Question:
4 months post-op Lapband, weight down, A1C up

I am looking for some support. I just had my labs done, 4 months post-op lapband. I've lost 42 pounds since surgery, 56 since my highest. (Technically I am a "lightweight" according to the definitions of this site, having less than 100 pounds to lose overall.) I was on glucophage and glyburide for Type II diabetes. My surgeon ordered me to drop the glyburide. He also said my readings would come down after I had lost some weight. Well, I HAVE lost some weight. But I had my labs done this week, and my A1C is HIGHER (8.0) than it was 6 months ago! (All my other levels were great.) Now my NP wants to put me back on the glyburide, which I hate the thought of, because it made me hungry. The NP suggested I look at my diet. Sheesh, I've been looking at my diet for the last 4 months, with an extremely critical eye. No bread. No sugar, low carbs, low fat, small portions, a modest amount of exercise, resulting in a steady weight loss of 1-2 pounds per week. Has anyone moved in this direction? How did you handle it? Do I need to lose the weight faster to avoid the second med? I always thought this wasn't a race, but she (NP) says I have to do something about my diabetes. I thought I was, by having WLS and losing weight. Apparently my other options are Actos and insulin. I am more discouraged today than at any other time in the past 6 months. This has all gone so smoothly, so far. Did I have the wrong surgery?! Advice, please. — mum (posted on August 6, 2008)

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August 6, 2008
I see very few lap band people at my support groups, normally about 98% RNY. The RNY patients with Type II diabetes usually come off half of their meds within 2-4 weeks after surgery. Most are off of any diabetic med within 6 wks. Lap band surgery is a slow wt loss, taking up to 2 years. RNY is faster at initial wt loss for the first 8 months or so. Patients who only need to lose 60-100 pounds nomrally have the band surgery, others who need to lose over 100 pounds are usually the typical RNY patients, meeting the criteriea from their insurance companies. I think there is a lapband forum here, and there may be some more exacting answers for you. I know that one recent study was considering recommending the RNY surgery to "cure" type II diabetes, due to the RNY high success rate of making the diabetes stop. DAVE
— Dave Chambers

August 6, 2008
I thought only RNY reversed diabetes, not LAP-BAND. Granted you've lost weight but diabetes is a sneaky disease. I hate health professionals who start ragging on diabetics about our diet. Strange Ive been on glyburide for 15 yrs and it never made me hungry. I'm on avandia and it causes you to retain fluid, plus the glyburide AND metformin. I would be curious to know if therer are any other meds also out there that dont cause side effects. I have also heard insulin causes one to gain weight. Sorry, I havent been much help to you. Hope someone else can shed some light here. God bless and congrats on all the good you've done so far.
— zieberrae

August 6, 2008
Alice, I know your pain. I do think you got the wrong surgery but I had Lap RNY and my diabetes is making a come back. My A1C was lower than it has been in years at 6.5 but my sugars are still higher and still diabetic. I went home from the hospital with no insulin (took Humalog pens, 25/75) but used metformin, 1000 twice a day. I weaned myself off that in 6 weeks but higher sugars since then have caused me to go back to that med again. At the risk of sounding like a God freak...which I am...He has promised that within the 6 mo. timeframe when diabetes usually is resolved, that I will be free of diabetes due to his interfearing with it. He tells me I will be diabetes free if I stop worrying about it and just trust Him. So that is what I am doing. Believe me it is not easy but I am trusing Him to do what He does best, taking victory where no victory is in sight by human attempts. I have to remind myself many times a day to wait till He is ready. I WILL be diabetes free at that time. Lyn Anders
— SkinnyLynni2B

August 6, 2008
Alice, chill out. I was on 20 units insulin in am and 20 at night, plus glucophage and actos. I'm 8 months post op RYN and am only taking 5 units of insulin in the a.m. My PCP sez I will always be diabetic just under control (i'm not sure if I agree with his thinking) but things are looking a whole lot better. Just keep with the program, avoid anything "white" and get more than a modest amount of exercise. I walk about 5 miles a day, 7 days a week!
— katie3314

August 6, 2008
You are doing great and don't let anyone tell you different.....Your NP should know that being diabetic makes it a bit harder for you all the way around.......you will lose slower untill you get down enough that your sugars are good level.......and you have not had the wrong surgery......you have chosen a great tool to help you thru this period in your life......You have something that a lot of other WLS patients don't have and that's the ability to increase your weight loss with a fill....and when other surgery patients are stretching out thier stomach.....you can get a fill to make sure you don't gain your weight back......Make sure you are getting at least 65 gr of protein a day..... that and water and other liquids is the key to band surgery weight loss....hang in there.....you'll do fine. Pam / Ft Worth....Bandster Bites [email protected]
— pphillips4720aol.com

August 6, 2008
Alice, I am so sorry to hear about your A1C. How frustrating. Stay strong and keep your eye on the prize. I had the RNY back in December and right before the surgery, I was on glucophage, actos, lantus and some other med for diabetes alone. I was also on meds for my thyroid, hbp, etc. When I left the hospital, I no longer needed the insulin, actos, glucophage, etc. My sugar has continued to be completely under control. I do know this much for sure. . . the actos and insulin combination caused me to gain 30 lbs easily within a six month period which also conflicted with my diabetes. Speak candidly with your doc about your concerns and try your best to watch everything that goes into your mouth. I would hate to see you get back on those meds (unless it is the last resort!). Keep us posted.
— Breathin4him

August 6, 2008
Your A1C results are telling you how you're sugars have been running over the last 3 months. Our bodies are very complex and when you have surgery that stresses your body out resulting in increased blood sugars while you recooperate. Stress (mentally) from not being able to eat what you "want" also can increase blood sugar. You should increase your "modest" exercise to "vigorous" to obtain your goal of lower blood sugars and try a mental stress reducer to cool down, like yoga or meditation. When we exercise our bodies pull sugars out of the blood and move it into our cells without having insulin present. Without excercising our bodies need insulin to "unlock" our cellular door in order for the cell to use the sugar for energy.....thus exercising is lowering blood sugar, saving our pancreas, and decreasing insulin resistance naturally!!! good luck! sassypaige, RN
— sassypaige614

August 6, 2008
Alice, I am having surgery lap RNY on Monday and I too am a diabetic. I dont have any post op advice for you , but I do have a medication advice. I used to be on Actos, and it cause alot of weight gain, then my endocrinologist switched me to Januvia which supposedly does not have that side effect. You may want to inquire about that, if indeed you need a little help just to get you over this hump. Remember these meds are hopefully not forever. They are a temporary thing that will go away with time. Good Luck.
— eyenjeff

August 6, 2008
Alice -- As I've posted other times on this site, I was diagnosed with mild Type II diabetes prior to my VBG (vertical banded gastroplasty -- don't think they even DO that kind of surgery anymore) in April 2000. After the surgery I lost well over 100 pounds and my diabetes "disappeared". HOWEVER, because I had a number of genetic risk factors -- my father AND my paternal grandmother both had Type II; I had severe gestational diabetes when I was pregnant with my first son; I had two babies that weighed (more or less) 10 pounds at birth -- it "came back" in April 2006, and by then I was like 130 pounds lighter from when I was diagnosed the first time. So if weight was the only reason I was a type II, that makes absolutely no sense -- and in the last 2 years I've probably lost another 20-30 pounds from the meds, and I still have it. The point of all this is do you have any genetic factors (such as I described above) that would increase your chances of having your Type II be more than weight-related? Type II can be easily controlled with diet and meds (my dad controlled his type II with diet alone for the better part of 30 years -- he had steel-belted willpower -- took pills for a couple of years, and didn't have insulin at all until the month before he died of pancreatic cancer) and it's easier to manage when you DON'T weigh 350 pounds, as I can personally attest. I know it's discouraging, but it's not the end of the world, and if you're losing a pound or 2 a week that's great, and 42 pounds in 4 months is GREAT! Just keep doing what you're doing -- as it sounds like you're doing what you should. I don't think you had the wrong surgery if it was the "right" surgery for you, and there may be circumstances beyond your control (like genetic factors) that are impacting your sugar levels. Even if your diabetes isn't "cured", it should, with time, get better, as you drop more weight and manage your sugar levels more easily. Blessings --
— Cheryl Denomy

August 7, 2008
I don't know about lap-banded people but R-N-Y is touted to be the "cure" for diabetes. I am R-N-Y(2 years now) and was put back on glucophage a couple of months post surgery. I was taken off glucophage IMMEDIATELY after surgery, while still recovering in hospital by doctors who are of the mindset that R-N-Y is "the cure". In my case it was NOT. Sounds like that is the case for you as well. Don't let some doctor bully you around while you continue to have elevated A1C. Change doctors, if necessary, to someone who does not have preconceived notions about these things.
— [Deactivated Member]

August 7, 2008
Absolutely no carbs may be the issue as this can put you into ketoacidosis & create sugars from protein. Your body has to have them & will make them if you don't give it any. Please do take your nutritionist up on the offer of looking at your food journal. I had lap-band 4/19/07. My A1C is down from 7.3 to 5.3. My diabetes is currently in remission. It took a year & I was never on meds, just diet & exercise. Remember banding does all the same things, it just takes a little longer. Donna, lapband diabetic & RN
— Donna O.

August 7, 2008
Alice, congratulations on your weight loss - that's a great accomplishment! First of all, let me say that Lap Banding is just as good for diabetes control as RNY - under the advice of my doctors, I chose to have the lap band to help with my diabetes. You chose the right surgery for you - - everyone's choice is different. When I was banded on April 29, 2008, I was on metphormin, my A1C was running about 6.1 to 6.2. I left the hospital the next day off of my metphormin and my blood sugars have been running in the 80's since then. My suggestion is to increase the exercise a little bit and hang tight for a little whiel longer - - like someone said, the A1C is a three month accumulative. Maybe you should meet with the nutritionist or a diabetes educator to review your diet. Best of luck to you.
— Monte57

August 7, 2008
I just thought maybe you could investigate a little more about the food you are eating. Some foods that claim they have no sugar are actaully very high in sugar alcohols (and are they even honest??? I've read consumer reports that say they are not)...And maybe before surgery this never affected you...but after it could. Weird things happen after any surgery...It could be that you are more sensitive to sugar alcohols now? Just an idea...I'm not sure about lapband surgery, but RNYers have all kinds of hormone spikes and weird changes that affect us...(Stuff I don't quite understand or know much about) Also are you also watching the glycemic index of the foods you are eating? One last thing to consider is that because the AIC is a 3 month period....Your sugar actually may have been higher 3 months ago and are now down and just didn't show that on the A1C. It's just an average that may not have showed an accurate measure of how you are RELLY doing NOW! I would just test your blood again (daily) and see if you can find what/when and why it is spiking...Hopefully it's already going down and you just had a premature reading...I wish you much luck.
— .Anita R.

August 8, 2008
I had lap band 4-16-08 and I was on insulin 4xday and then it was lowering my blood sugars (one week later) and I was put on oral medications (actos and amaryl) my blood sugars were in the 8.9 and now the A1C in July was 7.1 and I had lost 42 pounds and I know that the lap band there is a 75% chance I could lose the diabetes and maybe it will come in the next few months. It is not automatic but a great probability. Just going back on oral medications is great for me.
— dyates2948

November 6, 2008
Update, 6 mos post-op Lapband. My A1C is now back to where it was 3 mos pre-op. (Jan 7.6; surgery in April; Aug 8.0; Nov 7.6 again.) Seeing my NP this afternoon to check on meds. Down 53 lbs since surgery, 67 overall. Recently attended a class on Type II diab., the only way to beat it, if it's in your genes, is gastric bypass. With both parents' histories, my diab. wasn't a matter of if, it was a matter of when. Being obese meant I got it sooner. Being slim doesn't mean I get rid of it. Back to the pills or insulin.
— mum

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