29 yrs old BMI 33.3 DM, HTN, PCOS, reflux, hyperlipidemia. St Joe's Hamilton

Hello, I am turning 30 in May. My BMI is 33.3. I have diabetes which progressed to needing treatment with continuous insulin infusion. I also take metformin and januvia. I take ramipril and propranolol for BP. Omeprazole for reflux, and spironolactone for PCOS.

I do have joint pain and back pain but i have not had it investigated it further, but my doctor is aware.

I have developed peripheral neuropathy due to DM, but am told this can improve with improved glucose control. My A1C's have been in the 9's for over 4 years, but recently came down to 8.3. this is because i now use a continuous glucose monitor. But in spite of continuous infusion of over 100 units a day i still have a poor a1c.

I have elevated cholesterol but my doctors do not believe in medicating for my age group.

I have significant symptoms with my PCOS.

My family doctor agreed to make the referral on Feb 25^th. He said “his girls” had another one to do so it should be in the mails soon. (these were his words, I know it is an electronic referral process) I will be refereed to St. Joe's Hamilton based on my postal code.

I asked if there was a chance of being rejected due to BMI 33.3 and the requirement being being 35 with health problems. My family doctor stated it will not be an issue (but he is not always a reliable source.)

Will I get any priority due to the severity of my health issues at such a young age ? What can I expect ?

I also have hypothetical questions about insulin changes pre-surgery. I would not be comfortable discontinuing insulin until I saw evidence of my sugars normalizing. With the pump you can administer very small doses.

Typically, patients are accepted with a bmi of 35 (with comorbidities) and anyone under that number is steered towards the weight management program or the Optifast program.

It's hard to say with your health issues if they would make an exception.  It's really hard to say since of course, surgery is no guarantee that your diabetes will be "cured" in any way.  I think you have to have an open mind that you may be steered in another direction and not necessarily towards surgery. I wouldn't want you to be disappointed thinking that you'd be necessarily approved.  I don't know for sure either way.  People that I've known (as a support group leader) that were that low in bmi were always steered to the other options. You never know though - good luck!

I wish you well wherever the road takes you. Please keep us updated.

Dawn

I don't really know about the other options. I can't be on any type of ketogenic diet due to DM (and an issue I encountered where I became acidotic due to low carb intake )

I have been seen by an RD since my DM dx in 2001, I really need to see a dietician who is also a certified diabetes educator, the standard for diabetics is to eat a minimum of 130 grams of carbs a day (the 130 g per day is a very controversial issue, however, advising a diabetic to eat less than 130 grams of carbs a day could land an RD in trouble with the college of dieticians)

Not sure if they accept people with your bmi, but it would make sense to me if they did. Maybe someone on here has been in the same situation and can help?  I can tell you that I also have PCOS so I know it is really difficult. I was told if I did not do something that I could become diabetic as I have insulin resistance at this time.  I am hoping that RNY will help with both the PCOS and insulin resistance.  Apparently it is just as effective on us PCOS ladies too, which is good to know.  My BMI is at 46 at this time, so I was approved without issue. Perhaps you could contact St. Joe's with your questions? Best of luck to you and I hope others can answer your questions.

How much weight do you need to gain to be over the 35 % that is needed with comorbids? If it is close you could look at the effect of a few high salt meals and a lot of water just before weigh in at first actual appointment. I believe that is from when they will track your weight.

that's a sure way to get ahead of the line, huh ?

I am confused about my BMI because my GP clearly stated 33.3, yet I weighed 109 something kg at my new endocrinologist on Feb 21, and 108 something kg at my family doctor when he stated 33.3.

i am 6 feet tall with a long torso and disproportionate short legs. My build is such that my legs and thighs are thin but i have really significant abdominal obesity. I think i sometimes measure at 5'11.

I think i would pretty much need to gain 18-20 pounds.

I am prepared that the diabetes will remain, there are case studies of people *****mained insulin dependent, but needed far less insulin and improved their a1cs down to 6.9.

I hope they would also consider the disastrous health consequences my dad has endured at a similar BMI – multiple heart attacks leading to congestive heart failure, multiple strokes, toe amputation and sever eye and kidney complications from DM.

There is literature on ppl in obese class one which is BMI 30-34 getting bariatric surgery. And the Mayo Clinic says it is appropriate in BMIs of 30 with health issues.

It seems a little silly to say you have to be at 35 exactly. Also, my weight fluctuates as a result of fluid balance issues because I have periods of extreme hyperglycemia ex. 20-30 mmol/L for an extended period which leads to dehydration.

http://asmbs.org/2012/09/bariatric-surgery-in-class-1-obesity-bmi-30-35-kgm2/

I think I would pretty much need to gain 18-20 pounds. It is difficult to find info on this bc it is clandestine to prevent anorexics from abusing this behavior.

if you doctor sent a referral with current weight and then you come for a consult 20 pounds heavier, wouldn't they question that ? I was heavier by 4 pounds on my consult with RN/RD a month after surgeon's appointment and I was right in the middle of my period where I retain water like crazy. They questioned the gain right away. These 4 pounds disappeared right after my period but you are talking about 20 lb to qualify. I am 160 lb overweight with a BMI of 42 and they offered me to try 6 month OPTIFAST diet only because I want a sleeve instead of bypass

Thanks for pointing that out. I am not going to intentionally put on weight as in fat stores. I don't think water consumption would make a big difference, I am on a diuretic. Don't really want to d/c that bc it is for tx of the PCOS