Post Op Diabetes

I know from research that DS is a good operation for people that have diabetes. So good in fact that I heard some European countries are recommending it just for diabetes. That said, is it also true that DS'ers can't become diabetic post op? If that is the case can anyone explain why? Or is it just a cure but people can still develop diabetes later in life post op?

Just for the record, I didn't have diabetes pre op and I am avoiding sugar post op so no plans to develop diabetes either. Just an academic question here.

No one seems to know WHY the DS is so good at resolving diabetes. And yes, it's still possible to become diabetic after having the DS---but it's really, really rare. One reason I chose the DS is because diabetes runs in both sides of my family, and I felt I needed all the protection WLS could give me.

And yes, there are surgeons in Europe who do the intestinal portion of the DS on non-obese diabetics.

The most likely diabetes for us is probably type III.  That's when you were a two and you turn into a 1.  There's a lot of factors that go into your risk for diabetes, weight, family history, lifestyle, etc.  Anyone can get it but it's not all that hard to figure out who has the most risk.

 

The reason we aren't likely to get diabetes postop goes back to the physiology of the disease itself.  The most likely theory is that diabetes presents because of overproduction of intestinal hormones in the small bowel.  Hormone production is triggered by food passing through the bowel.  Most of our small bowel is bypassed so food never passes through it, therefore less intestinal hormones.  That's why for most the diabetes goes away immediately postop and has little to do with weightloss or lifestyle changes.

 

My H was one of the people who went to Spain for surgery.  He had only the intestinal portion(switch) done because his BMI was close to normal.  You are right about the switch being done in Europe for diabetes...for almost 20 years now.  But it's not impossible to have it done here, self pay, of course, because it would be classified as experimental.  Following is his story I wrote for another board.

 

Dan's Story

 

Dan died almost a year ago and I thought long and hard before posting this. In the end I decided to go ahead because that's what he would have wanted me to do. I hesitated because I didn't want people to think the DS had anything to do with his death. He probably would have died sooner if he hadn't had the DS. He probably would have lasted longer if he would have done it sooner!

Back when dinosaurs still roamed the earth I had my DS. I'm a researcher and a reader from way back and I'm always looking for answers. My H was diagnosed with type 2 in the mid 90's. He most likely had it for a while before he was diagnosed. His family has a truly dismal history of diabetes and heart related issues. They all died from some consequence of diabetes. H was never MO. He was sometimes O but he fought weight constantly because of his family history. He knew becoming fat would be a disaster for him healthwise. After he was diagnosed, he did everything right. No carbs other than green veggies and daily exercise. He walked on that treadmill every day. He hated being diabetic with passion.

He developed the usual co-morbs. Hyperlipidemia, retinopathy, and neuropathy in his feet. He got his HA1C into the normal range with oral meds and strict control of his diet. According to medical science, he was controlling his diabetes perfectly. But his co-morbs just got worse and worse. He was seeing his future as being blind in a wheelchair.

I noticed with great interest that diabetes either went away or was much improved with the DS. I researched it constantly, looking for papers or any work done on the subject. One day I tripped over exactly what I was looking for. The DS had and was being done for diabetes in Europe. I found cases in Spain and Italy. One of the docs who figured prominently was Aniceto Baltasar in Alcoy, Spain.

Dan didn't hesitate. When I showed him the research and he read the papers, he immediately said yes. He wanted to have the surgery. His logic was that it was better to take a chance on having a normal life than to just keep on the path he was on. He was tired of going downhill with no hope.

I contacted Dr. Baltasar and as it happened, I had an appointment with Dr. Buchwald(my surgeon). I learned they were good friends and had even vacationed together. Dr. Buchwald told me he would let Dr. Baltasar operate on him or one of his family members with no reservations whatsoever. Then to my surprise, Dr. Buchwald offered to do Dan's surgery! It didn't work out financially/insurance wise, so we went to Spain.

Then another surprise happened and I ended up with 2 patients to care for. My sister decided to have surgery too! Dan had surgery on Valentine's Day 2004 and my sister had hers done a couple days later. Dan's BMI was 27 so Dr. Baltasar elected to do only the switch and do nothing to his stomach. Dan's CC was 50cm.

Dr. Baltasar told us, and my own research confirmed, that Dan would lose about 30lbs postop and then gain it back over the next 2 years or so. Dan's recovery was perfect and that's exactly what happened. Dan's diabetes went away completely postop. He never needed another dose of diabetes meds. About 2 weeks after surgery, he got up one morning and remarked he wasn't seeing well. His vision was blurry. We decided to wait a bit then call the doc. Then we figured out the only problem was that Dan no longer need glasses to see. His vision had gone back to 20/20 without glasses. His retinopathy was resolved. Years later, Dan's ophthalmologist confirmed he could no longer see any evidence of retinopathy. The neuropathy in Dan's feet improved somewhat but sadly, most of the nerve damage was permanent and he would live the rest of his life with foot pain. His lipidemia resolved as well and his cholesterol always tested low normal after surgery. Dan's lifelong problem with constipation also ended after the DS.

In short, Dan ended up with the best of both worlds. He could eat as he pleased, including junk foods, and not gain weight. And his diabetes was gone. High protein was no problem because he loved meat. Vites were no big deal because he was already used to taking every supplement known to man. His labs were always good and just to be honest, Dan ate like a horse! I think he was making up for all the years he did without.

Dan was thrilled with his surgery and had no regrets. He always said he would do it over again in a heartbeat. The results were exactly what he had hoped for.

BTW, Dr. Baltasar had done many DS for diabetes surgeries before and after Dan with 100% success. The DS for diabetes has been done in Europe since the late 80's. The US is just behind the rest of the world. Why? Who can say for sure but it is true that diabetes is a multi-billion dollar per year industry. And insurance companies don't want to pay for surgery. I once had the chance to discuss this with someone in the business and here's what I was told. The insurance companies say you will change providers every three years on average. So paying for your covered diabetes supplies is cheaper for them than paying for surgery. Sad, but probably true. Cheaper to maintain you with a chronic disease than to cure you. They play the odds, hoping you will change providers before you go blind or need to have something amputated.

Dan died of heart problems in January of 2012. It wasn't DS related. Most likely, he needed a stent and I believe he knew something was wrong with him. I think he didn't take care of himself because he was afraid of running up huge bills he couldn't pay. Dan had been laid off in 2009 and hadn't been able to find a new job. He was a Mechanical Engineer. But we will never know for sure.

I do think it's criminal that people die every day here for lack of healthcare. Not because it doesn't exist, but because it's not affordable. Dan was more afraid of the bills than he was of dying.

 

Patty, I am sorry you lost Dan.

 

Patty,

I'm sorry for your loss. I'm thankful for you sharing that story and I'm thankful for your continued participation on these boards. Your knowledge and experience has without question been useful to me and I'm sure to many others. we probably couldn't even put a number to how many people you've helped.

Jaiart,

I was never officially diagnosed with diabetes. I took metformin, 1000mg 2x a day, I had morning injections of victoza but I never had the diabetes fully diagnosed. I was diagnosed with prediabetes and metabolic syndrome, I also have terrible edema and was taking 2 different types of diuretics.

Since having the DS less than a week ago I thought I'd like to resume using the meter. My doc never understood why I wasn't a full blown type II so he gave me blood sugar meter and use it 4 times a day for a month. The meter itself recorded all readings and could feed back some really good compiled data. Anyway my experiment will be to start using it again at set times throughout the day. I want to do this because I see the meter in my bathroom now and then and think hey I wonder what my blood sugar is. Both times I checked it was 119 and 120. Those number are higher then my previous 3 day, 10 day 20 day and 30 day averages. My avg before having the DS was 103, the highest on record for me was 148 and I rarely ever saw it go over 120. I have a level of concern here and I will begin running my experiment starting tomorrow morning.

 

@Patty,

Your story was very moving.  I am so sorry for your loss! 

All the best...

I was an insulin pump dependent diabetic pre-op...had had diabetes since 1998. Had been on an insulin pump since 2002.

I was also on metformin pre-op (2000 mgs per day) due to having PCOS. (metabolic syndrome)

I did not come off either immediately but I did come off both eventually.

My surgery was the 24th of Jan 2011. Because I was on the pump and had had surgeries before, I decreased my basel rate to half of what was normal. (MY nitwit of a surgeon's nurse wanted me to leave my pump at home. But not all insulin dependent diabetics are in remission right away). 

On the first of Feb, I took my pump off for the last time (tired of chasing lows at night).

On the 11th of Feb, I took my last insulin shot.

I also had started cutting my metformin pills in half and only taking one half a day (total of 500 mgs per day).

By April, I had stopped the metofrmin.

I still test daily (MWF in the morning, TTS in the afternoon and Sun in the middle of the day) and whenever I feel low.Average is below 100 but I do see between 100-110 sometimes. I also test at the one or two hour mark after meals on occasion...highest I have seen is 145.

Pre-op, eating the same way....I would have seen over 200 so while anything below 145 is a vast improvement, it does reinforce the "I'm still not that far out yet" and need to be aware of what I eat and how it affects my blood sugar even after surgery.

A type 2 who becomes a type 1 was never truly a type 2 to begin with...they are a LADA (type 1.5)

 

What was your A1c preop and what is it now?  Just curious....

My pre-op A1C was 8,2, it is now a 5.4. My PCP downloaded my meter this last time and said it was the most boring graph of BG readings he had seen in months...they all stayed in the green range!

The 8.2 was WHILE I was on insulin, watching all my carbs like a freaking hawk, and on 2000 mgs daily of metformin.

The 5.4 is on NO meds at all, nothing, nada, zip, zilch!

I still eat like I am a diabetic...protein first, fat second, veggies third, and carbs last.

This is the big reason I got the DS.  I would have been 4th generation diabetic.  My mom used to be very sensitive to carbs, where if she ate nothing but a piece cake, for example, her blood glucose would go up then plummet in the 40s or 50s.  Now she is, of course, type 2 DM.  I would do the same thing and knew I was doomed.  She is on Lantus, Victosa (sp?), glipizide, metformin, and sliding scale insulin to keep her A1c at 6.  Her neuropathy is horrendously painful.   You also do not need to be obese to be diabetic in my family.  I was afraid that if I only got the sleeve, it would not help in the long run.