double diabetic
(deactivated member)
on 1/4/12 9:26 pm - Woodbridge, VA
on 1/4/12 9:26 pm - Woodbridge, VA
Glad you're at least considering your options; nothing is more painful to read than someone who was fed a line of BS about one procedure or another and made their decisions based on that without more thorough research.
Just some food for thought:
Many patients have gotten the DS with a BMI of less than 50. I happen to have a local friend who got her DS at a BMI of 35 (she had type 2 diabetes) and is now 4+ years out, healthy and maintaining. The DS is the most statistically successful tool for those with a starting BMI of 50+, but that does not make it "riskier" for those with lower starting BMIs, and it is still statistically the most effective for type 2 diabetes regardless of BMI (they even do just the intestinal part of the DS in some other countries on NON-OBESE type 2 diabetics as a means of resolving the diabetes for those who don't even need to lose weight).
Also, the DS doesn't have a "pouch," but rather a "sleeve." I know some surgeons still refer to it as a pouch, but there are important differences: first, the pylorus (the valve that regulates the flow of contents from stomach to intestine) is NOT bypassed with the DS, while it IS bypassed with the RNY. This is what leads to increased risks of dumping syndrome and reactive hypoglycemia in RNY, plus it allows foods to leave the stomach faster, which can make you hungrier again sooner after eating. And, while the DS sleeve is typically larger than the RNY pouch, it still offers great restriction - you will NOT be able to eat the same amount of food at one time as pre-op. They essentially remove about 70-85% (depending on the surgeon) of your stomach, and the remaining sleeve is made from a less stretchy part of the stomach than the RNY pouch (many RNYers have trouble in the long run because they stretch out the pouch and/or the stoma - the connection between pouch and intestine where the pylorus used to be - and then they almost never feel full because the fod flows so quickly out of the pouch).
Please keep in mind that only about 30% of RNYers experience dumping syndrome in the long term, so don't rely on that as a means of controlling what you will eat (plus, some RNYers end up experiencing severe reactive hypoglycemia, not just dumping, which, as you know, can be very dangerous). Not to mention that we are human - I know multiple RNYers who can tell you that dumping does not always work as a deterrent; they just plan their eating so their dumping episodes will happen when they're home with time to deal with it. They also get frustrated because some things that they would expect to make them dump don't, and sometimes they experience dumping and can't pinpoint the cause. Multiple studies have shown that negative reinforcement (punishment) is much less effective than positive reinforcement for behavior adjustment; even dog trainers know that scolding or hitting a dog when they've done something wrong is pretty much useless - rewarding them for GOOD behavior is the better way to train :)
You're very fortunate that your insurance covers both procedures without having to fight!
Just some food for thought:
Many patients have gotten the DS with a BMI of less than 50. I happen to have a local friend who got her DS at a BMI of 35 (she had type 2 diabetes) and is now 4+ years out, healthy and maintaining. The DS is the most statistically successful tool for those with a starting BMI of 50+, but that does not make it "riskier" for those with lower starting BMIs, and it is still statistically the most effective for type 2 diabetes regardless of BMI (they even do just the intestinal part of the DS in some other countries on NON-OBESE type 2 diabetics as a means of resolving the diabetes for those who don't even need to lose weight).
Also, the DS doesn't have a "pouch," but rather a "sleeve." I know some surgeons still refer to it as a pouch, but there are important differences: first, the pylorus (the valve that regulates the flow of contents from stomach to intestine) is NOT bypassed with the DS, while it IS bypassed with the RNY. This is what leads to increased risks of dumping syndrome and reactive hypoglycemia in RNY, plus it allows foods to leave the stomach faster, which can make you hungrier again sooner after eating. And, while the DS sleeve is typically larger than the RNY pouch, it still offers great restriction - you will NOT be able to eat the same amount of food at one time as pre-op. They essentially remove about 70-85% (depending on the surgeon) of your stomach, and the remaining sleeve is made from a less stretchy part of the stomach than the RNY pouch (many RNYers have trouble in the long run because they stretch out the pouch and/or the stoma - the connection between pouch and intestine where the pylorus used to be - and then they almost never feel full because the fod flows so quickly out of the pouch).
Please keep in mind that only about 30% of RNYers experience dumping syndrome in the long term, so don't rely on that as a means of controlling what you will eat (plus, some RNYers end up experiencing severe reactive hypoglycemia, not just dumping, which, as you know, can be very dangerous). Not to mention that we are human - I know multiple RNYers who can tell you that dumping does not always work as a deterrent; they just plan their eating so their dumping episodes will happen when they're home with time to deal with it. They also get frustrated because some things that they would expect to make them dump don't, and sometimes they experience dumping and can't pinpoint the cause. Multiple studies have shown that negative reinforcement (punishment) is much less effective than positive reinforcement for behavior adjustment; even dog trainers know that scolding or hitting a dog when they've done something wrong is pretty much useless - rewarding them for GOOD behavior is the better way to train :)
You're very fortunate that your insurance covers both procedures without having to fight!
Yes, I know negative reinforcement will not work on me so that is a concern if I go the RNY route. I have 2 friends who did the RNY which is why I was looking into it first. Both of them had to keep going back in to reopen the stoma which is not something I want to deal with either.
I'm sure the insurance will find something to fight me on lol, but yea I am grateful the insurance part will be the least of my worries.
I'm sure the insurance will find something to fight me on lol, but yea I am grateful the insurance part will be the least of my worries.
"The RNY has proven to cure type 2's.. the only thing that has been proven to cure it. "
You are absolutely incorrect. The articles below show that the Duodenal Switch cures Diabeties as well or BETTER than the RNY. Just read the conclusions and you'll see.
1. " Bileopancreatic Diversion with Duodenal Switch Lowers Both Early and Late Phases of Glucose, Insulin and Proinsulin Responses After Meal."
http://www.dsfacts.com/Type-2-Diabetes-Cure.html
You are absolutely incorrect. The articles below show that the Duodenal Switch cures Diabeties as well or BETTER than the RNY. Just read the conclusions and you'll see.
1. " Bileopancreatic Diversion with Duodenal Switch Lowers Both Early and Late Phases of Glucose, Insulin and Proinsulin Responses After Meal."
http://www.dsfacts.com/Type-2-Diabetes-Cure.html
2. Duodenal switch provides superior resolution of metabolic comorbidities independent of weight loss in the super-obese (BMI > or = 50 kg/m2) compared with gastric bypass.
Prachand et al. Feb 2010
PubMed Abstract
OBJECTIVE: Increased body mass index is associated with greater incidence and severity of obesity-related comorbidities and inadequate postbariatric surgery weight loss. Accordingly, comorbidity resolution is an important measure of surgical outcome in super-obese individuals. We previously reported superior weight loss in super-obese patients following duodenal switch (DS) compared to Roux-en-Y gastric bypass (RYGB) in a large single institution series. We now report follow-up comparison of comorbidity resolution and correlation with weight loss.
METHODS: Data from patients undergoing DS and RYGB between August 2002 and October 2005 were prospectively collected and used to identify super-obese patients with diabetes, hypertension, dyslipidemia, and gastroesophageal reflux disease (GERD). Ali-Wolfe scoring was used to describe comorbidity severity. Chi-square analysis was used to compare resolution and two-sample t tests used to compare weight loss between patients whose comorbidities resolved and persisted.
RESULTS: Three hundred fifty super-obese patients [DS (n=198), RYGB (n=152)] were identified. Incidence and severity of hypertension, dyslipidemia, and GERD was comparable in both groups while diabetes was less common but more severe in the DS group (24.2% vs. 35.5%, Ali-Wolfe 3.27 vs. 2.94, p
Sher--the bear mama
I have decided to put the DS back on the table as an option. My main concern, after possibly reversing the type 2 diabetes of course, is which one will be better in the long run since I will still be at risk for complications with the type 1. I also don't want to end up with issues of going too low so much that I make my health worse of just in the other direction. Ugh, it all gives me a headache lol.
We have a few Type 1 or even Type 1.5 (LADA) DSrs on the site I mentioned to you in my message. Somehow they've managed to have sucess with the DS. It's a great surgery and a lot of the myths about it (stinky poop, diarrhea, etc.) don't actually happen or can be prevented easily. I'm glad you're considering your options. I know it's daunting. I wish you luck with this journey!
Sheri
Sheri
Sher--the bear mama
Sher Bear Mama has deleted this message.
"Double diabetes" is more commonly known as LADA (latent autoimmune diabetes in adults) or Type 1.5 diabetes. It's not that your Type 1 becomes Type 2 - it's that you have features of BOTH type 1 and type 2. Most LADAs do not produce enough insulin, so we need to inject insulin when we eat (and likely a basal insulin as well). We also typically have insulin resistance, which is the Type 2 feature. And, yes, I am one and have been for 25 years. Just had RNY in September and am doing very well.
If you are truly a "double diabetic", just know that your Type 1 diabetes doesn't go away and you'll still need insulin to manage it. But, you'll likely need less after surgery and certaily as your weight decreases, you'll need less. I have seen that happen since the beginning. I'm using about 30% less basal (Lantus) insulin with much better results. I have also decreased my meal time insulin and only need about 3-4 units per meal, as opposed to 5-10 befor - again with better results.
I have seen the greatest impact in my oral medications. I had taken a number of them - actos, glimepiride and metformin - all at close to max dosages. I am now only using metformin - 500 mg. twice per day, which is HALF of what I used before. My blood sugars seem much better and the range of them, especially post-meal blood sugars, are much improved too. I'm also off blood pressure and cholesterol meds.
I have lost about 40 pounds since the surgery and have about 40-50 left to go. I did the surgery NOT for the weight loss, but to positively impact my diabetes. Most LADAs are diagnosed in their early 30's and typically are not overweight, but that's not always true. I was 29 at diagnosis and am 54 now. So, after 25 years, I realized that I wanted to do something to lengthen my life and also address the quality of it. The surgery has been helping me do that.
I researched the surgery for 9 years before going forward. I'm glad I did - thrilled in fact. Good luck and feel free to ask questions!
Good luck with your journey.
If you are truly a "double diabetic", just know that your Type 1 diabetes doesn't go away and you'll still need insulin to manage it. But, you'll likely need less after surgery and certaily as your weight decreases, you'll need less. I have seen that happen since the beginning. I'm using about 30% less basal (Lantus) insulin with much better results. I have also decreased my meal time insulin and only need about 3-4 units per meal, as opposed to 5-10 befor - again with better results.
I have seen the greatest impact in my oral medications. I had taken a number of them - actos, glimepiride and metformin - all at close to max dosages. I am now only using metformin - 500 mg. twice per day, which is HALF of what I used before. My blood sugars seem much better and the range of them, especially post-meal blood sugars, are much improved too. I'm also off blood pressure and cholesterol meds.
I have lost about 40 pounds since the surgery and have about 40-50 left to go. I did the surgery NOT for the weight loss, but to positively impact my diabetes. Most LADAs are diagnosed in their early 30's and typically are not overweight, but that's not always true. I was 29 at diagnosis and am 54 now. So, after 25 years, I realized that I wanted to do something to lengthen my life and also address the quality of it. The surgery has been helping me do that.
I researched the surgery for 9 years before going forward. I'm glad I did - thrilled in fact. Good luck and feel free to ask questions!
Good luck with your journey.
Thanks for you input. I used the term "double diabetes" because most people are still unfamiliar with type 1.5. It seems to clarify the fact I have characteristics of both.
I have been a type 1 since age 3 and became resistant around age 30 (almost 5 years ago). I have been considering surgery for the same reason as you. I was told by my doctor that I take too much insulin to lose any weight. Now I feel like I'm being bombarded with complications much faster than I can lose the weight to reverse the type 2 on my own.
Unfortunately, I come from a tamily of type 2's, but my mother, brother, and I were the only type 1's. I have lost all except one member of my family due to some complication of diabetes (they didn't take care of themselves well). I've seen the amputations, the kidney dialysis and transplants, blindness...you name it. I am scared to death to have the same fate. I am hoping that doing WLS, while I am still somewhat young, will lessen my chances of surgery complications. At the same time it will be my first surgery EVER so I want to make sure I know what I am getting myself into.
I have been a type 1 since age 3 and became resistant around age 30 (almost 5 years ago). I have been considering surgery for the same reason as you. I was told by my doctor that I take too much insulin to lose any weight. Now I feel like I'm being bombarded with complications much faster than I can lose the weight to reverse the type 2 on my own.
Unfortunately, I come from a tamily of type 2's, but my mother, brother, and I were the only type 1's. I have lost all except one member of my family due to some complication of diabetes (they didn't take care of themselves well). I've seen the amputations, the kidney dialysis and transplants, blindness...you name it. I am scared to death to have the same fate. I am hoping that doing WLS, while I am still somewhat young, will lessen my chances of surgery complications. At the same time it will be my first surgery EVER so I want to make sure I know what I am getting myself into.
Lacey - you are on the right path. Best of luck to you.
I had a million questions prior to the surgery about how to treat my lows. I sometimes drop down in the middle of the night and just felt that I needed to be comfortable with how I was going to help myself.
First, I have found that I need MUCH less to treat lows that I did previously. I think it must be because everything goes straight into your blood stream. But, I used to need a solid 6-8 ounces of juice to get back up. Now, I need about 1-2 ounces and I'm fine. And I don't have the rebound blood sugars that I used to have either. The lows are so much easier to treat now - that was a big surprise to me and alleviated a big concern.
I have not experienced dumping at all - another worry that I had. And, even if you do have some, you'll likely need a lot less carbs to get your blood sugar back up. I had these exact kinds of questions prior to surgery, but I couldn't find answers to them. I am glad that you made it here.
I applaud you for wanting to understand what you are getting into. I was very scared too, and did a lot of years of research. I saw three surgeons before I decided on the person to do mine. Unfortunately, 2 out of the 3 were just all focused on the weight loss and didn't really engage with my concerns/issues about diabetic management. The surgeon that I chose in the end was the only one that did - he got that I was more concerned about a positive impact on diabetes and helped me with my questions and concerns. I was actually referred to him by an endocrinologist, and so I felt very good about his level of engagement on this. That was critical to me, and continues to be.
I had a million questions prior to the surgery about how to treat my lows. I sometimes drop down in the middle of the night and just felt that I needed to be comfortable with how I was going to help myself.
First, I have found that I need MUCH less to treat lows that I did previously. I think it must be because everything goes straight into your blood stream. But, I used to need a solid 6-8 ounces of juice to get back up. Now, I need about 1-2 ounces and I'm fine. And I don't have the rebound blood sugars that I used to have either. The lows are so much easier to treat now - that was a big surprise to me and alleviated a big concern.
I have not experienced dumping at all - another worry that I had. And, even if you do have some, you'll likely need a lot less carbs to get your blood sugar back up. I had these exact kinds of questions prior to surgery, but I couldn't find answers to them. I am glad that you made it here.
I applaud you for wanting to understand what you are getting into. I was very scared too, and did a lot of years of research. I saw three surgeons before I decided on the person to do mine. Unfortunately, 2 out of the 3 were just all focused on the weight loss and didn't really engage with my concerns/issues about diabetic management. The surgeon that I chose in the end was the only one that did - he got that I was more concerned about a positive impact on diabetes and helped me with my questions and concerns. I was actually referred to him by an endocrinologist, and so I felt very good about his level of engagement on this. That was critical to me, and continues to be.
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