What meds do you still take?

I had RnY surgery on July 10th, and my recent A1c is much worse than the one I had prior to surgery. I'm pretty much at my goal weight. I'd like to lose a little more, but if I don't, that's fine. My doctor wants me to come in and discuss options.

For people like me whose diabetes didn't improve after surgery, what medications do you take? I've been on Lantus all along, but I stopped all oral meds while in the hospital. Prior to that, I also injected Byetta.

Is Byetta an option, or does slowing the rate the stomach empties post-RnY a bad idea? If you take Metformin, is it extended release or regular release? I've read that regular release can be especially hard on the stomach even when one's stomach isn't altered, but extended release doesn't work well for us.

I've heard negative things about Januvia, but there's negatives to any drug. Januvia is one of the few I've never tried.

I'd really appreciate any input anyone cares to share.

Thank you,

Melissa

Melissa: What is your A1C?  I have been off and on Januvia, I didn't think it was as effective as Byetta.  Byetta really helped control my hunger and my sugar.  Januvia is okay now that I have lost some weight, although the real sugar control comes from low carbs and lots of exercise.  Pre op I was on Actos 30, Byetta 5 X2, and Glyburide 1.5.  Post op I'm on Januvia 50 PRN, only 2 or 3 times per week.  Best of luck to you. Greg

Greg,

Hi. Thank you for responding! I'm ashamed to say my last A1c was 10.9, up considerably from before surgery. It just doesn't make sense. I thought losing a lot of weight and drastically altering my eating would be the answer, but it hasn't been.

So, Byetta works for you post-RnY? Interesting. I had such an awful time the first 3 months on Byetta, but I had great glucose control, until my body adjusted. I no longer vomitted, and my numbers crept back up, but not as high as they've been since I was taken off oral meds post-RnY.

It's very frustrating!

Thank you,

Melissa

Melissa:

Sorry to hear that you are having so much trouble.  I can understand how frustrating it must be.  I am a Lap Band (realize) patient so I can't speak to RNY.  I will relay that I've heard a few people with Type II say that they went on insulin for a while to give their pancreas a break.  Many of the Type II drugs simply force you pancreas to secrete more insulin, eventually it just burns out.  I have never heard this from my doctor so it may not be true.  I would encourage you to discuss your options.  I'm pretty sure that Actos is one drug that does not stimulate your pancreas.  Let me know what you decide.  Best Regards,  Greg

Greg,

I was on Actos a couple years ago but had to stop because it caused such crazy edema for me. I have a feeling my PCP (who is awesome!) may send me back to the Endo, since this is getting complicated. The Endo didn't want me to have WLS. BTW, Lap Band was what I was originally going to have done.

Melissa

 My understanding is that you don't want to take "extended release" versions of ANYTHING post-op because medications (like everything else) stay in your system for a much shorter period of time than pre-op. Your extended release meds will be extending medication right into the toilet!

I'm still pre-op, but I am taking metformin and Janumet (which is a combo Januvia and metformin). I haven't had any negative side effects from the Januvia.

With the Byetta, I'm not sure I fully understand how it slows the rate at which contents empty from the stomach. With the RNY, there is no longer a valve between the stomach and small intestines, so contents empty into the intestines freely and typically faster than pre-op. My guess, without researching exactly how Byetta slows the emptying of the somtach, is that the Byetts wouldn't have this effect on an RNY patient, but would still have the other effects of increasing insulin production in response to high blood glucose levels and suppressing glucose production from the liver.

Jill,

Hi. I Googled Byetta and GBS last night, hoping to find answers to exactly what you just wrote, but I couldn't find anything. Since the majority of diabetics who have RnY seem to no longer need any medication, I guess there hasn't been much research done for those of us who still do need some help with our glucose control.

Thank you,

Melissa

I just had surgery and was taking 20 units of Insulin prior to surgery,  I also was taking metformin 2 x a day along with floresimide and liptor  

However I was taking a Diabetic Dialy Vitimin pack from Walmart daily for 2 years and it helped me with my neurapathy and the Charcots foot.  They have the suppliment called Alpha Lipoc Acid.  in it that I just swear by.    I have already discussed it with my surgeoen and once I am able to tolerate solid food again he see no reason not to go back on it. 

I can feel the pain and sensations coming back at night which is a sign of the neuropathy

i'm almost 4 months out from surgery,

they lower my lantus from 42 to 20 units before surgery, when i was on the liquid diet. then after surgery during the first month i went down to 10 units, ( A1C 7.9) and off it when my fasting sugars where under 100 every morning.  at my 3 month follow-up my A1C was 5.7, so i'm very happy about that, & i'm hoping when i see my PCP that she will be lowering the metformin. right now i'm still taking 2000 mg day.

but really i'm afraid to stop taking the metformin all together.  it has been like a life saver for me..... it was the only thing that worked to bring my blood sugar under controll, when i was having a hard time trying to loss weight & eat right.............

After a recent visit to my PCP, she's convinced that I'm closer to a Type I than a Type II. She says that they're learning more about the different kinds of diabetes, and it's not a cut and dried Type I or II all the time. I'm more a Type I now, but since my numbers aren't inthe 700-800 range, she thinks my pancreas is creating a tiny bit of insulin, but it's close to nothing. I guess that's why GBS didn't help my diabetes.  :(

Melissa