RNY and Diabetes
My wife (Chris) is a type 2 diabetic. She had a lap. RNY on Dec. 22 with high hopes that her surgery would help her Diabetes. It has to a certain extent. Her blood sugars have stabilized in the low 200s. Before they would be all over the place from very low to very high. She still takes insulin. As a result her weight loss has been slow.
Before her surgery, she talked to a lot of "success stories". She knows what works. She also followed her surgeons and dietician's instructions to the letter. She came home from her visit to the surgeon today in tears. He told her:
She didn't have as much weight to lose as some of his patients so that is why she's losing slowly. He said that maybe her protein intake was too high. She should strive for balance with protein and carbs. (She's been taking Unjury supplements.)
Her constipation problems are a result of too many fiber supplements. (She can't tolerate Metamucil.)
She's depressed and discouraged. She's lost confidence in her surgeon. (fantastic at surgery...lousy as a doctor)
Any thoughts or ideas on the subject?
Before her surgery, she talked to a lot of "success stories". She knows what works. She also followed her surgeons and dietician's instructions to the letter. She came home from her visit to the surgeon today in tears. He told her:
She didn't have as much weight to lose as some of his patients so that is why she's losing slowly. He said that maybe her protein intake was too high. She should strive for balance with protein and carbs. (She's been taking Unjury supplements.)
Her constipation problems are a result of too many fiber supplements. (She can't tolerate Metamucil.)
She's depressed and discouraged. She's lost confidence in her surgeon. (fantastic at surgery...lousy as a doctor)
Any thoughts or ideas on the subject?
She is 5'5" tall. She weighed approximately 287 lbs. She's had diabetes for 12-13 years. Since her surgery, she's lost 40 pounds. Her blood sugars have stabilized in the low 200s. It used to be all over the place...even reaching to the high 400s on occasion.
She takes lantus and regular humalog on a sliding scale that her PCP set up. I see progress. She sees the people who had surgery at the same time having lost twice as much. She's frustrated, angry and depressed. Her regular doc is monitoring her closely.
Her surgeon is Dr Van Wagner.
.
She takes lantus and regular humalog on a sliding scale that her PCP set up. I see progress. She sees the people who had surgery at the same time having lost twice as much. She's frustrated, angry and depressed. Her regular doc is monitoring her closely.
Her surgeon is Dr Van Wagner.
.
Are you sure she's a type 2? Insulin usually means type I, and nothing cures that. I'm type 1 and take a lot less insulin since RNY - went from 200 units a day to 50-60. Same for me, very slow weight loss. Hunger issues. I think it may have something to do with the insulin I still have to take. Remind her it is not a race. Slow and steady will get her to her goal. I know the frustration - I really get aggrivated too.
She was diagnosed as Type 2. Oral medications helped for awhile, but after about 5 years
(I think)they were no longer enough. Insulin was added. As the Diabetes progressed, so did the weight gain.
I see improvement...but she was so upset after her last followup appt. I did this post. It's the conflicting opinions that make her crazy on everything from the amount of protein, to fiber supplements...plus she said it was a really bad day at work too.
I appreciate the comment and encouragement. So does Chris.
(I think)they were no longer enough. Insulin was added. As the Diabetes progressed, so did the weight gain.
I see improvement...but she was so upset after her last followup appt. I did this post. It's the conflicting opinions that make her crazy on everything from the amount of protein, to fiber supplements...plus she said it was a really bad day at work too.
I appreciate the comment and encouragement. So does Chris.
(deactivated member)
on 2/6/09 7:41 am - Woodbridge, VA
on 2/6/09 7:41 am - Woodbridge, VA
Unfortunately, there is no 100% sure cure for type 2 diabetes. I am so sorry to hear that she is still struggling with her diabetes post-RNY. I think the doc's recommendation about balancing carbs and protein is total BS. Most type 2s do better on a LOW carb diet, despite what mainstream medicine might have you believe.
If she ends up not losing enough weight or regaining weight, I hope she considers a revision to the Duodenal Switch. It has the highest type 2 cure rate of any of the procedures (up to 98.9%, whereas RNY has up to about 84%).
However, no surgery will cure her if her pancreas is no longer producing sufficient insulin, which can happen after years of living with not-so-well-controlled type 2 (which sounds like the case if she was seeing numbers in the 400s and bouncing around so much).
If she ends up not losing enough weight or regaining weight, I hope she considers a revision to the Duodenal Switch. It has the highest type 2 cure rate of any of the procedures (up to 98.9%, whereas RNY has up to about 84%).
However, no surgery will cure her if her pancreas is no longer producing sufficient insulin, which can happen after years of living with not-so-well-controlled type 2 (which sounds like the case if she was seeing numbers in the 400s and bouncing around so much).
Mary Catherine
on 2/6/09 8:17 am
on 2/6/09 8:17 am
I understand completely what your wife is going through. You are very helpful by asking for information about this.
Insulin makes you hungry and it turns whatever you eat to fat. What worked for me was going off the insulin and onto Janavia, micronese, and metformin. I worked with my primary care doctor and my endocrinologist. Weight loss surgeons are not experts in diabetes, mine thought I was just eating too many carbs.
Once the insulin was gone, the hunger went away and the weight started to come off again. I now have morning sugars between 70 and 100. But it took a year to get things adjusted.
I know people with very out of control diabetes that were instantly cured after RNY. It is not guaranteed and your wife and I were not that lucky. I think she needs to try to get off the insulin and onto medicines that do not cause weight gain.
The first thing I asked the endocrinologist was to do testing to make sure that my pancreas was still producing insulin. The fact that your wife has been on insulin is good. The oral medicines wear out the pancreas. Taking insulin preserves the pancreas and there is a good chance that she will be able to get along without insulin.
Now that my weight is gone, I am working to wean off of the oral medicines too. I am doing that slowly and working closely with the doctor. Even if I always have to take some medicine, I have decided that is not so terrible.
Insulin makes you hungry and it turns whatever you eat to fat. What worked for me was going off the insulin and onto Janavia, micronese, and metformin. I worked with my primary care doctor and my endocrinologist. Weight loss surgeons are not experts in diabetes, mine thought I was just eating too many carbs.
Once the insulin was gone, the hunger went away and the weight started to come off again. I now have morning sugars between 70 and 100. But it took a year to get things adjusted.
I know people with very out of control diabetes that were instantly cured after RNY. It is not guaranteed and your wife and I were not that lucky. I think she needs to try to get off the insulin and onto medicines that do not cause weight gain.
The first thing I asked the endocrinologist was to do testing to make sure that my pancreas was still producing insulin. The fact that your wife has been on insulin is good. The oral medicines wear out the pancreas. Taking insulin preserves the pancreas and there is a good chance that she will be able to get along without insulin.
Now that my weight is gone, I am working to wean off of the oral medicines too. I am doing that slowly and working closely with the doctor. Even if I always have to take some medicine, I have decided that is not so terrible.
(deactivated member)
on 2/6/09 8:10 pm - Woodbridge, VA
on 2/6/09 8:10 pm - Woodbridge, VA
If you (or anyone else) are on both Januvia and Metformin, they now make a product called Janumet, which I am currently taking. It is Januvia and Metformin combined and comes in 2 dosages: 50/500 and 50/1000 Januvia/Metformin.
Just an FYI, as it could save you some $$ in buying one instead of two (although I still buy two, as I take Januvia in the morning and just metformin in the evening, but everyone is different).
Just an FYI, as it could save you some $$ in buying one instead of two (although I still buy two, as I take Januvia in the morning and just metformin in the evening, but everyone is different).
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