Metabolomic Analysis of Hepatic Insulin Resistance

Inclusion Criteria:

Subjects eligible to participate in the study will be:

1. Adults over age 18;

2. Patients enrolled in the bariatric surgery clinic who are planning to undergo and
have insurance approval for bariatric surgery;

3. Insulin sensitive (based on HOMA-IR calculated from screening labs) OR insulin
resistant (based on HOMA-IR and or personal history of diet controlled diabetes)

4. Able and willing to give informed consent.

Exclusion Criteria

The following will exclude subjects from study participation:

1. Clinically significant medical issues outside of diabetes (eg, pregnancy,
cardiovascular disease, uncontrolled pulmonary disease). If female and of child
bearing potential, a pregnancy test will be performed and confirmed negative prior to
participation in the study and prior to the scheduled glucose clamp procedure.

2. A history of hematologic (platelets <100 x107/L), hepatic (liver function tests
[LFTs] >2X upper limit of normal), renal (Creatinine >1.5 mg/dL), pulmonary/ cardiac
abnormalities (ie, abnormal electrocardiogram [EKG]).

3. Use of anti-diabetes medication, anticoagulants, or medication that might alter
lipids. If the subject has a history of diabetes, it should be controlled by diet
alone.

4. Inflammatory or celiac intestinal disease;

5. Untreated thyroid disease;

6. Excessive alcohol use, illicit drug use, or active untreated psychiatric disease.