ObesityHelp

I am post op VSG 5 months. I am a Diabetic Type 2 and highly carb sensitive. I was on Novolog Insulin, Lantus Insulin, Glypizide and Metformin (Long Release) Pre-op. My highest weight was 270lbs (A1C 11.2), I lost 45lbs Pre-op, surgery weight was 225lbs (A1C 6.8 off all insulin) and now I am 190lbs (A1C increased to 7.8) I am on 750mg per day of Metformin. 

Pre-op my previous doctor placed me on 20-30grams of carbs per day, I worked out 3-4 times per week but this made me very sick and I went Hypoglycemic 4 times with a Glucose reading of 28,35,31 and 30. I fainted 3 times. My nutritionist said 80-100g per day for my body to function pre-op.

Now I am going on to my 7th week stalling at 190lbs, I have increased my exercise, water and getting in my protein, I am on 900cals per day and my average carb intake is 70g per day. My new Endocrinlogist said between 80-100g of carbs per day is good, BUT my nutrtionist said I should never be eating that many carbs. I drink skim milk, low fat dairy, flax seed products, no pasta, rice and very rarely I will have starchy vegetables, but everything has carbs in it and it all adds up.

I would love to hear from some of the post-opers with Diabetes who could give me your opinion and experience with carbs post-op and how many carbs you were having 5 months out. Between my nut and endocrinologist I am so confused. I need my A1C to get down to under 6.0!

Wow - glad that I got something right!  :-)  You should be fine to wait on the metformin.  I used to take 2000 mg per day and went without for about 2-3 months.  I started back at half the dose - no problems. 

You go girl!  Keep up the good work!

You were completely right. I met with the diabetic nurse and I'm getting that test this morning.

She also said that waiting a bit to start the metformin again is fine.

I am wondering if being anemic would make my A1C level inaccurate. Just read about the testing and since they check the the sugar in the red blood  cells, then average it. Seems like it would be off in a person who has a low red blood cell count from being anemic. Any info is greatly appreciated.

Aha.  When i was originally tested for insulin resistance and PCOS I was told that the GTT was the only test that would tell if I had IR.

You are now telling me there is a simply blood test and so thank you. That is the information that I need so after surgery my doctors can still check to see if I have insulin resistance.

Insulin production is what needs to be tested for me because my blood sugar levels remain the same no matter what.

Thank you

I'm getting RNY.

Currently I do not check my blood sugar but the issue with insulin resistance is that my blood sugar will always be normal, it's the amount of insulin in my body that changes.  My understanding is that only the glucose test can check insulin. Maybe there is a blood test that can tell?

I posted this question on the PCOS board as well.

I don't have diabetes but I do have insulin resistance and am on metformin.

I was diagnosed with IR by doing the glucose tolerance test.  I am having surgery on Tuesday and have decided not to take metformin the month I'm on liquids because it's too complicated to get that in liquid form.

Once I lose a lot of weight how can a doctor test to make sure I still have IR if I can't do the glucose test?

I have not had any of that.  I do battle constipation a bit now, and go just about every other day.  I've learned by reading some of the RNY boards how to manage it though and have talked to my doctor about it.  (It's super common....)  I usually take 1-2 stool softeners about every day and also have added some fiber chews.  That stuff and staying hydrated and exercising really does make a big difference.  It's annoying, but certainly not life altering, if you know what I mean....definitely manageable.

I do find that I belch a bit more now, but nothing terrible.  It seems to happen when I drink fluids a bit more.  I guess air and liquid get in there and need to find their way out.  But definitely not gross or smelly farts or anything like that.  None.

Another hesitation I had about DS was exactly the gas issue. There is someone else I know who had it and that issue is the talk of his staff.....I couldn't fathom it.  I know him and know that he also eats a lot of sugar, carbonated bevs, etc. and that can't be helping that problem.  But I was mortified at the thought that my digestive issues might be the talk of my office, so that was another thing I was concerned about (like you). 

Keep the questions coming.....I wish I had had someone answer some of these things for me in the decision making process!  And get some sleep.....

Well, I DO have a biased opinion because I also had RNY...but I did research heavily so that I made the right choice for me based on what I learned.

You mentioned that your mom had a difficult time post-surgically.  I am so sorry to hear that. Was her surgery open or laparoscope?  I am betting that, since it was 2004, it was open.  Things have really changed since she had her surgery.  Many surgeries are now laparoscopic - less pain, less chance for complication, quicker healing - all very positive changes.   I have to say that I breezed without much trouble at ALL and mine was a laparoscope.  That should be part of what you explore with a potential surgeon - how does he/she do these surgeries?  is there any reason why you cannot have yours done that way?  these are all great questions for a surgeon and his team.  They will lay all of this out for you and talk with you about what is best for YOU.

I was in the hospital for 3 full days and discharged on the morning of the 4th day.  I was kept an extra day for blood sugar control issues.  I did not even need any pain medication at ALL after the first full day, even though it was readily offered to me.  I just didn't need it.  I came home with a prescription for pain medication than I never even had to fill.  Liquid Tylenol was all I needed.

Even the nausea was very, very limited and I had none in the 4-6 weeks after surgery.  After I started on solid food, I had 2 very small episodes of vomiting.  But, basically I took a bite of something that didn't sit right and it just came right out.  No drama, no dry heaves, no ongoing issues - nothing.  It went in - and it came out.  Done.  And I instantly felt fine.

I also have not had any dumping at all in 8 months.  My stomach makes some interesting noises sometimes, but I have not suffered any of the classic dumping issues.  Not once.

I was prepared for all of these issues, but that's why I said I breezed.  I followed directions to the letter, walked a ton, and was really in good shape very quickly.  The morning of my discharge, the residents came in at 6 a.m. and I blasted the with "I Feel Good" off my iPod - because I DID feel good. 

Again, I hope you don't mind me addressing these things so directly.  I am not telling you what to do, but rather sharing my experience with you.  But, as a diabetic, I do think the malabsorptive aspects of RNY or DS will make a big difference in T2.  And all of that can only have a positive effect on your other medical issues as well.  Talk to a surgeon - heck, talk to two surgeons. Go to info sessions, ask questions, read, check out this site - you'll get your brain wrapped around the significant issues for you and then you will come to know what is best for you.  Look how much you've benefitted by just posting in here, right?!

Here's my two cents on it - and I will first say that I am 25 years a diabetic (type 1.5 - insulin dependent and insulin resistant) and had RNY in September 2011.  I researched this a LOT - 9 years in fact, so here's what I know from that process:

The RNY sugery not only changes the size of your stomach, but there is also surgery to the upper part of your intestines - that the bypass part.  As you may know, the surgery is both restrictive (reducing the size of the stomach) and malabsorptive (changing the way that your body digests and uses food).  That is where the "magic" happens for diabetics and where the potential is to normalize blood sugar.  I cannot describe what that action is, nor can most doctors (not in layman's terms anyway).  But, the enzymes and hormones that are at work in that part of your body have a very positive reaction to the surgery and really work toward normalizing blood sugar.  So, although you are certainly eating fewer calories, the body is now processing what you've eaten in a different way.  And, again- that's where the good things happen for diabetics.

Since the band is ONLY restrictive (NOT malabsorptive), your stomach size is reduced so you eat less.  But your body still processes everything the same.  So, you don't get that "magic" as a diabetic.  And that is why there is some question about whether the band really is effective for diabetics.

In my case, I never considered the band for that reason.  I considered both RNY and duodenal switch surgery.  DS is also considered very effective for diabetics for very similar reasons, but the surgery action is MORE malabsorptive than RNY.  I already have osteopenia (a step before osteoporosis) and had already had a spinal fracture because of it, so I deemed the risk too great for DS.  Calcium is one of the minerals that the body has some difficulty retaining after either surgery, so you have to up your calcium a lot after either.  But DS is slightly worse.

I was not an overeater before the surgery and carefully watched my calories and carbs because of being a long-term diabetic.  But I gained almost 100 pounds after I went on insulin.  Now, 8 months after the surgery, I've lost 70 of those pounds, and only eat about 200 calories less than I did before the surgery.  But, now my body can actually metabolize and I lose weight.  It's all because of the surgery that occurred to my digestive track.  And that DOES NOT HAPPEN with the band.

Of course, you need to talk to a surgeon and get more information about what options are best for you.  I saw 3 different surgeons before choosing the one who did my surgery.  As I mentioned, I researched for 9 years.  I've done very well and could not be happier.  I do still use insulin, but that is because I am more of a type 1 diabetic.  However, I use MUCH less of other diabetic medications (eliminating 2 orals, 1 injectable), less overall insulin now, and half of one of my orals.  I've eliminated cholesterol medication and recently went back to my blood pressure med on about half the dose.  So, the effects have been very positive.

Does this help at ALL?  It's a big decision, so you owe it to yourself to research, ask questions and fully understand what you options are.  That is how you will make the best decision for you. 

Please post again with any additional questions or thoughts, OK?

Best of luck!