Metabolics of Roux-en-Y Gastric Bypass (RYGB) With Gastrostomy

The rapid and durable remission of type II diabetes mellitis following the gastric bypass
operation challenges the current concepts about the etiology of the disease. The surgery,
which excludes food from the stomach, duodenum, and proximal jejunum, is quickly followed by
a durable drop in glucose and insulin levels. As a result, 4 out of 5 diabetic, morbidly
obese individuals who undergo the operation return to a long-term euglycemia with a
prolongation of life and a reduction of health care costs.

The investigators at East Carolina University and those at Johnson and Johnson propose to
further complete the profile of the upper gut by extending their observation to three
additional human models. The investigators will study patients having the gastric band
procedure, the gastric sleeve procedure, and those who have a gastric bypass but have a PEG
tube inserted later.

Inclusion Criteria:

- Female

- 18-60 years of age

- BMI of 35-65

- Willing to comply with study requirements and long term follow-up

- Capable of understanding the requirements and consequences of surgery and the study

- Is scheduled to have bariatric surgery performed

- Has a negative pregnancy test

Exclusion Criteria:

- Repeat gastric bypass procedure

- Patients who are unable to hold their insulin coverage for 48 hours prior to research
visits

- Patients taking TZDs