title: [Bariatric surgery in a patient with adipositas permagna and uncontrolled  insulin resistance].
abstract: METHODS
  A 58-year-old patient had a 21 years history of diabetes mellitus and multiple diabetic complications. In addition he suffered from severe obesity with a body mass index of 42.7 kg/m² and a waist circumference of 141 cm. After all treatment options according to the national guidelines had failed the patient was admitted to a diabetes clinic.
  
  
  METHODS
  All approaches on the metabolic ward to control insulin resistance failed as well and finally blood glucose levels could only be stabilized with the aid of continous subcutaneous insulin infusion with more than 500 units per day. The patient's quality of life and the options for physical activity were extremely limited.
  
  
  METHODS
  Thus, the indication of bariatric surgery was discussed with the interdisciplinary team of specialists and with the patient. After informed consent a Roux-Y gastric bypass was established with the aid of minimal invasive surgery. Already two weeks after the operation insulin demand had decreased to 100 units per day and metabolic control and the treatment could be further optimized. Three months later the body mass index was reduced to 34.3 kg/m². The treatment improved the patient's quality of life, optimized metabolic control and resulted last but not least in lower costs for the diabetes treatment.
  
  
  CONCLUSIONS
  Bariatric surgery is an additional option in the treatment of obesity and insulin resistance. The collaboration between diabetologists and bariatric surgeons is a prerequisite for the successful selection of patients and for longterm control after surgery.
authors.affiliation: Diabetes Zentrum Mergentheim, Bad Mergentheim. haak@diabetes-zentrum.de
authors.forename: T
authors.initials: T
authors.lastname: Haak
authors.forename: T
authors.initials: T
authors.lastname: Horbach
mesh_terms: D050110:Bariatric Surgery; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications* / Q000628:therapy*; D016896:Treatment Outcome