 2 diabetes for several years. His ...

[tiara099]

Mr. McKinley has had type 2 diabetes for several years. His physician shared with him that after surgery he will not be on any medications for his diabetes and that he may be able to stop his medications for diabetes altogether.
 
  Describe the proposed effect of bariatric surgery on the pathophysiology of type 2 diabetes. What, if any, other medical conditions might be affected by weight loss?

Question 2

Calculate what Mrs. Joaquin's energy needs will be once she begins hemodialysis.
 
  What will be an ideal response?

[aliotak]

Answer to Question 1

 Glucagon-like peptide 1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP) stimulate insulin secretion. GLP-1 also suppresses glucagon and slows gastric emptying, which delays digestion and reduces postprandial glycemia. GLP-1 also acts on the hypothalamus to induce satiety. Bariatric surgery increases the levels of these hormones and are hypothesized to dramatically improve glycemic control post-operatively.
 Weight loss will improve insulin sensitivity and contribute to improved glycemic control.
 Bariatric surgery restricts food intake to a small portion of food at each sitting, which increases satiety and helps prevent hyperglycemia.
 Other conditions that may be affected by weight loss include cardiovascular disease. If hyperglycemia can be controlled, it may reduce the damage to the blood vessels, which aids in reducing risk of cardiovascular disease.
 Sleep apnea will be improved with weight reduction, as there is less mass around the respiratory muscles.
 Hyperlipidemia can be improved. As the patient eats more consistently with a decreased capacity, lipid profiles may begin to normalize as the patient loses weight.
 Blood pressure can be lowered with weight reduction, aiding in resolving hypertension.
 May reduce risk of cancer as obesity is linked with some forms of cancers
 May improve psychological health as obesity is associated with feelings of guilt, depression, anxiety, and low self-worth

Answer to Question 2

 SBW is 60 kg and her aBWef is  70 kg
70 x 35 = 2450 kcal
 Mrs. Joaquin's energy requirements are at least 2450 kcal/day or rounded to 2500 kcal/day.

[tiara099]

Thank you!

[aliotak]

Always glad to help...