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These data suggested that the gut makes a hormone(s) that regulates insulin levels, and they came to be known as incretins which were defined by Creutzfeld as factors that i) are released from gut in response to carbohydrates, ii) stimulate insulin secretion, and iii) act only in the presence of high blood glucose (2)

If youve got severe obesity and severe OSA and youre not an ideal MMA candidate right now, a course of GLP-1 therapy followed by surgical evaluation is a reasonable path

I take two lessons from this story

A bag of pretzels that didnt matter before now represents a missed opportunity for 1520g of protein

Gastric emptying is now recognized as a major determinant of postprandial glycemic excursions in both healthy subjects (6) and people with diabetes (7) and accounts for about a third of the variance in the initial rise in glucose postoral challenge (ie, first 15-30 minutes) (6)

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