Diabetes: Low-carb to gastric bypass and diabetes

While it is true there are slender (skinny, even) diabetics, I think they are a different type of Type II that most of us who have insulin resistance. As we all know, there are a lot of factors to consider in the treatment of diabetes. I was diagnosed hypoglycemic at age 18 and have been struggling with BG, IR and diet ever since.

In my case, I have gold standard health insurance. My out of pocket cost for the pre-surgery, surgery and post-surgery this year will be $1000. If I had to pay huge amounts it could not have happened, since I also got caught in the recession and am living on savings instead of working. I suppose it could be said I'll save at least $1k on food this year - although I may make that up in supplements. ;^)

The doctors at Tufts say that when we finally figure out what the bowel resection does to affect BG (other than malabsorption) this operation will seem like when we lopped off limbs with no anesthetic. (Note - there was very little pain with my surgery/recovery. ) This particular bariatric program is very intensive in terms of making sure people are appropriate candidates and while they don't turn anyone away, it may take a year or more for someone to get approved if they have a food addiction or problem like bulimia. I appreciate their paying attention to the mindset/addiction portion of the problem. I moved through rapidly because of my history of weight loss and documentation of my intense efforts to control portions, carbs, etc. I eat more stringently than the dietary guidelines suggest even now.

The word I get from the HOWL folks and the psychologists who have been with this program is that practically anyone can lose weight, the problem is keeping it off. Most of the people in the bariatric program are great at losing weight (some of them have lost 1000 pounds through a lifetime and then gained it back with more on top - lose 50, gain 75, etc.) The problem is keeping it off an that requires a disciplined approach as well as the intervention of the bypass (or band). The bypass is the golden standard these days because you lose the feeling of hunger (for the most part) for a year or more (although you can still have mouth hunger or psychological hunger) and the weight loss for most people is more rapid - which is important if you need to lose 100 pounds in order to get a kidney transplant or something like that. You are still hungry with the band - and the feeling is that the lap band (or its equivalent) will go away in the next few years as
most people with them require more than one surgery and it just doesn't seem to work as well. I don't have an opinion on the band, but the folks I know with it spend a lot more time in the doctor's office getting fills and removals of saline through the port under the skin of the stomach, and many do have more than one surgery - which ups the medical risks. (shrug)

The surgical isn't easy out, by any means. You still have to live on a rigid diet and you can (if you are determined enough) destroy the effectiveness of the surgery. That's why the program tries to be so very careful with who gets it. What the surgery did for me was add malabsorption into the mix and whatever hormonal change that happens so that I left the hospital on no diabetes meds. I don't like being at 140, and so far I have never gotten in the 80's - which is where I want to be, but considering I take zero BG meds and I used to be on 10 mcg of byetta a day plus the maximum dose of fortamet daily, it really is a big change. I still have dawn effect, even if I eat protein before bed, and that is annoying, but it is not extremely high. The BP will drop with the weight loss as will the BG. My doctor suggests I always take a small amount of my BP med to protect the kidney, so I probably will as long as I don't get low BP.

The people I see at HOWL are the motivated ones - the ones who want to succeed for a lifetime. I don't know how people who dong' get ongoing support group services do. Maybe okay, maybe not okay. One of the things I do now is use sparkpeople to track food, water and exercise. I was surprised to find out I was underfeeding for awhile - upped my protein and am now losing weight again. I work harder now on my eating than I did on byetta.

I wanted to do this before I got to an age where I'd be considered too old, or medicare would not cover it, or I lost enough weight on my own to be under the BMI required by the FDA to be considered a candidate. For me, it was the right choice. For others, it might be impossible or totally the wrong choice. Options, options, options - it is all about exercising the options we have - from lantus to byetta to low-carb to gastric bypass.