DS and Type 2 Diabetes: Predictive Factors in CURE
The reason is highly likely to be how many insulin-producing cells you have left - type 2 diabetes kills them off by exhausting them (requiring them to work too hard because of insulin resistence), and you have to have enough left when the underlying problem causing insulin resistence is cured to do the job.
Do you really want to risk NOT curing your diabetes with your first WLS? If you still have diabetes or it comes back, your risk of cure go down the longer you are diabetic.
Obes Facts. 2011;4 Suppl 1:18-23. Epub 2011 Mar 31.
Biliopancreatic Diversion with Duodenal Switch in Patients with Type 2 Diabetes mellitus: Is the Chance of Complete Remission Dependent on Therapy and Duration of Insulin Treatment?
Cho EY, Kemmet O, Frenken M.Source
Department of Surgery, St. Josef Krankenhaus Monheim, Germany.
Abstract
Background: Rapid resolution of type 2 diabetes mellitus (T2DM) is a common feature after intestinal bypass surgery bypassing the duodenum and parts of the jejunum. However, the parameters determining the individual chance of remission are imprecisely defined. Methods: Biliopancreatic diversion with duodenal switch and sleeve gastrectomy (BPD-DS) was performed in n = 86 patients with T2DM (mean age 50 years, range 26-68, 51 females; BMI 47 kg/m(2), range 26-71). The patients were retrospectively divided into 4 groups according to the treatment modality and the duration of insulin treatment preoperatively: n = 18 patients were treated with oral antidiabetic drugs only (group 1); n = 32, n = 24, and n = 12 patients were treated with insulin for less than 5 years, for 5-10 years, and for more than 10 years (groups 2, 3, and 4), respectively. Results: At discharge from hospital, all patients of groups 1 and 2 were free of insulin usage, 30% and 75% of the patients of groups 3 and 4 used up to 48 units of insulin per day (mean 24, n = 16). After 1 year, only 4 patients of group 4 permanently required small amounts of insulin (mean 17 units per day) to keep blood glucose below 200 mg/dl. These 4 patients had been using insulin preoperatively for 13, 15, 22, and 25 years. In 3 of these 4 patients, fasting C-peptide was measured and found to be low (
This is the main reason I got the DS. To get a cure for my diabetes. I am 5 months out. I am not taking any diabetes meds now. (was on 4 orals plus insulin pre-op). My morning blood sugars have gone from the 180's/190's at three months out to the 140's. My surgeon wasn't concerned at my 3 month appt. I know my pcp is starting to get concerned. He's only had a couple of patients that have had RnY, a lot with the band, and I am his only DS patient. He doesn't totally "get" the DS and all that goes with it. I get my 6 months labs at the end of Nov., and I am hoping that my numbers are on the downward trend.
Pre-operatively, I was on insulin and the 4 meds for about a year right before surgery. And I was on insulin in about 2008-2009 for a year before I lost 30lbs back then. So accumulatively I was only on insulin about 2 1/2 years. I am hoping that I have this diabetes thing GONE!!!
ANY pre-op that is diabetic needs to look at the DS. It is the best chance to get rid if this terrible disease. As you said, do it right the FIRST time.
Lisa
I had been using insulin for over 13 years and oral meds for not quite 13 years when I had my DS. My C-peptide and insulin levels were VERY low, so my endocrinologist warned me not to get my hopes up.
On the day of surgery, I went into the hospital on an old fashioned tight control insulin regimen of usually four shots a day. Over 160 units of insulin total per day, plus Actos, could not get me a fasting blood sugar under 200.
Three days later, having taken 20 units of NPH insulin only, I walked out of the hospital with a blood glucose of 90.
I was off insulin completely within a month, off Actos within three months. Had a normal A1c at my three month checkup (below 5.5) and it has stayed that way for five years, without so much as a blip upward.
My endocrinologist (I was his first DSer) was reluctant to call me cured. I wanted a glucose tolerance test to prove it, but he felt he couldn't justify prescribing one to the insurance company. So I looked up how much glucose I had to gag down for that test, dissolved a whole bunch of glucose tablets and made my own.
Results? Dead normal across the board. Made a believer out of my endo doc :-).
