Metabolomic Analysis of Hepatic Insulin Resistance

Inclusion criteria

Subjects eligible to participate in the study will be:

• Adults over age 18;
• Patients enrolled in the bariatric surgery clinic who are planning to undergo and have insurance approval for bariatric surgery;
• 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)
• Able and willing to give informed consent.

Exclusion criteria

The following will exclude subjects from study participation:

• 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.
• 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]).
• 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.
• Inflammatory or celiac intestinal disease;
• Untreated thyroid disease;
• Excessive alcohol use, illicit drug use, or active untreated psychiatric disease.