More questions on WLS and Type 2 Diabetes

Good morning.  I posted yesterday on the RNY forum and was directed to Jilly Bean's take on WLSurgeries.  RNY vs The DS.  Doing my own research there are so many unknowns about all WLS procedures. Many variables come into play. Jilly you indicate you are very young thus your diabetes is not longstanding?
My original post was asking about WLS in a 12-13 year ongoing Type2 diabetic with some years of poor glucose control with high A1C readings. Diabetes was brought on by pregnancy and Obesity followed with the miscarriages. (perhaps also depression from the Misses,  Fast Food places became a good friend. )-:  ....
I am more than twice your age so the MO will be different in many aspects. When the Endo mentioned WLS recently, she was not all that enthralled  but said the only surgery to eradicate this (diabetes) was Gastric Bypass. She indicated that had I not have diabetes she would recommend a less invasive procedure.  The DS was never mentioned. Perhaps she was not aware of the DS.  Seeing a cardiologist for clearance. she was jumping up and down for Joy that I was considering WLS  for 1. resolution of type2 diabetes and 2. BP control, 3. Lipid control. Yes, I did consult a name brand, well known, WL Center and it was the RNY that was recommended to me.  I am in the process of Insurance clearance now. Reading several articles in the past few days on WLS, I discovered the DS procedure. And this well may be the Platinum Standard for SOME diabetics but not for all.  (I am referring to only Type2's now) This also goes for the RYN.  With both procedures..those with long standing diabetes and those with poor control diabetes, the chances of long term remissions SO FAR, are questionable Thus the decline in percentages listed of complete diabetic resolution, say in 7 years from now.  The earlier you have surgery and this includes the RYN and the DS...the stats seem to be more favorable.
I went further yesterday and contacted some large hospitals around the country to see which ones do the DS surgery.   I was surprised to find that many do not do the DS surgery.  Some smaller hospitals do.  In my own city, two of the biggest and best hospitals do not do the DS surgery. All other weight loss surgeries were performed.  I did find a smaller hospital doing it.  Contacting the WL surgeon I am thinking of having surgery with, no comment on this as of this writing....Does he do them?  DS is listed but RNY stood out with Lap Band a close second. 
Each individual MO needs to be fined tuned.  What may be excellent for Jilly and some others may not be the right choice for every diabetic out there.  What comes to mind is a friend of mine  Diagnosed with Breast cancer. Should she have a Total mastectomy or a Lumpectomy for long resolution from Breast Cancer?  You will have those who swear by the Mastectomy and those who swear by the Lumpectomy.   This drove her crazy for weeks while she was having radiation pre-op to surgery.  We all want to do what is right for "us"...and in our own cir****tances.
We need long term stats on both surgeries pertaining to Diabetes, age of diabetic, years of diabetes, higher A1C readings in the pre-op patient,  insulin dependent diabetic, oral med diabetes, etc. etc. before a true picture surfaces.  One hospital yesterday stated, "the stats on DS just have not been convincing to allow this procedure in our hospital"
I wish all of us free of this dreadful disease.   God Bless Us.

There is no surgery that is an automatic guarantee of a cure for type 2 diabetes. If you can find anyone who has ever stated a 100% resolution rate for ANY procedure, I'll show you a liar, DS forum or not. It's also not always immediate - my glucose levels were higher in the hospital than pre-op; remember that physical stress can cause a diabetic's glucose levels to get out of whack. The only time I've ever been injected with insulin in my life is when I was in the hospital immediately following my surgery. I also later found out that the IV they had me connected to in the hospital included sugar in the fluid - something for those of you who are still pre-op to take notice of while you're in the hospital. And it's not like I went to some Joe Schmoe hospital - I went to Johns Hopkins. We all have to be our own advocates, no matter the reputation or level of trust with your medical team.

ETA: Just a word of advice that's pretty unrelated to the actual topic at hand, take what Old Medic says with a grain of salt - he's been proven a liar on multiple occasions and has been asked to provide support (studies, articles, anything) for some of his outrageous claims, and he refuses to do so - likely because it doesn't exist. I will just leave it at that.

In Beemerbeeper's defense, you are inferring, she is not stating, the 100% cure rate. I do know many people who say the DS cures T2DM while the RNY merely puts it in "remission," and they say this based on the long-term stats of recurrence. I think I used to say such as well but have since switched to just saying "resolved" since some people vehemently fight the idea of ANYTHING being a "cure." I am an active member of a large diabetes forum separate from OH, and when I initially mentioned that I wanted to get surgery primarily for my diabetes, you would have thought I'd told them I was going to chop off a limb or something - most of them thought I was crazy for doing something so "drastic" (as opposed to living with diabetes from the age of 25?), others fought me tooth and nail that there was no such thing as a cure for type 2 diabetes...it was mayhem, I tell you!  I find the optimism here refreshing, regardless of surgery type, because at least here in the WLS community, we acknowledge that there IS hope (although I have also come across the "there is no cure" adamant posters here on OH as well, but not as often).

Sorry, think I strayed a bit from the intended topic, there...

I'm not going to get into the ridiculousness of everyone on a message board ensuring they not leave anything open for inference - I could infer multiple things from your posts, but I don't because I, as a reader on a public forum, have the responsibility of not jumping to conclusions and of finding additional resources to substantiate certain statements. Moving on...

I've posed the question to the audience of type 2 diabetics: how would you define "cured?" I'm astounded at how many say you can never be cured, period. I ask them if they have good glucose control (as in normal fastings, A1Cs, post-prandials, etc.), are off of medications, and can eat sweets/carbs without spiking, are they not cured? If this continues until the day they die, are they not cured? They argue that to truly be cured, you would have to be able to go back to eating crappy and still not have any problems, but that line of thinking doesn't make sense to me. Take your example of cancer - if you are cured of, say, lung cancer and see no signs of it for 10 years, then start smoking daily and end up with lung cancer again, I would argue that you have cancer AGAIN, not that it never went away to begin with. It's such a game of semantics - and, in some cases, stubbornness!

You're right that I am young and did not have diabetes for very long pre-op (well, if you don't count the 10 years of pre-diabetes...). However, even still, the surgery I ended up with was a DS with a very long common channel (NOT a standard configuration), essentially a VSG with about the amount of malabsorption of a proximal RNY, and my diabetes is NOT fully resolved. So clearly, for me, even as such a young person who was only diagnosed with my type 2 about a year before my surgery, the RNY would NOT have fully resolved my diabetes.

My decision to have the DS (a real one, not the BS I woke up with) was based on every scrap of information I could find, including some studies that STILL show higher T2DM resolution rates with the DS than with the RNY even when the DS patients' diabetes was more severe pre-op than the compared RNY group. I believe they also include a bit of explanation as to why more surgeons do not perform the DS.

Not a lot of surgeons are capable of performing the DS - I would say there are maybe 40 truly skilled DS surgeons throughout the entire United States. You can check www.dsfacts.com for a more detailed list of DS surgeons.

I'm not sure I follow your train of thought in general. Regardless of the severity of your diabetes pre-op, the DS holds a higher rate of resolution tha the RNY. The RNY will likely help to make the diabetes easier to control or may even resolve the diabetes initially - I never said it wouldn't. But if you had any other disease, and someone offered you two treatment options: one is a procedure with short-term resolution rates of about 80-85% but a 20-45% chance of recurrence, and the other has a 92-98.9% short-term resolution rate and little to no chance of recurrence, which would you choose?

You're clearly trying to "defend" your decision to have RNY even though I've never attacked you. I've never stated that every type 2 diabetic should get the DS. I would NEVER say such a thing - the choice is dependent on the individual. For example, if someone couldn't be bothered to have good control of their diabetes pre-op, then they probably won't be educated and/or proactive enough to handle a DS successfully (this does NOT apply to those who DID try to control their diabetes, but to those who instead chose to ignore it or only follow doctor's orders instead of conducting their own research and questioning additional possible treatment options). If you have GERD that is a more pressing issue than your diabetes, then I would more closely consider the RNY (higher resolution rate for GERD than the DS). If someone cannot commit to taking vitamins 3-4 times per day, then they should NOT get the DS. Just a couple of examples, not an all-inclusive list. In an uninformed or lackadaisical patient, the DS can be deadly (as can the RNY, but likely not as quickly).

I will say that if someone has type 2 diabetes and, for whatever reason, decides they want the RNY over the DS, I would find a surgeon willing to discuss and entertain the idea of a longer intestinal bypass, more like an extended or distal RNY, as some studies have attributed the higher and more durable T2DM resolution rates of the DS with the longer intestinal bypass. I also highly recommend that patients consult with a real DS surgeon before making their decision one way or the other - an RNY surgeon isn't going to suggest a DS, just as a Honda salesman won't suggest you buy a Toyota, even if the Toyota truly better suits your needs. DS surgeons, on the other hand, can do both the RNY and the DS, so they have direct experience with both and are in a better position to make a more fully-informed recommendation. Although I still think it's best if the patient decides what they want before they ever even see a surgeon - no one knows you better than YOU.

Hi there Jill, I've reading a few posts here with some interest and I'd like to make sure I have it clear YOU are a post-op  "Sleeve" with a RNY type BYPASS...If so why not be more open to other options when responding to other posters here on OH. I know what I've said is likey to be misread but is not my intention. I rarely post but read often and seen several DSrs generally force their WLS choice on others. I'm not stating it's not a good choice as I could not do such. It's just my believe if you tell someone your reasons and success along with the hardships in which they may face most are capable of deciding.
In short perhaps responding milder than your super sharp aproach may well be better recieved. This since I've have read some apparently do take slight to your current method. I know your opinion is your opinion but so is mine which just suggests a lighter take on it. Be well.    

Jill does NOT have a sleeve with "RnY type BYPASS", she has a sleeve with a much longer common channel than most DSers and longer than she was expecting.

There is a very big difference between the intestinal configuration of the DS and RnY.... I'll leave you with just that tid bit so you can go research it for yourself and not continue to look like a fool when you post that DSers "generally force their WLS choice on others".  I am a DSer.  I could care less what WLS you get -- and because you are obviously not that great at understanding simple anatomy, chances are you would not be a good candidate for the DS.  What I care about is that people KNOW and UNDERSTAND their choices -- neither you nor the OP of this post does.

You are perpetuating inaccurate information and adding your scolding on top of it -- you would likely be better received if you knew what the hell you were talking about and weren't so judgmental on top of the inaccuracies.