type 1/g-bypass/pumping

Any type 1s, pumping, having gastric bypass? How to correct lows without dumping? How soon allowed to reconnect pump? How low were basals set?

Fern

Dear Fern,     I'm responding 'cause as you might know, we Type I's are a definite minority!!  I had the lapband done & was told that bypass would be too dangerous simply because of having to treat the lows.  But I had less than 100 lbs to lose & the docs thought that lapband would be ideal for me.  I'm also quite motivated, so for those reasons alone, we went with the banding.  I wore my pump throughout the surgery.  The anethisiologist asked me my opinion & I said that it would make it easier for me & them to have me wear my pump.  If not, they would have to give me I.V. insulin & glucose & try to determine an exact balance.  Little by little, even a little before surgery, I was working with my endo to decrease my insulin.  There are many ways of doing this, including changing the insulin sensitivity factor, changing the insulin to carb ratio, suspending the insulin pump for short periods of time, changing the basal rates...I think I played around with a little of everything.  As we go through the different phases: clear liquids, full liquids, pureed & then real food, we'll constantly be changing our insulin.  I'm in the pureed phase, 1 month out from surgery.  My insulin requirement already is about 1/2 of what it was before surgery.  I am working very closely with my nutritionist as well.  That way, you can at least have a meal plan for each phase & know how many carbs to bolus for.  What works well for me is to have a constant # of carbs for most of my meals/snacks.  Right now, my breakfast is about 21g of carb +/-.  If you treat your diabetes for now like a science experiment, you'll see what I mean.  There has to be some kind of constant or something that does not change in order for the "experiment" to work.  If we're constantly changing what we eat, it's harder to know how certain foods are affecting us.  I know, for example, that even now, higher fiber foods help me maintain my blood sugars longer than other carbs with less fiber.  You'll experiment, hopefully with the help of a good nutritionist & you'll see what works for you.  Good luck with whatever surgery you choose!

Hi, many many thanks for the reply. I'd love to keep my pump on. How much did you lower your basals the day of surgery? My endo. cut me down to almost half for that day, and starting the day before. There seemed to be no concern about a g-bypass and the type 1.

Glad to hear you're doing well.

Fern

Dear Fern, My insulin dosage had been steadily decreasing from well before the surgery date.  On the day of surgery, I just tested my sugar in the morning & since it wasn't too low, they just left my pump in tact.  I didn't lower it at all the day of surgery since I had been lowering it well before then.   I believe that the lapband was the best option for me, 'cause even today, I had another low BG.  If I couldn't get quick glucose into me, I don't know how I would do it.  I have on occasion, turned off my pump for 1/2 hr at a time, which I also did today.  The low BGs really frustrate me more than anything else.  I will be working with my endo beginning again next month to see if my rates are still too high.  It's also frustrating because of the progression through the different types of food we have to eat depending on the stage after the surgery.  Right now, I'm still eating pureed foods.  I thought it would be easier than the full liquid phase, but unless I can get more settled into certain foods at certain times of the day, my BGs are not going to be happy.  I am also working with my nutritionist.  She's the best!!  She's even been helping me figure the # of carbs in foods such as mashed carrots!!!  It's really weird!   Keep in touch!  Sharon 

You've made an important point, working with a nutritionist.  I hadn't really understood the importance of that.  Maybe I'd better make an appointment with her for immediately after the surgery.  Wow, thanks!  Fern

Dear Fern,    In one of my above blogs, I think I told you that it's easier to think of our bodies as a science experiment.  As crude as that sounds, it has really helped me to better understand how my body functions.  The meal plan is important, 'cause that's our constant in the experiment.  The other factors are variables & if I haven't forgotten my 7th grade science education, you have to have something that remains the same & then you can add other things to it to see how they affect the constant.  In our situation, the constant could be that we eat the same breakfast in the morning & once we confirm that it works nicely with our blood sugars, we may be able to change it up with similar carbs, proteins & fats for example.  What worked really well for me before the surgery was 1/4 c dry oatmeal (measured dry & then cooked w/water) with 1 Tbsp. raisins & a tsp. or so of margarine.  That was my breakfast & my blood sugars loved it!  They behaved so well with that combo even though I skipped the protein.  Now, since I can't have oatmeal yet, I'm eating low-fat refried beans, pureed with 1/4 c fat-free cheese & 1/4 c. mashed carrots.  I'm still trying to determine if my blood sugars are happy with that combo.  Your nutritionist should be able to give you a meal plan to start off with, but just remember, it WILL change!   Good luck with everything! Sharon

You just changed my mind again. I'll get an appt. BEFORE I go in for surgery. Thanks, Fern

I'm sorry, Fern!  (*SMILE*)  I just know that Type I's can't do it alone.  We need the surgery, but we also need additional tools to make the surgery work.