Type 2 diabedic: Which surgery do I pick?

[Marty G]

I just started my path of my pre surgery consultations by meeting with a Nurse Practitioner, nutritionists, and Physical Therapist at OHSU in Portland, Oregon. I have had type 2 diabetes for nearly 8 years (maybe longer undiagnosed), I do not take insulin, but know it is only a matter of time, I am on the max dose of metformin, and just increased to 8 mg of glimepiride after my last A1C was 9.2 I went into this thinking that Gastric bypass was the surgery that had the best chance at putting my Diabetes into remission, but after speaking with the NP, I am having second thoughts about Gastric Bypass and opting for Gastric Sleeve.

The NP said she was not trying to influence my decision, but clearly seemed to be pushing me toward Gastric Sleeve due to fewer post-op complications and risks. She added that even though Gastric Bypass seems to show the best results in it's effects on Type 2 Diabetes, that is likely due to the number of years, patients studied, and number of studies done on gastric bypass as compared to gastric sleeve. she said not to make the decision just based on potential diabetes results.

Also a friend of mine just had the Gastric Sleeve procedure, when I asked her why she chose the sleeve over the bypass, she said she knew four people who had serious, life threatening complications form the gastric bypass surgery.

I'm just trying to make the best decision I can and want the surgery that will help me the most and give me the best chance to get off my meds and lose my extra weight. Any thought?

 

[Stephen Jacquindo]

I am in the same boat as you (only I take insulin) and have been doing a lot of research and have come to the conclusion that for me and my diabetes the gastric bypass is the best option. the reason I say this is studies have shown a larger drop in A1C levels compared to the sleeve. the way I am looking at this surgery is I want the surgery that improves my diabetes the most. my suggestion is to ask you family Dr. or your endocrinologist to get their view from a medical side of it.

 

[Agim]

Good read.helps me is a question I've been searching for an answer .goingbto have one or the other done.didnt know Which way to go

 

[Saska]

I just started my path of my pre surgery consultations by meeting with a Nurse Practitioner, nutritionists, and Physical Therapist at OHSU in Portland, Oregon. I have had type 2 diabetes for nearly 8 years (maybe longer undiagnosed), I do not take insulin, but know it is only a matter of time, I am on the max dose of metformin, and just increased to 8 mg of glimepiride after my last A1C was 9.2 I went into this thinking that Gastric bypass was the surgery that had the best chance at putting my Diabetes into remission, but after speaking with the NP, I am having second thoughts about Gastric Bypass and opting for Gastric Sleeve.

The NP said she was not trying to influence my decision, but clearly seemed to be pushing me toward Gastric Sleeve due to fewer post-op complications and risks. She added that even though Gastric Bypass seems to show the best results in it's effects on Type 2 Diabetes, that is likely due to the number of years, patients studied, and number of studies done on gastric bypass as compared to gastric sleeve. she said not to make the decision just based on potential diabetes results.

Also a friend of mine just had the Gastric Sleeve procedure, when I asked her why she chose the sleeve over the bypass, she said she knew four people who had serious, life threatening complications form the gastric bypass surgery.

I'm just trying to make the best decision I can and want the surgery that will help me the most and give me the best chance to get off my meds and lose my extra weight. Any thought?

Hi, I was diagnosed with diabetes late last year. I was told by my primary care doctor that both procedures are considered a cure for non-insulin dependent diabetes. My bariatric surgeon recommended the gastric sleeve for me and said that this would be the best option for the diabetes and fewer complications. He has been doing more gastric sleeves now in patients than the bypass as he is seeing better results with it (the weight loss is only about 5% less than the bypass, so it isn't a big thing to choose the sleeve over the bypass). It also helped make my decision that the doctor I chose to do the surgery is one that other physicians and nursing staff would elect to see over the 4 other surgeons in the area. That to me says a lot if medical professionals make this kind of recommendation. I would however discuss both with your doctor and consider other factors in addition to the diabetes. I chose the sleeve because it would give me the option in the future to take the occasional advil, and it doesn't have weakened areas where the bypass is grafted. Also I was hoping it would have fewer complications with malabsorbtion with nutrition. But again talk with your doctor about your choices that way any questions you have will be answered by the experts.

 

[dancinbr]

I am post op 3+ years.

I was taking up to 90 units of fast insulin a day to control my diabetes.

I had the gastric bypass. The very next day after the operation, I know longer needed any diabetic meds; went right to not needing anything immediately.

Diabetes is a killer. A whole lot worse than the surgical risk of having the gastric bypass.

The key to a successful operation is finding a doctor who is one of the best as I did as well as going to a hospital that is a "center of excellence" bariatric surgery hospital.

Also, today the operation is done laproscopically. Probably spelled that wrong.

So, the risk is way down.

Hope I helped

Best wishes,

Ralph

 

[Jackie1017]

I'm diabetic. On Metformin WE 2,000mg daily, glimepiride 2mg daily, and Trulicity weekly. The Trulicity has helped lower my A1c from 8 to 6.8 in just a couple months.
I'm scheduled for the sleeve surgery to be done May 15th.
Best of luck with your decision.
I'm looking forward to this journey to a healthier me.

 

[Cjprebypass60]

I am diabetic, have been for 20+ years. I was leaning towards the sleeve first, but after talking with my surgeon I am having the bypass. His reasons for wanting me to have the bypass include 90% success rate of remission of diabetes , GERD gone, HBP gone, and High Cholesterol gone. He told me with the sleeve, the gerd will come back in 3-5 months more severe than it was. I choose to believe him as he has the numbers in his practice to prove it. Closest thing to a cure for me that I will ever get, so I am going for it. I've known lots of people who have had the sleeve also, however their weight loss slowed down rapidly after 3 months. He has told me the weight loss will come off faster in the 1st year with the bypass. I'm a little nervous of the dumping syndrome that could possibly come with it, but if I follow the diet, as I will, It should not become a problem. Just my thoughts on it. Good luck on whatever you decide.

 

[Keith Wells]

I just started my path of my pre surgery consultations by meeting with a Nurse Practitioner, nutritionists, and Physical Therapist at OHSU in Portland, Oregon. I have had type 2 diabetes for nearly 8 years (maybe longer undiagnosed), I do not take insulin, but know it is only a matter of time, I am on the max dose of metformin, and just increased to 8 mg of glimepiride after my last A1C was 9.2 I went into this thinking that Gastric bypass was the surgery that had the best chance at putting my Diabetes into remission, but after speaking with the NP, I am having second thoughts about Gastric Bypass and opting for Gastric Sleeve.

The NP said she was not trying to influence my decision, but clearly seemed to be pushing me toward Gastric Sleeve due to fewer post-op complications and risks. She added that even though Gastric Bypass seems to show the best results in it's effects on Type 2 Diabetes, that is likely due to the number of years, patients studied, and number of studies done on gastric bypass as compared to gastric sleeve. she said not to make the decision just based on potential diabetes results.

Also a friend of mine just had the Gastric Sleeve procedure, when I asked her why she chose the sleeve over the bypass, she said she knew four people who had serious, life threatening complications form the gastric bypass surgery.

I'm just trying to make the best decision I can and want the surgery that will help me the most and give me the best chance to get off my meds and lose my extra weight. Any thought?

Yes I to have known someone that has had issues with the bypass but it was doctor error. I had the Gastric bypass in Feb of this year and I no longer take any meds for my type 2. in fact my A1c has dropped into the normal levels... The study's of the Gastric Bypass is less then 1% of having and issue.... It is your choice, I just wouldn't want you to decide on the fact that some others may have had issues.. Ask you doc how many time he has seen issues or had people have issues... I did and felt good with my doc doing the bypass...
I know people that have had both surgery's and are having good results, the one that had the bypass has lost more, but the bypass limits you on never being able to have things again.... with the sleeve you are not as limited.... I just felt I would be more tempted to fall back into old habits like drinking soda or eating sweets... Good luck on your choice... My doc recommended the gastric bypass or the switch for the issues and my goal. and all have been great... The switch if you don't know is basicly the sleeve that bypasses like the gastric by pass... Instead of a small pouch you have the sleeve and then the intestines are moved like in the bypass... I hope this helps

 

[Stella57]

I just started my path of my pre surgery consultations by meeting with a Nurse Practitioner, nutritionists, and Physical Therapist at OHSU in Portland, Oregon. I have had type 2 diabetes for nearly 8 years (maybe longer undiagnosed), I do not take insulin, but know it is only a matter of time, I am on the max dose of metformin, and just increased to 8 mg of glimepiride after my last A1C was 9.2 I went into this thinking that Gastric bypass was the surgery that had the best chance at putting my Diabetes into remission, but after speaking with the NP, I am having second thoughts about Gastric Bypass and opting for Gastric Sleeve.

The NP said she was not trying to influence my decision, but clearly seemed to be pushing me toward Gastric Sleeve due to fewer post-op complications and risks. She added that even though Gastric Bypass seems to show the best results in it's effects on Type 2 Diabetes, that is likely due to the number of years, patients studied, and number of studies done on gastric bypass as compared to gastric sleeve. she said not to make the decision just based on potential diabetes results.

Also a friend of mine just had the Gastric Sleeve procedure, when I asked her why she chose the sleeve over the bypass, she said she knew four people who had serious, life threatening complications form the gastric bypass surgery.

I'm just trying to make the best decision I can and want the surgery that will help me the most and give me the best chance to get off my meds and lose my extra weight. Any thought?

I have just started the process also, I take insulin and Victoza along with Metformin. Both my regular doctor and the Bariatric Doctor suggested, that I could get the most out of the bypass regarding type II diabetes. It is my understanding that when the pouch is cut for the bypass there is a chemical that sends messages to the brain that controls your appetite that is severed by the surgery, so you have no appetite for a while this helps with the initial weight loss. It will repair itself and come back, but there is this "honeymoon" period that aids in the weight loss.

 

[Marty G]

I have just started the process also, I take insulin and Victoza along with Metformin. Both my regular doctor and the Bariatric Doctor suggested, that I could get the most out of the bypass regarding type II diabetes. It is my understanding that when the pouch is cut for the bypass there is a chemical that sends messages to the brain that controls your appetite that is severed by the surgery, so you have no appetite for a while this helps with the initial weight loss. It will repair itself and come back, but there is this "honeymoon" period that aids in the weight loss.

Hello Stella,
This initial post was actually made last year when I was in the beginning phases. I am happy to report that I am now over three weeks post op and I did get the RNY. Things are going very well and as far as my Type 2 diabetes, I am off all medication. I was taken off the once daily Lantus (long lasting insulin) immediately after surgery and my Metformin was also reduced. Then when I had my post surgery check up with my PCP, he took me off metformin, my Blood Pressure medication, and my Cholesterol medication. I have a total of 55 lbs. 30 lbs I lost over the 9 months leading up to surgery and i have lost 25 lbs in the three weeks after surgery.

As to you comment about the pouch controlling your appetite, I would say yes and no. It does control your Physical appetite where you get full very quickly and can only eat a few oz of food before you are full. however it doesn't do a great a job at controlling mental hunger, or "Head Hunger" as it's called in WLS jargon. I have heard some people use the term honeymoon period to describe the first 12 to 18 months when your body is more on auto pilot as far as weight loss. In some ways I agree with this, but there also is a great amount of work that has to be done. Many people are completely focused on only Weight Lose and judge all their success on the numbers on the scale. Needless to say these people can sometimes run out of steam when their weight loss starts to slow or they have stalls (which do happen). These people get all stressed out, feel as though they are failing, and revert right back to old habits and start to regain. you will learn that this surgery is not a quick fix but rather a tool to get you to a healthy place, from then on out it is up to you to make the positive choices to maintain a healthier lifestyle.

I wish you good luck on your journey and if you have any other questions feel free to message me. Also if you are interested, there are a number of videos and video blogs (Vlogs) on You Tube that can really help you learn exactly how and why WLS works... Or doesn't work in some cases. Two particular Bariatric Surgeons have tons of information, the first is Dr. Mathew Weiner MD, his program is called "A Pound of Cure." His videos are more like mini lectures but are chocked full of detailed information. the second is Dr. Duc Vong (Dr. V), his videos and vlogs are much more personal and he gives it to you straight. He is very much into conquering the "Fat Brain" as he calls it. That is the mindset and thinking that most Obese people have and what for the most part got us here. Also I highly recommend joining the "Baritastic Social" Facebook support page. It's a closed group, but is very active and you will learn a great deal. You will also see what I meant about people being obsessed about what their scale says. Take care and see you around ~Marty G.

 

[Stella57]

Hello Marty G.
Wow, congrats on your success, and thank you for all of that information. It was very helpful.

 

[Saska]

Hello Stella,
This initial post was actually made last year when I was in the beginning phases. I am happy to report that I am now over three weeks post op and I did get the RNY. Things are going very well and as far as my Type 2 diabetes, I am off all medication. I was taken off the once daily Lantus (long lasting insulin) immediately after surgery and my Metformin was also reduced. Then when I had my post surgery check up with my PCP, he took me off metformin, my Blood Pressure medication, and my Cholesterol medication. I have a total of 55 lbs. 30 lbs I lost over the 9 months leading up to surgery and i have lost 25 lbs in the three weeks after surgery.

As to you comment about the pouch controlling your appetite, I would say yes and no. It does control your Physical appetite where you get full very quickly and can only eat a few oz of food before you are full. however it doesn't do a great a job at controlling mental hunger, or "Head Hunger" as it's called in WLS jargon. I have heard some people use the term honeymoon period to describe the first 12 to 18 months when your body is more on auto pilot as far as weight loss. In some ways I agree with this, but there also is a great amount of work that has to be done. Many people are completely focused on only Weight Lose and judge all their success on the numbers on the scale. Needless to say these people can sometimes run out of steam when their weight loss starts to slow or they have stalls (which do happen). These people get all stressed out, feel as though they are failing, and revert right back to old habits and start to regain. you will learn that this surgery is not a quick fix but rather a tool to get you to a healthy place, from then on out it is up to you to make the positive choices to maintain a healthier lifestyle.

I wish you good luck on your journey and if you have any other questions feel free to message me. Also if you are interested, there are a number of videos and video blogs (Vlogs) on You Tube that can really help you learn exactly how and why WLS works... Or doesn't work in some cases. Two particular Bariatric Surgeons have tons of information, the first is Dr. Mathew Weiner MD, his program is called "A Pound of Cure." His videos are more like mini lectures but are chocked full of detailed information. the second is Dr. Duc Vong (Dr. V), his videos and vlogs are much more personal and he gives it to you straight. He is very much into conquering the "Fat Brain" as he calls it. That is the mindset and thinking that most Obese people have and what for the most part got us here. Also I highly recommend joining the "Baritastic Social" Facebook support page. It's a closed group, but is very active and you will learn a great deal. You will also see what I meant about people being obsessed about what their scale says. Take care and see you around ~Marty G.

Congratulations on your surgery and success so far. I can see how people can loss focus on what is considered success and just focusing on the numbers. I do actually weight myself daily, but that is not to stress over the numbers but to watch for trends. If it stalls I reflect back to what I ate and if I need to make changes, or did I exercise enough etc and modify what I do to keep the weight coming off. I also am excited by the 'little' things, like being able to run up stairs and not be out of breathe, or pick up a pen that fell under my desk and not struggle in the process, or being able to fly in an aeroplane without struggling to buckle the belt! Those are the exciting changes for me not the numbers. You are so correct when you say that this is a long term lifestyle change and not a quick fix. If that is what people want they would be disappointed when the weigh loss slows down, or struggle to maintain it years down the track. One thing that I have heard from everyone who I have met who has had bariatric surgery is to never drink anything with bubbles in it. I was at a restaurant a couple of weeks ago and after showing my surgery card to get a 1/2 portion of the meal, the server told me that she also had bariatric surgery, but had gained the weight back after drinking beer. I have also seen people who have not been successful with this type of surgery, and they all snack on high calorie foods like chocolate, and drink sodas.

I saw you mention that the social group on Facebook is a closed group, does that mean that no one outside of that group can see you are part of it or what is posted within it? The reason I ask is while my American friends, coworkers, and boyfriend's family know I had the surgery, of my own family only my parents know. I don't want the rest of my family knowing about it as some of them can be quite judgemental and I don't want to hear that I "took the easy way out" in my weight loss journey.