pre-op sleeve type 2 pump user
I am preparing for surgery. Just received approval letter for GB-RNY yesterday. BUT... My endocrinologist just quit her practice on very short notice. I am on an insulin pump which I have used for 3 1/2 years since my pancreas is shot. My surgeon wanted to go ahead and do the surgery and just put me on sliding scale regular insulin shots after surgery because he thinks I will not need insulin at all after surgery, but there is no way to know. I hope he is right. Anyone out there had any experience with this?
My gut feeling is to wait until I can get on board with a new endocrinologist that can be available to walk me through the transition if needed. I also have thyroid problems, so my thyroid medication may need to change as well. I am very disappointed in the possible delay because I was all set to have the surgery in July. Now, I may have to wait until September. My primary care Dr. has already told me she will not do pump management. I am a Type II but my pancreas is burnt out,so that is why I am on insulin. I am vacillating whether or not to wait.... been a long journey thus far and do not want to lose my momentum.
I am not asking for medical advice, just feedback and wondering if anyone else has gone through this...
thanks DPFlorida
My gut feeling is to wait until I can get on board with a new endocrinologist that can be available to walk me through the transition if needed. I also have thyroid problems, so my thyroid medication may need to change as well. I am very disappointed in the possible delay because I was all set to have the surgery in July. Now, I may have to wait until September. My primary care Dr. has already told me she will not do pump management. I am a Type II but my pancreas is burnt out,so that is why I am on insulin. I am vacillating whether or not to wait.... been a long journey thus far and do not want to lose my momentum.
I am not asking for medical advice, just feedback and wondering if anyone else has gone through this...
thanks DPFlorida
My first question - are you sure you are a Type 2? You MIGHT be a Type 1.5 (LADA) diabetic...have you had the tests to ascertain if you are? Type 1.5's are usually diagnosed around 30 and have a slowly failing pancreas - meaning that orals don't work and eventually, like all Type 1's, insulin management is needed. It's important to know if this is you, since it will mean that insulin will be needed, regardless of your weight loss.
I am a Type 1.5 for almost 26 years and insulin dependent for 25 of those. I had RNY in September 2011. I did not need insulin for the first day after surgery, and then right back on as soon as I was able to drink water. My blood sugar stayed very stable on my surgery day, but started to spike after. The good news is that my insulin needs have changed a great deal as my weight has reduced, but I still need insulin and always will. I've decreased my use of Lantus by 65%, gotten off of 3 orals, decreased metformin by 50%, but increased my bolus doses appropriately. I'm still making regular tweaks to all of this, even after 70 pounds lost and almost 9 months after surgery.
If you are not this type of diabetic, chances are you will experience what many do - you won't need insulin and that will happen very quickly after surgery. But it might be good to get this clarified now, so you can manage your own expectations about what the surgery will and will not do for you.
Here's my suggestion - take it for what it is worth - see if you can find out what endocrinologists are on staff at the hospital where you plan to have your sugery, and see them for a consult now. Since someone will have to follow you while you are in ths hospital, you might as well establish a relationship with them NOW so they can effectively help you with any management issues you will have both pre and post-surgery. I did that, as well as texted with my regular endo while in the hospital. I had to stay an extra day because of blood sugar control issues and was followed by the endocrinology group at the hospital. they were very good at working with me since I knew myself best.
Is your surgeon requiring you to get endo clearance before surgery? Maybe you already have that from the prior endocrinologist, but that's another reason I'd see the service that is at the hospital where your surgery is. I'm sure your surgeon's practice works regularly with someone, so perhaps they can suggest an endo - and maybe help to expedite an appointment so you stay on schedule with your July date.
You're also going to need to work with someone fairly closely in the weeks and early months after surgery. As your weight reduces, your insulin and medication needs WILL change, so I'd say it's worth it to see someone now and not wait. If it delays your surgery, that will be tough to take, but it may be worth it. I'm betting the surgeon's office can help you there though.
Let us know how things go please! And best of luck to you.
P.S. - Here's a link on LADA that might help you:
http://forecast.diabetes.org/magazine/features/other-diabete s-lada-or-type-15?page=0%2C1
To determine Type 1.5, you'll want to have a GAD-65 and a c-peptide blood test drawn. There might be one other as well?
I am a Type 1.5 for almost 26 years and insulin dependent for 25 of those. I had RNY in September 2011. I did not need insulin for the first day after surgery, and then right back on as soon as I was able to drink water. My blood sugar stayed very stable on my surgery day, but started to spike after. The good news is that my insulin needs have changed a great deal as my weight has reduced, but I still need insulin and always will. I've decreased my use of Lantus by 65%, gotten off of 3 orals, decreased metformin by 50%, but increased my bolus doses appropriately. I'm still making regular tweaks to all of this, even after 70 pounds lost and almost 9 months after surgery.
If you are not this type of diabetic, chances are you will experience what many do - you won't need insulin and that will happen very quickly after surgery. But it might be good to get this clarified now, so you can manage your own expectations about what the surgery will and will not do for you.
Here's my suggestion - take it for what it is worth - see if you can find out what endocrinologists are on staff at the hospital where you plan to have your sugery, and see them for a consult now. Since someone will have to follow you while you are in ths hospital, you might as well establish a relationship with them NOW so they can effectively help you with any management issues you will have both pre and post-surgery. I did that, as well as texted with my regular endo while in the hospital. I had to stay an extra day because of blood sugar control issues and was followed by the endocrinology group at the hospital. they were very good at working with me since I knew myself best.
Is your surgeon requiring you to get endo clearance before surgery? Maybe you already have that from the prior endocrinologist, but that's another reason I'd see the service that is at the hospital where your surgery is. I'm sure your surgeon's practice works regularly with someone, so perhaps they can suggest an endo - and maybe help to expedite an appointment so you stay on schedule with your July date.
You're also going to need to work with someone fairly closely in the weeks and early months after surgery. As your weight reduces, your insulin and medication needs WILL change, so I'd say it's worth it to see someone now and not wait. If it delays your surgery, that will be tough to take, but it may be worth it. I'm betting the surgeon's office can help you there though.
Let us know how things go please! And best of luck to you.
P.S. - Here's a link on LADA that might help you:
http://forecast.diabetes.org/magazine/features/other-diabete s-lada-or-type-15?page=0%2C1
To determine Type 1.5, you'll want to have a GAD-65 and a c-peptide blood test drawn. There might be one other as well?
Officially type 2 but my c- peptide was low when it was checked. Right now I have no endo and my surgeon knows it. He may have someone in the hospital who can manage it and I will definitely want to see them preop. better to know ahead what I am facing . I know I will be juggling and checking blood sugar forever, but I do that now anyway! Thanks sooo much for your input!
Denise
Denise
If your c-peptide is already low, then you likely are NOT a Type 2 diabetic. Type 2's typically have normal to high c-peptide readings, but their bodies can't effectively use the insulin they make. Those of us with low c-peptides are largely considered Type 1's (or 1.5's). Our insulin production is low to none and we need to supplement with exogenous (external injected) insulin to function.
I do hope you are able to get a consult with an endocrinologist. It sounds like you definitely need that to be successful with your diabetes management. And you will be really surprised how much the weight reduction and the diabetes management will interact!
Keep me posted!
I do hope you are able to get a consult with an endocrinologist. It sounds like you definitely need that to be successful with your diabetes management. And you will be really surprised how much the weight reduction and the diabetes management will interact!
Keep me posted!
I saw my endo. She is great! Gave me some new pump settings and advice to manage during transition. I will have surgery on Thursday,July 12. My sugars have been really good. I hope to decrease or get off insulin with continued weight loss, but no guarantees of course. My knees are already feeling better after losing 31 lbs.Thanks for your interest! Denise
I am now 15 days post sleeve.
I put myself back on the pump about 4 days post-op. My basal rate was 0.9/hr
Was not bolusing with my miniscule amount of carbs. My bg's were pretty good I thought. My endo called and told me to go back on the levemir, 10 units each night. And to "watch my diet" and to "vigorously excerise 40 min a day. LOL I am barely eating 400-500 calories a day, 50-70 g protein and less than 40 g carb. I am walking 1.5-2 miles a day, not strolling. I do not believe it is covering me enough. I do want to try this, I would like to think I can come off insulin, but it does not appear to be the case. I am confused why she took me off the pump and cut my insulin in half. I am not on metformin any more and would not like to go back on it, ever. It's crazy but I miss the control the pump gave me with my sugars. I just started with the new endo, but I would like an explanation as to why no pump. I built up antibodies against Lantus, it stopped working at all, so that's why I went on the pump in the first place. So now I have over a grand invested in pump supplies and insulin that I am not using. Again, I would like to be off all insulin, if I continue to lose at the rate I am, I'll be at goal in 10-12 weeks. But there are no guarantees of complete reversal of my diabetes. Sorry for the rambling, but I guess I need to call the endo back and get answers to my concerns. Thanks for listening. Denise
I put myself back on the pump about 4 days post-op. My basal rate was 0.9/hr
Was not bolusing with my miniscule amount of carbs. My bg's were pretty good I thought. My endo called and told me to go back on the levemir, 10 units each night. And to "watch my diet" and to "vigorously excerise 40 min a day. LOL I am barely eating 400-500 calories a day, 50-70 g protein and less than 40 g carb. I am walking 1.5-2 miles a day, not strolling. I do not believe it is covering me enough. I do want to try this, I would like to think I can come off insulin, but it does not appear to be the case. I am confused why she took me off the pump and cut my insulin in half. I am not on metformin any more and would not like to go back on it, ever. It's crazy but I miss the control the pump gave me with my sugars. I just started with the new endo, but I would like an explanation as to why no pump. I built up antibodies against Lantus, it stopped working at all, so that's why I went on the pump in the first place. So now I have over a grand invested in pump supplies and insulin that I am not using. Again, I would like to be off all insulin, if I continue to lose at the rate I am, I'll be at goal in 10-12 weeks. But there are no guarantees of complete reversal of my diabetes. Sorry for the rambling, but I guess I need to call the endo back and get answers to my concerns. Thanks for listening. Denise
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