I had RNY and I'm about 9 months out from surgery, and have lost about 110% of my excess weight. I do not want to lose more than a pound or two more, and my doc wants me to be stable as well. My surgeon also talks about the "average" person losing 70-80% of their excess weight.  

My surgeon does perform all surgeries, and is part of a AMBS Center of Excellence.  I suggest that you look for one of those if possible.  Like Tonya, I had severe reflux, so my surgeon recommended RNY  for me. 

My doc was very open about both the benefits and risks of the surgery, and you should make sure that your very comfortable having this discussion with your doc as well.  There should be no surprises.  This is a long journey, and I've been blessed by the improvement in my health, but I have had to make big changes in my lifestyle to be safe and successful with my new anatomy.

Like Tonya, I had severe reflux, so my surgeon recommended RNY  for me. 

I also had severe reflux...it's gone now. So while the RNY says it's best for that, it also might just be weight related and any surgery that gets the weight off will help.

My biggest consideration was the need to be able to use NSAIDS.

Liz

 I appreciate all of your input!  This IS what I need to do, if only for the cholesterol and heart disease that we have in my family. My mother was only 58 when she died.  I have a 2 year old. I need to do this for myself and my family.  Your right, It's not about the 50 lbs. The 50lbs is a perk!  It's about my health and being around longer for my son.  Thanks again, I feel much better about my decision :-)

I am also a diabetic.  I had 80 lbs to lose.  Doc said 60 to 80% which would have been 48 to 64 lbs.  I am 7 months out and have lost 76 lbs. with hopes of losing 94 total.  With all of my research the RNY is the best surgery for diabetic......DS is not.  The RNY gives a metabolic changes to help diabetics.  I was on 800 units of insulin with an A1C of 11.  I am taking 15 units of lantus and 3 units of novolog 2 to 3 times a day with an A!C of 5.3,  I am a type 1.  My kidney were starting to go so I felt like I had no choice.  There was no way I was going to lose weight on so much insulin.

 Kasey.... Thank you for responding. I'm sending you a message.

I think you're mistaken about the research supporting the RNY over the DS. The DS has a 98% cure rate and the RNY a 70% cure rate for type II. Either are better than the alternative though. One article below and there are more.

www.diabeteshealth.com/read/2009/06/09/6228/duodenal-switch- surgery-better-against-type-2-diabetes-than-gastric-bypass/  

--gina

Nope not mistaking............that would be correct if we were talking about type II diabetes but we are talking about type 1 diabetes. 

I stand corrected and apologize. Would you share some links to the studies? Thanks. :)

--g

Actually, it's the RNY that doesn't help even type 1's as much. The DS helps both by getting rid of the ghrelin (the hungeer hormone) of the stomach. It also accomplishes the other metabolic changes.

Now, there are more and more studies and ancedotal evidence of the RNY causing either Reactive Hypoglycemia (also known as late dumping) and or the return of diabetes several years later.

While very few type 1's usually qualify for surgery (their BMI is not typically high enough) most do go for the RNY...that does not mean it's best, just most used.

But the real kicker is why go far a surgery that can cause RH? I know from experience that it CAN be deadly! And unless you are a well controlled diabetic, it is very common.

Here is my research on RH and the RNY:

Since I was diagnosed with RH back in 1991 and had diabetes as well, I made sure I got a DS to avoid aggrevating it. So when I was doing my research, I came across many links on the subject. I collected them into one post and am posting them here for others to see during their research.

NIPHS Noninsulinoma Pancreatogenous Hypoglycemic Syndrome

See the bottom of that page:

Mayo Clinic doctors have recognized and reported on a seemingly rare but serious complication following gastric bypass called non-insulinoma pancreatogenous hypoglycemia syndrome (NIPHS) or post-bariatric surgery hypoglycemia. After a person eats, this condition can result in very low blood sugar levels that lead to severe neurologic symptoms, including visual disturbances, confusion and (rarely) seizures.

It’s not just Mayo doctors tho, I found other links as well:
Post-pradial Hypoglycemia

Noninsulinoma pancreatogenous hypoglycaemia syndrome (NIPHS) caused by an activating glucokinase mutation

Evaluation and Management of Adult Hypoglycemic Disorders: An Endocrine Society Clinical Practice Guideline

Electrical short-circuit in b-cells from a patient with non-insulinoma pancreatogenous hypoglycemic syndrome (NIPHS): a case report

Clinical features and morphological characterization of 10 patients with noninsulinoma pancreatogenous hypoglycaemia syndrome

Evaluation and Management of Adult Hypoglycemic Disorders: An Endocrine Society Clinical Practice Guideline Section 2.0

New Data on Weight Gain Following Bariatric Surgery


Surg Endosc. 2011 Jun;25(6):1926-32. Epub 2010 Dec 24.

Abnormal glucose tolerance testing following gastric bypass demonstrates reactive hypoglycemia.

Roslin M, Damani T, Oren J, Andrews R, Yatco E, Shah P.

Source

Department of Surgery, Lenox Hill Hospital, 186 East 76th Street, New York, NY, 10021, USA.

Abstract

BACKGROUND:

Symptoms of reactive hypoglycemia have been reported by patients after Roux-en-Y gastric bypass (RYGB) surgery who experience maladaptive eating behavior and weight regain. A 4-h glucose tolerance test (GTT) was used to assess the incidence and extent of hypoglycemia.

METHODS:

Thirty-six patients who were at least 6 months postoperative from RYGB were administered a 4-h GTT with measurement of insulin levels. Mean age was 49.4 ± 11.4 years, mean preoperative body mass index (BMI) was 48.8 ± 6.6 kg/m(2), percent excess BMI lost (%EBL) was 62.6 ± 21.6%, mean weight change from nadir weight was 8.2 ± 8.6 kg, and mean follow-up time was 40.5 ± 26.7 months. Twelve patients had diabetes preoperatively.

RESULTS:

Thirty-two of 36 patients (89%) had abnormal GTT. Six patients (17%) were identified as diabetic based on GTT. All six of these patients were diabetic preoperatively. Twenty-six patients (72%) had evidence of reactive hypoglycemia at 2 h post glucose load. Within this cohort of 26 patients, 14 had maximum to minimum glucose ratio (MMGR) > 3:1, 5 with a ratio > 4:1. Eleven patients had weight regain greater than 10% of initial weight loss (range 4.9-25.6 kg). Ten of these 11 patients (91%) with weight recidivism showed reactive hypoglycemia.

CONCLUSIONS:

Abnormal GTT is a common finding post RYGB. Persistence of diabetes was noted in 50% of patients with diabetes preoperatively. Amongst the nondiabetic patients, reactive hypoglycemia was found to be more common and pronounced than expected. Absence of abnormally high insulin levels does not support nesidioblastosis as an etiology of this hypoglycemia. More than 50% of patients with reactive hypoglycemia had significantly exaggerated MMGR. We believe this may be due to the nonphysiologic transit of food to the small intestine due to lack of a pyloric valve after RYGB. This reactive hypoglycemia may contribute to maladaptive eating behaviors leading to weight regain long term. Our data suggest that GTT is an important part of post-RYGB follow-up and should be incorporated into the routine postoperative screening protocol. Further studies on the impact of pylorus preservation are necessary.

PMID: 21184112 [PubMed - in process]


Surg Obes Relat Dis. 2010 May-Jun;6(3):249-53. Epub 2009 Oct 29.

Re-emergence of diabetes after gastric bypass in patients with mid- to long-term follow-up.

DiGiorgi M, Rosen DJ, Choi JJ, Milone L, Schrope B, Olivero-Rivera L, Restuccia N, Yuen S, Fisk M, Inabnet WB, Bessler M.

Source

Columbia University Center for Metabolic and Weight Loss Surgery, Columbia University Medical Center, New York Presbyterian Hospital, New York, New York 10032, USA. [email protected]

Abstract

BACKGROUND:

Studies have shown that type 2 diabetes (T2DM) improves or resolves shortly after Roux-en-Y gastric bypass (RYGB). Few data are available on T2DM recurrence or the effect of weight regain on T2DM status.

METHODS:

A review of 42 RYGB patients with T2DM and >or=3 years of follow-up and laboratory data was performed. Postoperative weight loss and T2DM status was assessed. Recurrence or worsening was defined as hemoglobin A1c >6.0% and fasting glucose >124 mg/dL and/or medication required after remission or improvement. Patients whose T2DM recurred or worsened were compared with those whose did not, and patients whose T2DM improved were compared with those whose T2DM resolved.

RESULTS:

T2DM had either resolved or improved in all patients (64% and 36%, respectively); 24% (10) recurred or worsened. The patients with recurrence or worsening had had a lower preoperative body mass index than those without recurrence or worsening (47.9 versus 52.9 kg/m2; P = .05), regained a greater percentage of their lost weight (37.7% versus 15.4%; P = .002), had a greater weight loss failure rate (63% versus 14%; P = .03), and had greater postoperative glucose levels (138 versus 102 mg/dL; P = .0002). Patients *****quired insulin or oral medication before RYGB were more likely to experience improvement rather than resolution (92% versus 8%,  P

While all this refers to type2, the RH can happen to a type 1 just as easily if not easier.

ONLY a pancreas transplant will cure a type 1.

ALL WLS will lower insulin requirements but why go with a surgery KNOWN for problems with RH later on and go with one NOT known for RH and allows NSAIDS...the DS. 

Liz

 

 

Hi, I didn't have a chance to read the articles in the links, but I was hoping you could answer a couple questions for me.

A little background:  I was a Type II diabetic for years, and then (according to my endocrinologist) my pancreas gave out and I no longer make enough natural insulin to keep my blood sugar stable after eating.  Before surgery I was on just 30-40 units of fast acting humalog per day (about 10 per meal).  I also took about 10 units of the long acting Lantus. My endo says that essentially I became aType I diabetic.

I had the RNY surgery 8 months ago and since I eat less food and even fewer carbs, I use much less insulin.  Only 2-4 units per meal and none of the long acting Lantus.  If I eat sugar or carbs, my blood sugar rises just as much as it always did pre surgery.

Here's the question that this post brought up for me:  if I don't have the pancreas cells to make enough insulin, how will I ever develop reactive hypoglycemia?  Is it is even possible for TYPE I diabetics?  The pieces of articles you posted above seem to be about Type II diabetics, who usually have lots of insulin.  Therefore, I would think that the DS and the RNY would be exactly the same vis a vis Type I diabetes.  If you have no insulin, how can you become hypoglycemic?

Thanks for any info!!

p.s. for the original poster, I am 5'3" and got a lapband (aka crapband) at 200 lbs (self pay), lost 30 lbs and then gained it back.  I was 195 at RNY surgery and am now around 140.