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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
Lapband 12/11/08 - Slip 6/16/09 - 2nd Slip & Removal 8/3/09...Sleeve 12/22/11
on 3/16/09 2:37 am - Woodbridge, VA
Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis.
Buchwald H, Estok R, Fahrbach K, Banel D, Jensen MD, Pories WJ, Bantle JP, Sledge I.Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA. [email protected]
BACKGROUND: The prevalence of obesity-induced type 2 diabetes mellitus is increasing worldwide. The objective of this review and meta-analysis is to determine the impact of bariatric surgery on type 2 diabetes in association with the procedure performed and the weight reduction achieved.
METHODS: The review includes all articles published in English from January 1, 1990, to April 30, 2006.
RESULTS: The dataset includes 621 studies with 888 treatment arms and 135,246 patients; 103 treatment arms with 3188 patients reported on resolution of diabetes, that is, the resolution of the clinical and laboratory manifestations of type 2 diabetes. Nineteen studies with 43 treatment arms and 11,175 patients reported both weight loss and diabetes resolution separately for the 4070 diabetic patients in these studies. At baseline, the mean age was 40.2 years, body mass index was 47.9 kg/m2, 80% were female, and 10.5% had previous bariatric procedures. Meta-analysis of weight loss overall was 38.5 kg or 55.9% excess body weight loss. Overall, 78.1% of diabetic patients had complete resolution, and diabetes was improved or resolved in 86.6% of patients. Weight loss and diabetes resolution were greatest for patients undergoing biliopancreatic diversion/duodenal switch, followed by gastric bypass, and least for banding procedures. Insulin levels declined significantly postoperatively, as did hemoglobin A1c and fasting glucose values. Weight and diabetes parameters showed little difference at less than 2 years and at 2 years or more.
CONCLUSION: The clinical and laboratory manifestations of type 2 diabetes are resolved or improved in the greater majority of patients after bariatric surgery; these responses are more pronounced in procedures associated with a greater percentage of excess body weight loss and is maintained for 2 years or more.
PMID: 19272486 [PubMed - in process]
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
on 3/16/09 1:49 am - Woodbridge, VA
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.
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
Lapband 12/11/08 - Slip 6/16/09 - 2nd Slip & Removal 8/3/09...Sleeve 12/22/11
on 3/12/09 10:35 pm - Woodbridge, VA
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
