A1C/surgery concerns
My husband has been going through the program to have a VSG. Our insurance requires 6 months with a dietician and he started the program in April. After having his blood work done for the program, it was discovered that he is diabetic and he was put on met. He has been losing a significant amount of weight (without diet or exercise change) over the past 6 months and we can only assume it is because of his uncontrolled diabetes. He has weighed over 325lbs for over 10 years and has been heavy his entire life but because of the unexplained weight loss, he is now down to about 260lbs. He just had follow-up blood work done that showed his A1C is still 11.5 so they will likely push off his expected surgery date. If his surgery is pushed off anymore, he's afraid that he won't get insurance approval because his BMI may drop below 35 but he's also worried that once the diabetes is controlled, he will gain the weight back and have to start all over. Has anyone been through a similar situation or have any advice? The NUT just kept telling him to make sure he doesn't lose anymore weight so he basically has been eating horribly for 2 months - obviously it shows w/ his A1C - but he has still managed to lose 1-2lbs a wk.
he needs to get the diabetes under control or very few good surgeons will do non emergincy surgery
if he is losing with out the surgery maybe he does not need it , weight loss will help with his a1c as will different meds
if he is not going to a good endocrinologist it is a must for him , make shore they don't put him on Actos , I was put on it and gained 100 lb in a little over 1 year , I was taken off it and put on slow acting insulin and Byetta and got my a1c down to 5.8
now after losing 100 lb and getting a vsg I am off all meds except mediformin and my blood sugar is around 100-120 every morning , and I was told that after I lose more I might be off all meds
the insurance companies usually go by the bmi at the time you are referred to the surgeon or when you first see him/her
weight lost under his/her care don't count, talk to the insurance person in youe surgeons office to make shore
I agree that getting his hbA1c down is paramount. He needs to do that first and foremost for his HEALTH, and also for surgery. His healing will be compromised and his life threatened if he does not do that. It's a matter of setting health priorities here - and getting better control is the #1 priority right now. Without it, nothing else matters or will be possible - plain and simple.
You are right that his weight loss is likely due to his uncontrolled blood sugar. His body is just burning everything, but his health is not good.
Also, remember that diabetes is a co-morbidity, which means that you are generally eligible for surgery at a lower BMI (35+ vs. 40+) because you have another serious medical condition. So, I would advise NOT worrying about the weight loss and make the goal health improvement overall.
Best of luck!
Thank you for the response. It has been a crazy few weeks and since my original post, my husband was put on Lantus and more metformin. Unfortunately it is still not doing it's job because his fasting glucose numbers are around 300. Our primary doctor is not being as proactive as we'd like (doesn't plan to see him or retest his A1****il December) so I have made him an appointment with an endocrinologist. We're hoping to get this under control as soon as possible since we realize just how out of control it is. He has also been trying to follow a diet high in protein and low in carbs w/ as little saturated fat as possible. We cut out white carbs a long time ago so at least that was a non-issue. Thank you again for all the help and advice with this!!
Mickey is right about the time frame for the hbA1c....it's not going to change too drastically until a month or two goes by. I would agree with your approach to see an endocrinologist. It sounds like he definitely needs insulin, at least in the short-term, to bring things under control. Lantus is really a basal insulin in that it can bring down his sugars over a 24 hour period, but it really doesn't do anything to cover the spikes that occur with meals. Short-acting (Novolog) insulin addresses that need specifically, and it is not at all unusual to be taking Lantus, metformin AND novolog for blood sugar control. (That's what I used prior to RNY surgery, along with a number of other oral medications). I use an insulin pump now, so all I use is Novolog through the pump, and metformin.
Keep us posted. This is a good place to get both information AND support. Getting those blood sugars control is critically important - the rest will come in its time.
I was on a long acting insulin and metaformin , and actos in the past the actos made me gain 100 lb in 1 year , I was taken off the actos when I seen a endocrinologist and put on Byetta , My a1c came down I lost 75 lb in 9 months , a side effect of byetta is it kills your appetite and helps you lose weight
now after my vsg im only on 2 metaformines no bytetta no insulin my a1c is 5.8 last check , my blood sugar fasting runs between 90 -130 , and 2 hours after diner 74-100
I had the same problem with my diabetes. My A1C was 15.5 and I went to and endocrinologist. It was the best thing I've ever done! He put me on Novolog before each meal because it is a fast acting insulin. Then I take Levemir in a small dose in the morning so that it will stay in my system all day and a larger dose to get me through the night. Your A1C should be checked every 3 months for an average. Within three months I was down to 7.4. I go back next week to be tested again and I feel certain it will be lower. My surgeon will not operate if it goes any higher. I adjust my insulin according to what I eat. That's what helps my A1C level reading. I am unable to drop any weight because my nutritionist said I take so much insulin, which isn't my fault. Insulin that isn't used by your body is stored in your fat cells. Therefore, I'm unable to loose the weight. My doctor feels that once I have the surgery I should be diabetes free. WooHoo! I hope that this helps you in some way. I would suggest you see an endocrinologist asap to get your sugar under control. I would hope that it might help you as it did me. I hope this helps and I am wishing you the best! Hang in there!
