my doc has me taking in the last four to six weeks like ensure shakes to reduce the size of my liver and to help him in having more room to work carnation make a sugarfree version of ensure and thats what there recommended for me to maintain sugar controls

This is my first time on any post. The Ins nurse suggested it since I couldn't find a support group to go to in my area. I am also a Type 1 for the last 6 yrs and on the pump for 5 of them. I had rny done in Nov 09 and am down 60 lbs as of date. I had a couple of minor set backs that I think had contributed to the slower weight loss. But all in all I'm feeling great have my energy level high and weight is coming off even if it is slower I'm ok with that. I am exercising and toning as I go. Cause let's face it after all of these costs from surgery I can't afford a plastics Dr. And Ins usually won't cover it. So I do what I can and hope I'm still elastic enough.

I do have a question though. I'm just ready to start menopause and between my blood sugars and the hot flashes it is sometimes hard to tell which is which. And from my experiences I do think one spurs the other. Has anyone else had this? When I flash my sugars will drop which in turn makes you have to eat. So I do the good choices but my lows/ flashes are in the middle of the night. I have adjusted my rates to reflect this but I don't flash every day at the same time. Any words of wisdom would help.

So, you have an extended or distal RNY as opposed to proximal? I absolutely believe a distal RNY would have higher success rates than a proximal RNY, but then you're living with both a pouch AND extensive malabsorption (some call it the worst of both worlds). I would think this would be a great idea if you also suffer from severe reflux or GERD pre-op, as the pouch is better than a sleeved stomach at improving or resolving those types of issues. I am so glad to hear that your T2DM is doing well so far, and I absolutely hope it stays away, but with a distal RNY, please be extra on top of your labs and supplements. heh, in a support group meeting filled with mostly RNY patients, I once mentioned that I keep my own extensive spreadsheets to track all my lab results so I can see the trends and such, and most of them looked at me like I had 3 heads!

FYI, it's also possible to lose too much weight with the RNY. And most lightweights who get the DS do NOT lose too much weight. I know one woman in my local area who had a DS at a BMI just barely more than 35 (so, like you, 35-point-something), and she is now almost 3 years out and doing fabulously - never lost too much weight and is off all the meds she had previously been on for type 2 diabetes, high cholesterol, and high blood pressure.

Perhaps since your surgical center hasn't been performing the DS for very long (they advertise it on their website as a "Latest Advancement" when it's been performed in its current state in the US for more than 20 years), they don't quite yet understand all of the intricacies of post-op DS care, such as the treatment options for those who lose below a healthy goal weight.

If the DS really posed such a risk of too much weight loss, then the ASBMS and NIH would require a higher starting BMI for the DS than for other procedures. Instead, they recognize that if you qualify for WLS, you qualify for whichever procedure best suits you. Additionally, an experienced DS surgeon knows how to adjust the measurements (sleeve size, common channel length, other limb lengths) to best suit the individual patient.

A quick search on PubMed for "duodenal switch" +bmi showed me a few studies where they discussed that the DS resulted in higher rate of T2DM resolution even when the patients had more severe cases of T2DM than in the compared RNY group (and, as you can see by my search terms, that wasn't even the info I was looking for!).

I'm not going to tell you you should get a DS or that you should not get the RNY - that's obviously your choice. I can say that, if I were in your shoes, I would at least have a consultation with an experienced DS surgeon just for a second opinion. Diabetes is evil enough that I wish you luck in fighting it no matter which weapon you choose.