How does bariatric surgery cure type II diabetes? The hypothesis of a pathogenic insulin analogue that interferes with the function of endogenous insulin causing insulin resistance and NIDDM

Abstract

This hypothesis proposes that a Pathogenic Insulin Analogue (PIA) exists which is absorbed in the proximal gut and interferes with the insulin binding receptors, preventing the normal function of endogenous insulin. PIA causes or substantially contributes to the development of Impaired Glucose Tolerance, Insulin Resistance, and Non Insulin Dependent Diabetes Mellitus (NIDDM). PIA is produced by the intestinal microbiota in the proximal gut in the presence of food. Bariatric surgery is effective in curing NIDDM because it prevents food entering the proximal gut, (stomach, duodenum, jejunum) hence stopping the formation and absorption of PIA resulting in lasting remission of NIDDM.