I'm new to all this, but I was wondering if rny is safe for a double diabetic (I am a type 1 that became a type 2)?  I am sure the doctors would have to look at my particular case, but has anyone (double diabetic) had success with it?  I have appointments set up with the bariatric center and endocrinologist already, but in case there are some serious issues with it I figured I better mentally prepare myself in case someone tells me this is not an option.  
I've lost all but one member of my family to type 2 diabetes ...all of them at young ages.   I am determined not to have the same fate, but I have not been able to reverse the type 2 on my own. I'm thinking this is my last resort... 

 Lacey,

I just had the RNY done almost a month ago and my husband had it done 4 months ago. We both are type 1 diabetics. Your endocrinologist would be the person I would talk to about the diabetes information. Your type 1 will never go away but will be in better control once you have the surgery done. If you are gaining better control, I would assume that your type 2 will go away. The RNY has proven to cure type 2's.. the only thing that has been proven to cure it. 

I am on an insulin pump and my insulin daily totals doses went from about 90-100 units before surgery, down to 40-50 4 weeks after surgery(that includes food). My husband decided to go on a "pump vacation" about a year ago but his daily total went from about the same as mine.
I hope this helps.
Steph
RNY 12/08/11

 Thank you.  Have either of you  had many problems with your blood sugar dropping too low?  I was concerned because there is so much talk about staying away from carbs altogether because they will make you sick.   Others have said type 1's can have severe problems with dropping too low...I just don't want ot replace one problem with another is that is the case.
I was on a pump 5 years ago but currently I am not and take around 300 units by injection...no wonder I can't lose any weight.  Anyway, I'm sure the nutriionists will help me with it, but it is still scary to think about taking that much insulin awhile losing weight rapidly.

 I have not had too many problems with it. For 2 weeks prior to surgery I was on protien shakes only and I had to adjust my settings in the pump. after the first 2 days, I dropped my basal rates by 50% then after a week, I dropped them another 25% (if I did need to correct a low I took poweraid). Even on surgery day and the week after I dropped them another 10% just in case and I ran at 180-200 bg.
Now that I'm on food, my BG's are increasing so I will have to readjust again.  As for dumping, being a type 1 diabetic you may not get dumping with sugar since your body does not produce insulin...
I did go low the first week out and I put a small piece of fudge under my tongue and it worked.. frosting under the tongue can work too so then the sugar will be absorbed directly into the blood stream.  Now that I'm on food, I just have a greek yogurt and that raises my sugars back up

 good to know, thanks. It helps to kinda know what to expect and come up with questions for the surgeon for when I see him.

On January 1, 2012 at 9:58 PM Pacific Time, mysterymonkey6 wrote: The RNY has proven to cure type 2's.. the only thing that has been proven to cure it. 


Just a point of clarification/correction - the RNY is not a proven type 2 diabetes cure in that it does not work 100% of the time and is not always a PERMANENT cure. It's also not the "only" proven cure. The DS has a higher success rate at resolving type 2 diabetes than the RNY plus has better long-term statistics for keeping the diabetes in remission (or cured or whatever word you want to use).

More info available in my profile and right here: http://www.obesityhelp.com/forums/diabetes/3751535/If-you-ar e-Type-2-and-considering-WLS/

 From what I can tell it looks like DS is better for those with a bmi of 50 or more and riskier for people under that.  I am at 38 right now.  I see also that it is a bigger pouch, which kinda makes me think it would be more practical, but at the same time that mentality can be my down fall if I get into the habit of allowing myself to think I can get away with eating more...especially without the dumping issue.  I don't know though I had ruled it out, but,enough people have mentioned it that now I have put it back on the table.  DS and RNY, besides the band, are the only ones my insurance will cover so it's just between those.  At least I still have a lot of time to figure it out and all this gives me things to ask the bariatric team about on Monday.  Thanks.

I had a BMI of 40 when I was approved for the DS--and when I actually had surgery I was at a BMI of 38.  We have plenty of light weight DSrs and it's absolutely untrue that it's a surgery reserved only for the super morbidly obese.  As long as you meet the nationally accepted standards for bariatric surgery, you can have the DS.  Regarding the RNY, many people with the RNY end up overeating because they either don't dump (not everyone does) or because they become reactive hypoglycemic and need to eat right away after the food has pushed it's way through that stoma.  They HAVE to eat in order to raise their blood sugar levels.  With the DS, as long as you stay away from most carbs (or limit them severely), you can eat lots and lots of protein and lots and lots of fat.  Only 20% of fats are absorbed and many of us need to eat enormous amounts in order to keep our stool soft enough to poop.  Most DSrs eat way more than the average person.  You're limited by the size of your stomach (mine feels TINY!) but the most important thing with the DS is to make sure you get 100 g or protein at least a day.  So you're either drinking shakes or eating foods that are high protein to get the minimum in.  For dinner tonight I had an egg (my tummy is still TINY) with extra thick bacon mixed in and lots and lots of cheese mixed in.  On New Year's eve, I had 1/4 of a crab cake (it was all I could eat), half hour later I had part of a lobster SOAKED in butter.  I did not feel deprived.  But with the RNY, you'd be in some serious trouble with all of that fat.  If you ask around, many people who've gotten the DS will say that one of the reasons they chose it was because it allowed much more opportunity to eat like a normal person and yet not gain the weight back.  No surgery is a sure thing and one can gain back weight with any of them.  With the ds, if you fill up on carbs instead of protein, you'll gain back the weight--or at least some of it.  But if you're filling up on protein first, you'll only have room for very few carbs and then you're pretty much eating how you'd want.  As a Type 1 or 2 diabetic, you are supposed to be avoiding carbs anyway so it shouldn't be too much of a lifestyle change from what you need to be doing anyway.  

Also, the malabsorption with the RNY pretty much disappears after the first 2 years or so so you're more likely to gain back your weight.  This isn't the case with the DS--the malabsorption doesn't go away--therefore there must be a lifelong commitment to taking vitamins, meeting protein requirements, and getting enough fat into your diet.  I love hearing about how DSrs eat.  It sounds like a lot of fun.  Their slogan is always, "Bacon makes everything better!"  Or, "Just add some heavy cream to it!"  

Just give it some thought and do LOTS of research about the benefits and draw backs of the RNY.  We have SO many RNY to DS revisions on the other board that I'd NEVER consider the RNY.

Oh and as far as the risks regardng doing the DS on a lightweight such as myself (or you), these were my surgeon's exact words,"I wish I had more patients like you.  You're BMI isn't out of control, you're pretty fit and can move around well so healing will be better, and your younger (I'm 37).  I wish I had more HEALTHY patients come in here for surgery like you."  He made no mention of more risk with the lower BMI. Infact, he said it was BETTER. 

Again, I wish you luck!

Sheri

 Thanks, so far from what I can see at least one of the maintenance plans for the DS is exactly the same thing I am currently doing (it's just the 12-1600 calorie diabetic exchange diet).  I am sure I can stick to that so the transition wouldn't be a problem.  
I think I just get a little freaked out over the complication list being longer than RNY.  Have you had any problems with acid reflux getting any worse?  Or if you had it before did it go away?  I currently do have it and my doctor thinks it would go away once the sleep apnea goes away.  Still, I know what it's like to eat something and immediately get sick afterward.  I don't even go out to eat much because I'm afraid I'll throw up in public.  If that's what will happen with the RNY I'd probably be more likely to stop eating altogether just to prevent the dumping and I don't think that part of the surgery will increase my quality of life.  
Anyway, we'll see what they recommend for me and go from there I guess.  

 I did not experience ANY of the complications listed for the DS.  I had a little acid reflux before surgery--after ward, I had a little as well.  In fact, I realized early on that I needed a stronger med for it (the reflux made me nauseous and I was on pepcid in the hospital)  So I changed to Prilosec--I started taking it 2 times a day at week 2  and it was gone!  and now at week four I forget to take it all the time because I feel fine--then about a day or two after not taking it I feel it coming back a little and pop one and it's gone again.  The surgeon said that his patients (all bariatric patients) go on some type of acid reducer for the first 6 months or so because it's likely to be a problem (with ANY of the surgeries).  I have had no diarrhea, no real gas (less than before surgery actually), and my bowel movements have been relatively solid or soft-serve.  I'm finding now this week, that I must up my fat content because I haven't had a movement in 4 days.  Last time I had lots of butter seemed to get me going but this week I've had very little appetite.  

With the DS, you won't find yourself feeling like you're going to throw up after eating (it's not a common side effect).  What you'll find is that you'll feel full after a bite during your recovery.  Now that I'm four weeks out, I can eat several bites, but if i eat them too quickly, I start feeling like I was just at at Thanksgiving feast and can feel that food in the back of my throat.  So, even if i can take 5 bites, I have to eat them waiting a few minutes before the next bite.  But I haven't felt sick to my stomach at all.  Now directly after surgery it's not uncommon to feel nauseous.  However, this is common with all of the weight loss surgeries and can usually be fixed by taking something like Zofran on a regular basis until it passes.  

What part of the list of DS complications are you worried most about?  If it's the vitamin thing, yes, you'll HAVE to supplement in order to get enough vitamins, calcium, iron, etc. because of the poor absorption.  The vites seem to cost most people between $60 and $110 a month.  It varied depending on where you get your vitamins and what your lab results look like. But, RNY patients are also supposed to take lots of vitamins and many don't--which leads to lots of complications down the road.  DS patients are know for being very medication and vitamin compliant.  Any diarrhea that a DS patient experiences can usually be avoided by using the process of elimination to figure out which foods trigger it--usually it's sugar or other carbs but I have no problem with carbs at this point (though I try and avoid them since I'm not far out from surgery and since I'm already a Type II diabetic).  Gas can also be controlled through diet.  Give me a list of some of the things you're worried about with the DS?

Glad you're at least considering your options; nothing is more painful to read than someone who was fed a line of BS about one procedure or another and made their decisions based on that without more thorough research.

Just some food for thought:

Many patients have gotten the DS with a BMI of less than 50. I happen to have a local friend who got her DS at a BMI of 35 (she had type 2 diabetes) and is now 4+ years out, healthy and maintaining. The DS is the most statistically successful tool for those with a starting BMI of 50+, but that does not make it "riskier" for those with lower starting BMIs, and it is still statistically the most effective for type 2 diabetes regardless of BMI (they even do just the intestinal part of the DS in some other countries on NON-OBESE type 2 diabetics as a means of resolving the diabetes for those who don't even need to lose weight).

Also, the DS doesn't have a "pouch," but rather a "sleeve." I know some surgeons still refer to it as a pouch, but there are important differences: first, the pylorus (the valve that regulates the flow of contents from stomach to intestine) is NOT bypassed with the DS, while it IS bypassed with the RNY. This is what leads to increased risks of dumping syndrome and reactive hypoglycemia in RNY, plus it allows foods to leave the stomach faster, which can make you hungrier again sooner after eating. And, while the DS sleeve is typically larger than the RNY pouch, it still offers great restriction - you will NOT be able to eat the same amount of food at one time as pre-op. They essentially remove about 70-85% (depending on the surgeon) of your stomach, and the remaining sleeve is made from a less stretchy part of the stomach than the RNY pouch (many RNYers have trouble in the long run because they stretch out the pouch and/or the stoma - the connection between pouch and intestine where the pylorus used to be - and then they almost never feel full because the fod flows so quickly out of the pouch).

Please keep in mind that only about 30% of RNYers experience dumping syndrome in the long term, so don't rely on that as a means of controlling what you will eat (plus, some RNYers end up experiencing severe reactive hypoglycemia, not just dumping, which, as you know, can be very dangerous). Not to mention that we are human - I know multiple RNYers who can tell you that dumping does not always work as a deterrent; they just plan their eating so their dumping episodes will happen when they're home with time to deal with it. They also get frustrated because some things that they would expect to make them dump don't, and sometimes they experience dumping and can't pinpoint the cause. Multiple studies have shown that negative reinforcement (punishment) is much less effective than positive reinforcement for behavior adjustment; even dog trainers know that scolding or hitting a dog when they've done something wrong is pretty much useless - rewarding them for GOOD behavior is the better way to train   :)

You're very fortunate that your insurance covers both procedures without having to fight!

 Yes, I know negative reinforcement will not work on me so that is a concern if I go the RNY route.  I have 2 friends who did the RNY which is why I was looking into it first.  Both of them had to keep going back in to reopen the stoma which is not something I want to deal with either.
I'm sure the insurance will find something to fight me on lol, but yea I am grateful the insurance part will be the least of my worries.

 "The RNY has proven to cure type 2's.. the only thing that has been proven to cure it. "


You are absolutely incorrect. The articles below show that the Duodenal Switch cures Diabeties as well or BETTER than the RNY.  Just read the conclusions and you'll see.

1.    " Bileopancreatic Diversion with Duodenal Switch Lowers Both Early and Late Phases of      Glucose, Insulin and Proinsulin Responses After Meal."

   http://www.dsfacts.com/Type-2-Diabetes-Cure.html

2.  Duodenal switch provides superior resolution of metabolic comorbidities independent of weight loss in the super-obese (BMI > or = 50 kg/m2) compared with gastric bypass.
Prachand et al. Feb 2010
PubMed Abstract 

OBJECTIVE: Increased body mass index is associated with greater incidence and severity of obesity-related comorbidities and inadequate postbariatric surgery weight loss. Accordingly, comorbidity resolution is an important measure of surgical outcome in super-obese individuals. We previously reported superior weight loss in super-obese patients following duodenal switch (DS) compared to Roux-en-Y gastric bypass (RYGB) in a large single institution series. We now report follow-up comparison of comorbidity resolution and correlation with weight loss.

METHODS: Data from patients undergoing DS and RYGB between August 2002 and October 2005 were prospectively collected and used to identify super-obese patients with diabetes, hypertension, dyslipidemia, and gastroesophageal reflux disease (GERD). Ali-Wolfe scoring was used to describe comorbidity severity. Chi-square analysis was used to compare resolution and two-sample t tests used to compare weight loss between patients whose comorbidities resolved and persisted.

RESULTS: Three hundred fifty super-obese patients [DS (n=198), RYGB (n=152)] were identified. Incidence and severity of hypertension, dyslipidemia, and GERD was comparable in both groups while diabetes was less common but more severe in the DS group (24.2% vs. 35.5%, Ali-Wolfe 3.27 vs. 2.94, p