Erin lay on a bed in the emergency room, finally serious about getting help. Her second episode of diabetic ketoacidosis in a single year had sent her to the hospital shaking and vomiting. For the past seven years, she had been driven by one desire: to lose forty pounds. She refused to give herself her full dose of insulin, fearing weight gain. She hadn't seen her endocrinologist or checked her blood sugar for a year or two.
As we wrote back in 2008, the EndoBarrier is a very clever way to simulate the effect of a gastric bypass without the unpleasant scalpel part. It looks like a long clear plastic stocking, and it's simply threaded through the patient's mouth and stomach, down to the small intestine, where it lines the intestine's upper section (the same part that is bypassed in traditional surgery). Food slips right through it, but digestive enzymes are trapped on its other side. The two don't get to join forces until a couple of feet further downstream, so the effect on diabetes is a lot like that of a bypass: It resolves the symptoms of type 2 diabetes.
Michael Hamman is a 63-year-old contractor. He recalls, "I first was diagnosed with type 2 diabetes five or six years ago. I probably had elevated blood sugar well in advance of that, but I was unaware of it. I don't remember how high my blood sugar was at the time, but I think my A1C was 7.5%. My blood sugar's never really been awful. Since I started monitoring myself, my sugar readings are normally between 150 and 165. I think it was pushing 200 before I was medicated, but the medications brought it down. They started me on glyburide and I took that for a long time, and then the A1C was moving up again, so they added the metformin. The A1C now is down in the mid-sixes. They consider it controlled, not well controlled or as good as it could be, but certainly for someone my size, it's probably as good as you can get."
The Centers for Disease Control and Prevention (CDC) has identified a swath of the southern U.S. as the country's "diabetes belt." In this region, made up of parts of 15 states, some 12 percent of the population has type 2 diabetes, compared with 8.5 percent of people in the rest of the country.
You know that awful feeling when a sugar low is coming. I break out into a cold sweat, feel panicky, get nauseated, and have trouble answering extremely simple questions like "Do you need to eat?" Well, I was feeling it again, and again, and I didn't know why. That's what I hate the most: When things go wrong, but I think I've been doing everything right.
Ellen Granberg is an obesity sociologist who studies the processes that people go through when they lose weight and keep it off. As she says, "If the problem were that we don't know what people should eat to lose weight, that would be one thing, but we don't have that problem. There are a hundred weight loss plans out there that are perfectly good. We understand all about the physiology of weight loss maintenance and the metabolic impacts, but nothing about the social and emotional impacts. People who sustain weight loss over time move through a lot of different challenges."
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