Bariatric surgery may improve pregnancy outcomes - mostly

Many women opt for bariatric surgery in order to increase chances of maintaining a healthy pregnancy.  A recent study suggests that weight loss surgery can help a woman do just that, but there are risks.

Personally, my full term post bariatric surgery pregnancy was different than my pre-WLS pregnancies.  I was at a more normal bodyweight at the time of my daughter's gestation, and I did not seem to suffer the ill effects of obesity on pregnancy like I had with my prior children.  I had no high blood pressure, no high blood sugar, nor did I land on bedrest - which I had with previous babies.    My post RNY pregnancy offered me anemia and rampant hypoglycemia.  I was not well. 

She was born healthy, but small, in comparison to my earlier babies.  I noted a lack of body fat at birth.  This is several weeks old.

My post bariatric surgery baby - my smallest birthweight baby.

 

New York Times - 

While the study found some risks for women who had surgery, including more babies born too small and a greater likelihood of stillbirths, experts said that overall the results were better.

The findings have implications for an increasing number of women and children, especially in the United States, where nearly a third of women who become pregnant are obese. Obese women have more problems in pregnancy, including gestational diabetes, pre-eclampsia, and stillbirth. Their babies are more likely to be premature, overweight or underweight at birth, have certain birth defects, and develop childhood obesity.

The study, published Wednesday in The New England Journal of Medicine, sought to find out if surgery could safely mitigate some of those effects. Swedish researchers, led by Kari Johansson, a nutritionist at the Karolinska Institute, evaluated records of 2,832 obese women who gave birth between 2006 and 2011, comparing women who had bariatric surgery before becoming pregnant with women who did not.

They found that women who had had surgery were about 30 percent as likely to develop gestational diabetes, which can lead to pre-eclampsia, low blood sugar, birth defects and miscarriage. They were about 40 percent as likely to have overly large babies, whose challenges can include lung and blood problems.

The outcomes were worse in some categories. Women who had surgery were twice as likely to have babies who were small for their gestational age, suggesting the need for better nutrition for pregnant women with surgically-reduced stomachs. And more of their babies were stillborn or died within a month after birth, although the number of such deaths in each group was very small and might have been due to chance, experts and the authors said. There was no significant difference in rates of premature births or babies with birth defects.

The study via NEJM -

BACKGROUND

Maternal obesity is associated with increased risks of gestational diabetes, large-for-gestational-age infants, preterm birth, congenital malformations, and stillbirth. The risks of these outcomes among women who have undergone bariatric surgery are unclear.

METHODS

We identified 627,693 singleton pregnancies in the Swedish Medical Birth Register from 2006 through 2011, of which 670 occurred in women who had previously undergone bariatric surgery and for whom presurgery weight was documented. For each pregnancy after bariatric surgery, up to five control pregnancies were matched for the mother’s presurgery body-mass index (BMI; we used early-pregnancy BMI in the controls), age, parity, smoking history, educational level, and delivery year. We assessed the risks of gestational diabetes, large-for-gestational-age and small-for-gestational-age infants, preterm birth, stillbirth, neonatal death, and major congenital malformations.

RESULTS

Pregnancies after bariatric surgery, as compared with matched control pregnancies, were associated with lower risks of gestational diabetes (1.9% vs. 6.8%; odds ratio, 0.25; 95% confidence interval [CI], 0.13 to 0.47; P<0.001) and large-for-gestational-age infants (8.6% vs. 22.4%; odds ratio, 0.33; 95% CI, 0.24 to 0.44; P<0.001). In contrast, they were associated with a higher risk of small-for-gestational-age infants (15.6% vs. 7.6%; odds ratio, 2.20; 95% CI, 1.64 to 2.95; P<0.001) and shorter gestation (273.0 vs. 277.5 days; mean difference −4.5 days; 95% CI, −2.9 to −6.0; P<0.001), although the risk of preterm birth was not significantly different (10.0% vs. 7.5%; odds ratio, 1.28; 95% CI, 0.92 to 1.78; P=0.15). The risk of stillbirth or neonatal death was 1.7% versus 0.7% (odds ratio, 2.39; 95% CI, 0.98 to 5.85; P=0.06). There was no significant between-group difference in the frequency of congenital malformations.

CONCLUSIONS

Bariatric surgery was associated with reduced risks of gestational diabetes and excessive fetal growth, shorter gestation, an increased risk of small-for-gestational-age infants, and possibly increased mortality. (Funded by the Swedish Research Council and others.)

PS.  Post RNY baby is eight years and four months old now.  She's fine.

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Vertical Sleeve Gastrectomy — Considerations and Nutritional Implications

Note - I pasted most of this article in full from "Today's Dietician" as it is chock full of good nuggets of information and vitamin information - scroll down - I do not own this information the links are all below -  GOOD GOOD STUFF here!  -MM  

Thank you Bariatric Fusion for the tip!

Vertical Sleeve Gastrectomy — Considerations and Nutritional Implications.  

All below.

WHO-proposed sugar recommendation comes to less than a soda per day

WHO-proposed sugar recommendation comes to less than a soda per day

WHO’s current recommendation, from 2002, is that sugars should make up less than 10% of total energy intake per day. The new draft guideline also proposes that sugars should be less than 10% of total energy intake per day. It further suggests that a reduction to below 5% of total energy intake per day would have additional benefits. Five per cent of total energy intake is equivalent to around 25 grams (around 6 teaspoons) of sugar per day for an adult of normal Body Mass Index (BMI).

The suggested limits on intake of sugars in the draft guideline apply to all monosaccharides (such as glucose, fructose) and disaccharides (such as sucrose or table sugar) that are added to food by the manufacturer, the cook or the consumer, as well as sugars that are naturally present in honey, syrups, fruit juices and fruit concentrates.

Much of the sugars consumed today are “hidden” in processed foods that are not usually seen as sweets. For example, 1 tablespoon of ketchup contains around 4 grams (around 1 teaspoon) of sugars. A single can of sugar-sweetened soda contains up to 40 grams (around 10 teaspoons) of sugar.

The draft guideline was formulated based on analyses of all published scientific studies on the consumption of sugars and how that relates to excess weight gain and tooth decay in adults and children.

Read the draft guideline and submit your comments

http://www.who.int/mediacentre/news/notes/2014/consultation-sugar-guideline/en/

Gastric Bypass Causes Hypoglycemia

Wait - this is news?

"Consistent with that is the fact that there are new conditions—nesidioblastosis, noninsulinoma pancreatogenous hypoglycemia syndrome, hyperinsulinemia and hypoglycemia—[that are] becoming more common after gastric bypass,”

If you are new to my blog -- I self-diagnosed (well, myself!) with reactive hypoglycemia as a result of gastric bypass surgery in my first post operative year.  

I found myself with a severe case of "hand-in-box" syndrome and subsequent blood sugar readings in the 20-40 range after eating.  I found that doctors were not quite versed in what was happening to me -- so I had to deal with my issue on my own.

Now, in my tenth post-operative year, I know how to Eat Around My Gastric Bypass Surgery To Avoid Damaging Blood Sugar Lows -- because as you may also note:  I became an epileptic post-RNY and severe low sugars can trigger seizure activity in the brain.  While it has been established that my epilepsy is not connected to my low blood sugar - it can be triggered by it - so I am careful to avoid stepping into obvious triggers.

We patients - have been screaming about these symptoms for years and often been laughed AT - or ignored.

Just hook us up to an IV bag of glucose - we'll lose our cyclic regains and stop the insanity.  

And yes, I know this article reads like an ad for the duodenal switch.  Because.

Enjoy -

Despite its reputation as the gold standard for weight loss, gastric bypass surgery may result in a post-meal glucose spike followed by a blood sugar crash that causes between-meal hunger, according to recent findings. The research examined the effects of different bariatric procedures on post-meal glucose reactions.

Mitchell S. Roslin, MD, Lenox Hill Hospital, New York City, and his colleagues first became interested in glucose tolerance testing after noticing that many of their patients who regained weight after gastric bypass surgery complained of inter-meal hunger, especially following meals rich in simple carbohydrates.

“Consistent with that is the fact that there are new conditions—nesidioblastosis, noninsulinoma pancreatogenous hypoglycemia syndrome, hyperinsulinemia and hypoglycemia—[that are] becoming more common after gastric bypass,” Dr. Roslin said. “These are entities surgeons rarely encountered previous to this [era in bariatric surgery].”

The research was presented at the 2013 meeting of the Society of American Gastrointestinal and Endoscopic Surgeons. The study was sponsored by Covidien.

Dr. Roslin and his team decided to compare glucose metabolism among patients who had undergone gastric bypass, sleeve gastrectomy or duodenal switch (DS), in which a common channel of at least 125 cm was preserved.

“This type of model gives us the ability to compare two operations that preserve the pyloric valve, as well as two operations that have an intestinal bypass component,” he said.

In the prospective, nonrandomized study, 13 patients received gastric bypass, 12 received sleeve gastrectomy and 13 underwent DS. All completed an oral glucose tolerance test (GTT) at baseline and at six, nine and 12 months. The nine-month GTT comprised a solid mixed-meal muffin. The only significant, preoperative difference among the patients was greater body mass index in the DS group. There were no significant differences in their glucose homeostasis parameters, fasting glucose or insulin.

At 12 months, the DS patients lost significantly more weight than the other two groups, although those patients also experienced good weight loss. All of the operations reduced fasting blood glucose levels as well. But after GTT, the gastric bypass group had much higher levels of one-hour glucose than the DS group, and the sleeve gastrectomy group had intermediate levels. The gastric bypass group also had higher one-hour insulin levels, higher even than their preoperative level, whereas insulin was suppressed in the DS group.

“When you have high insulin, glucose falls, and we know that hypoglycemia causes hunger,” Dr. Roslin said. “Looking at the one- to two-hour glucose ratio, the gastric bypass patients have the highest one-hour sugar [levels] and the lowest two-hour sugar [levels], and I think this begins to explain why we have inter-meal hunger with gastric bypass.”

All of the operations resulted in significant weight loss and other positive outcomes, but compared with gastric bypass patients, DS patients had a much smaller rise in one-hour glucose and insulin levels.

“The sleeve behaves intermediately to the bypass and DS, meaning that preserving the pylorus may be part of the explanation, but not the whole story,” Dr. Roslin said.

“Obviously, controlled trials between gastric bypass and DS are needed to determine the real long-term significance, but I think we should all be cautious before we label gastric bypass the gold standard operation,” he said.

Kevin M. Reavis, MD, of the Division of Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic, Portland, said that improved assays are allowing for a more rapid and better understanding of the true complexity of the physiologic changes that contribute to the results seen with each of the bariatric procedures.

“This study highlights aspects of glucose metabolism that have previously been underappreciated,” Dr. Reavis said. “Although it is a relatively small study, it illustrates that with gastric bypass, sleeve gastrectomy and duodenal switch, there are substantial metabolic changes we are just beginning to understand and must investigate on a larger scale in order to optimize clinical outcomes.”

Recommended Carbohydrate Levels After Gastric Bypass

Via Bariatric Times -

After you read this study, let's discuss:  

• Did your nutritionist give YOU guidance in regards to carbohydrate intake after your roux en y gastric bypass surgery?

• Background: Exact carbohydrate levels needed for the bariatric patient population have not yet been defined. The aim of this study was to correlate carbohydrate intake to percent excess weight loss for the bariatric patient population based on a cross-sectional study. The author also aimed to review the related literature.
• Materials and Methods: A cross-sectional study was conducted, along with a review of the literature, about patients who underwent Roux-en-Y gastric bypass at least 1 year previously. Patients had their percentage of excess weight loss calculated and energy intake was examined based on data collected with a four-day food recall. Patients were divided into two groups: 1) patients who consumed 130g/day or more of carbohydrates and 2) patients who consumed less than 130g/day of carbohydrates. 
• Limitations: The literature review was limited to papers published since 1993. 

• Results: Patients who consumed 130g/day or more of carbohydrates presented a lower percent excess weight loss than the other group (p= 0.038). In the review of the literature, the author found that six months after surgery patients can ingest about 850kcal/day of carbohydrates, 30 percent being ingested as lipids. A protein diet with at least 60g/day is needed. On this basis, patients should consume about 90g/day of carbohydrates. After the first postoperative year, energy intake is about 1,300kcal/day and protein consumption should be increased. We can, therefore, establish nearly 130g/day of carbohydrates (40% of their energy intake) 
• Conclusions: Based on these studies, the author recommends that 90g/day is adequate for patients who are six months post Roux-en-Y gastric bypass and less than 130g/day is adequate for patients who are one year or more post surgery. 
• The author concludes that maintaining carbohydrate consumption to moderate quantities and adequate protein intake seems to be fundamental to ensure the benefits from bariatric surgery.

- http://bariatrictimes.com/recommended-levels-of-carbohydrate-after-bariatric-surgery/

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Cleveland Clinic study shows RNY bariatric surgery restores pancreatic function by targeting belly fat

Cleveland Clinic study shows RNY bariatric surgery restores pancreatic function by targeting belly fat

Just to keep you on your toes, a couple days ago I shared the study that stated that WLS doesn't save you money in the long run.

Now, we hear once AGAIN that roux en y gastric bypass bariatric surgery fixes diabetes damn near immediately. This is just another study on THAT topic.

We already knew this.

Thanks, pancreas!  *thumbs up for working so well!*

*Waves to all the post bariatric reactive non-diabetic hypoglycemics*

Visit NBCNews.com for breaking news, world news, and news about the economy

Cleveland Clinic study shows bariatric surgery restores pancreatic function by targeting belly fat

2-year study indicates how gastric bypass reverses diabetes. In a substudy of the STAMPEDE trial (Surgical Therapy And Medications Potentially Eradicate Diabetes Efficiently), Cleveland Clinic researchers have found that gastric bypass surgery reverses diabetes by uniquely restoring pancreatic function in moderately obese patients with uncontrolled type 2 diabetes.

Nutrition for Reactive Hypoglycemia

 

Many post weight loss surgical patients deal with blood sugar fluctuations, particularly those of us whom have had roux en y gastric bypass.  Aside from dumping, we often have a blood sugar reaction after dumping -- and sometimes without -- called reactive hypoglycemia.  

 

Nutrition for Reactive Hypoglycemia -

via http://www.mckinley.illinois.edu/Handouts/hypoglycemia_nutrition_reactive.html

What is reactive hypoglycemia?

A blood sugar meter that tracks your patterns? The OneTouch Verio

 

 

Niiiiiice.  

This post is absolutely copied from PR for OneTouch, but I am super intrigued by this product.  I want one and I want to play with it.

 A meter that tracks your blood-sugar trends and gives you feedback on predicted lows -- highs.  I can see the potential use of this for those of us who have hypoglycemia issues after weight loss surgery.  If I were more aware of my lows or potential lows, perhaps I wouldn't pre-treat so often.  (My pre-treating?  EATING TO AVOID LOWS.  LOL.)  I wonder.

Via Diabetes Health -

LifeScan has introduced the OneTouch® Verio^TM IQ, a meter that not only tracks and displays blood sugar patterns, but also announces them with messages, such as "Looks like your blood sugar has been running LOW around this time."

The meter, which incorporates what LifeScan calls "PatternAlert^TMTechnology," is specifically designed fordiabetes patients who take insulin. LifeScan's reasoning is that insulin users are at greater risk of hypoglycemia than non-insulin users and must monitor their blood sugar throughout the day to adjust for meals and physical activity.

"All meters will tell you your blood sugar level at a particular moment in time, but this is the only one to compare your current result with your previous results and proactively alert you to important patterns you might not even be aware exist," says Michael Pfeifer, chief medical officer at LifeScan, Inc.

The PatternAlert Technology reflects the recommendation by diabetes experts that patients identify patterns of highs and lows that last at least two or three days in a row.

A "High Glucose Pattern" consists of three before-meal highs within the same three-hour window over the past five days. High (before meal) results are preset to 130 mg/dL or above to match current American Diabetes Association guidelines, but can be personalized to any result at or above 100 to 160 mg/dL.

A "Low Glucose Pattern" consists of two lows within the same three-hour window over the past five days. Low results are preset to 70 mg/dL or below to match current ADA guidelines, but can be personalized to any result at or below 90 to 50 mg/dL.

When the meter finds a pattern, a message appears, such as "Heads up. Your before-meal glucose has been running HIGH around this time." Patients may choose to view additional information about each test result in the pattern, such as the blood sugar value, day, time, and type of result (before or after a meal, for example).

A companion OneTouch® Verio^TM IQ Pattern Guide is available to patients from healthcare professionals or by contacting OneTouch directly at 888-567-3003. The guide offers possible causes and potential solutions for high and low patterns, based on guidance from leading diabetes experts.

Watch for the OneTouch Verio release on Twitter.

Tis The Season To Transfer Your Addiction - WLS and Alcoholism

*Reposting from 2010*

A few month gastric bypass post op writes --

"Can I have a glass or two of wine?  I used to have a few glasses when I had a drink, would it be okay to just have one, or two now?"

No.  

Hypoglycemia Prevention Program

This just hit my email, coinciding with my blood sugar on a rollercoaster today -- because I CHOSE to eat half a cup of soft pretzel nuggets for lunch.

I've been in a carb-coma for most of the afternoon, a walking zombie.  I'd go to bed for the night right now if I could.

Thud.

It's for patients of the Joslin Clinic (who are typically diabetic, I am not... I am a post roux en y gastric bypass patient with reactive hypoglycemia issues) in Boston, Massachusetts, but Right Now?  It looks about right.

But, I figure, there's got to be a FEW Diabetic Boston Area Patients in my readership --

Sugar Highs and Lows: Sugar on the Brain

New Data on Weight Gain Following Bariatric Surgery

Here's MM, jumping up and down, telling you, I TOLD YOU SO, SIX YEARS AGO!  RNY MAKES SOME OF US HUNGRY HUNGRY HIPPOS with constant blood sugar fluctuations!  However, I know this reads like PRbecauseitsortofis, it is much truth -

New Data on Weight Gain Following Bariatric Surgery | Lenox Hill Hospital -

Gastric bypass surgery has long been considered the gold standard for weight loss. However, recent studies have revealed that this particular operation can lead to potential weight gain years later. Lenox Hill Hospital’s Chief of Bariatric Surgery, Mitchell Roslin, MD, was the principal investigator of the Restore Trial – a national ten center study investigating whether an endoscopic suturing procedure to reduce the size of the opening between the gastric pouch of the bypass and the intestine could be used to control weight gain in patients following gastric bypass surgery. The concept for the trial originated when Dr. Roslin noticed a pattern of weight gain with a significant number of his patients, years following gastric bypass surgery. While many patients could still eat less than before the surgery and become full faster, they would rapidly become hungry and feel light headed, especially after consuming simple carbohydrates, which stimulate insulin production.

The results of the Restore Trial, which were published in January 2011, did not confirm the original hypothesis – there was no statistical advantage for those treated with suturing. However, they revealed something even more important. The data gathered during the trial and the subsequent glucose tolerance testing verified that patients who underwent gastric bypass surgery and regained weight were highly likely to have reactive hypoglycemia, a condition in which blood glucose drops below the normal level, one to two hours after ingesting a meal high in carbs. Dr. Roslin and his colleagues theorized that the rapid rise in blood sugar – followed by a swift exaggerated plunge – was caused by the absence of the pyloric valve, a heavy ring of muscle that regulates the rate at which food is released from the stomach into the small intestine.

The removal of the pyloric valve during gastric bypass surgery causes changes in glucose regulation that lead to inter-meal hunger, impulse-snacking, and consequent weight regain.

Dr. Roslin and his team decided to investigate whether two other bariatric procedures that preserve the pyloric valve – sleeve gastrectomy and duodenal switch – would lead to better glucose regulation, thus suppressing weight regain.

The preliminary data of this current study shows that all three operations initially reduce fasting insulin and glucose. However, when sugar and simple carbs are consumed, gastric bypass patients have a 20-fold increase in insulin production at six months, compared to a 4-fold increase in patients who have undergone either a sleeve gastrectomy or a duodenal switch procedure.

The dramatic rise in insulin in gastric bypass patients causes a rapid drop in glucose, promoting hunger and leading to increased food consumption.

“Based on these results, I believe that bariatric procedures that preserve the pyloric valve lead to better physiologic glucose regulation and ultimately more successful long-term maintenance of weight-loss,” said Dr. Roslin.

Gastric Bypass Surgery Can Reverse Diabetes, mostly.

ABC News -

Gastric bypass surgery works by reducing the size of the stomach so a person can't eat as much and shortening the length of the intestine so that the body doesn't absorb too many calories. But it might also have the side effect of normalizing blood sugar. 

"The fast effectiveness is due to, we think, an elaboration of hormones made by the intestines,"  Schauer said. "These are called incretins and these are dramatically increased after surgery in hours or days.

"These hormones stimulate the pancreas to make more insulin. And that's thought to be the underlying problem with type 2 diabetes."

Awesome.

But, please do not forget that there are thousands of us who never HAD Type 2 diabetes (and some who did but clearly dropped into the opposite spectrum) who suffer with severe hypoglycemia post gastric bypass surgery.  

Dear Doctors - DUH! WHAT HAVE I BEEN SAYING SINCE 2005?

I feel better now. I do.  I'm going to pack my hypoglycemic ass up and bring it to Minnesota until I find a Dr. who wants to use me as a lab rat.  I swear.

Random reactive.

Hypoglycemia can be random when it's reactive.

When my blood sugar drops, one of the early signs is cleaning. 

I tend to get things done, fast.  Why?  I don't know.  It's a rush of misdirected energy, and then it turns into more obvious signs of hypoglycemia, and usually ends in me, confused, in the kitchen.

I just found myself, somewhat confused, in the kitchen, taking out the trash, when I realized my blood sugar had tanked.  Or, was going to, or might be, or I was simply losing it.

I get a brain cloud, and always try to simply push through it, until something else tells me "SUGAR.  NOW."  (Which unfortunately is the same thing my brain says during a complex partial seizure, so my kids don't know whether to FEED me, or to make me sit down.)

I found the glucose tabs, and slurped a few down, followed by some vitamins and a peanut butter cup.  I will live.  Instant Rebirth!

(I share that I used a PB cup for following up the glucose, because it's what I found in my fridge -- you can thank my carb head husband -- and it served the purpose.  It's actually the perfect level,  about 105 calories and 12 carbs.  Typically I eat something like a slice of bread, turkey and mayo.)

The trigger for this low?

11am - Most of a snack-size cup of lowfat cottage cheese, smeared on about six Toll House Flips Pretzel + Cheese Crackers, and a snack-size "Take 5" bar.  *THUD*

This amazes me -- because -- that's nothing.  (I am 6.5 years post op.)  This is simply HOW random reactions can BE. 

Because -- I can eat.  Had that meal been two slices of pizza?  I would have no reaction.  Bodies are weird.  My body likes PROTEIN, TONS OF FAT and CARBS all smooshed together.  Don't give it protein and carbs only, don't give it carbs only, EVER.

Or, if you do ... be prepared to find me in your kitchen, trying to clean it, but confused and looking for a snack.

Hypostab.

Source - CJ

Did you catch the possible complications?

Did you?

Read it again.

I have NEVER seen it written this way. Never hypo as the FIRST complication and so "grave."

Welcome To ME, who has seizures every 1-3 days that began coincidentally with the onset of post RNY hypoglycemia but are NOT related.

I haven't been writing about hypoglycemia or seizures lately.  I still have both.  The hypoglycemia issues don't happen dramatically, EVER, that that's because I pretty much self-medicate with protein-fat-carb-protein-fat-carb all day long.  If I eat straight up carb, I DIE.  And, I can simply count minutes to crash, so I don't eat simple carbs, alone, EVER.  If I want potato?  It must be doused with fat and sided with protein.

That said, it still happens in baby crashes, just not anywhere near the dramatic lows I used to have.  I would say that it's mostly because I have awareness of how to eat and when to eat. And, how to eat?  Does not include: Skittles. LOL.  I don't eat stuff like that, ever, unless I have.. say... BEEF in my other hand.  ;)

The seizures -- happen every 1-3 days in a bad week.  This past week, two.  One the day before yesterday, and another a couple days before that. 

Both partial complex seizures that I have only the memory of what happened RIGHT BEFORE the moment.  Mr. was home during the first of last week's event - and he said I was on his computer, and stopped, starting typing crazy, looked away, stared off and said some crazy shit and hugged him.  He doesn't really react any more, I tend to ask, "What did I do?" and he tells me "Well, you said XYZ, and then it was over."  As do the kids.  "Mama, you just had a seizure.  Oh well."

The second, I felt coming, came and sat down here, was mid-Facebook update and hit send on a update full of typos.  (I find them later.)  I don't typically post anything with obvious blatant errors, even though I do not draft or edit anything I type, I try not to send out crazy 4i3qgrelgjslk;gj; stuff.

 

Are you aware of your blood sugar while exercising?

Often, after weight loss surgery, people who had diabetes, go into remission.

However, some people, particularly post op roux en y gastric bypass patients, have issues with blood sugar going in the OTHER DIRECTION -- LOW!  (Waves from the hypoglycemia bench! We are working on T-shirts!)

"Oh, I don't have a problem with hypoglycemia, I'm just fine."

Hypoglycemia causes symptoms such as - and in RNY post ops - very often AFTER EATING - how do you feel about 45 - 90 minutes after your meal?

• hunger
• shakiness
• nervousness
• sweating
• dizziness or light-headedness
• sleepiness
• confusion
• difficulty speaking
• anxiety
• weakness

Much of the advice given to diabetic patients can be useful for those of with low blood sugar problems.  Like:  how to deal with blood sugar and exercise.  Many of us have problems exercising or exerting -- we find that once we get moving -- we get CRASHING, fast.

Here's a quick article from the Joslin Diabetes Center about exercise and glucose control, bold-face type is mine -

"People with diabetes understand that physical activity is essential to leading a healthy life. It is an excellent tool for achieving weight loss, better glucose control, and cardiovascular health. Before you start any new program, however, you must visit your doctor so that he or she can review your plan.

Once your health care team approves your new exercise routine, it is important to follow a few guidelines:

• Snack first. Physical activity can lower blood glucose, so if you plan to exercise and take insulin, you must test your blood sugar before working out, and possibly also eat a light snack as well. Some good pre-workout snacks include a banana and a serving of peanut butter, an apple and a serving of cheese, or a small juice box. It is recommended that you see an exercise physiologist, however, to see what the right plan is for you. (Exertion can lower blood sugar in a non-diabetic as well, and testing before moving is probably a good idea, and eating a snack might also be effective in maintaining your blood sugar while you are moving.  While a banana or fruit juice might cause a worse problem in someone with post RNY hypoglycemia, a slice of whole grain bread with cheese or peanut butter might NOT.  It's trial and error here.  Personally, I have to eat. while. moving.  Err, drinking works, something like THIS.  And, I often feel woozy while moving, and I have to stop and take a break just to make sure my head is still on.)
• Avoid alcohol. Alcohol without food intake can lead to hypoglycemia and adding exercise further increases the risk of low blood glucose. In addition, if you have alcohol with your meal after physical activity, keep in mind that it will lower your blood glucose along with medication and any physical activity in which you have engaged.
• Test glucose often. The best way to figure out how your body reacts to a new exercise plan is to test your blood glucose (sugar) before and after you engage in physical activity. Record all of the results, and make sure to bring them with you to the doctor if you have any problems trying to balance diabetes and physical activity.
• Get into a routine. Since physical activity significantly influences your blood sugar, establishing a regular time for exercise is crucial to keeping your blood glucose in your target range. If you plan to exercise in the evening, be aware that physical activity in the evening could mean low sugar overnight. To ward off a hypoglycemic reaction in the night, be sure to have a snack before going to sleep.
• Skip hot tubs, saunas, and steam rooms after exercise. These activities all cause increased heart rate, and could lower blood glucose even after you stop exercising.  (Agreed - drowning is not cool.)

I will add - carry a medical ID - although I have always been horrible about doing so.  It may be necessary someday.

 

 

Lauren's Hope Medical ID Bracelet

Lauren's Hope Medical ID announced a program last week offering a gift certificate for any blogger willing to post about their products for $50.00.  I reposted to share about it -- because $50.00 is HUGE -- and for most of my readers -- that is a big deal.  I did not expect to get a gift certificate at all -- but they sent me one too.  I spent it immediately on the first bracelet that caught my eye.  I have been a very bad epileptic patient -- not wearing ANY medical ID since my last one broke.

I like it quite a lot!  The only issue - is that I am a little bracelet impaired - and I cannot get it on.  LOL.

ASMBS: Obesity Surgery Resolves Diabetes but for How Long?

Weight-loss surgery can lead to resolution of type 2 diabetes in some patients. Patients who do not maintain weight control are at risk of diabetes recurrence. 

I personally never had diabetes BEFORE my roux en y gastric bypass, though I am SURE I was pre-diabetic, I probably would eventually have been diabetic had I remained super morbidly obese.  I have had serious blood sugar problems since having gastric bypass -- for the same reason the bypass resolves diabetes.  IT WORKS.  Sometimes too well!  If I gain a lot of weight -- or reverse my bypass - I may resolve my problem.  (Ironic.)

ASMBS- 

Weight-loss surgery allowed a majority of obese type 2 diabetes patients to stop or reduce medical therapy, according to three studies reported here.As many as 90% of patients had improved glucose control following bariatric surgery, investigators told attendees at the American Society of Metabolic and Bariatric Surgery.

What I have learned about Revision at ASMBS

Although I am here at the conference as a non-professional, there are countless educational sessions going on this week for the professionals.  (This is why they come.)  As much as I would love to have learned about many things discussed here - there is a trickle down effect.  

And, yesterday there was one.  Dr. Garth Davis had attended a session regarding hypoglycemia after roux en y gastric bypass and revision surgery.  He shared with me that there is much promise for gastric sleeve surgery as an option in slowing and reversing reactive hypoglycemia.  This would mean a revision, but not a "reversal."  I would lose the malabsorption of the RNY but regain the stoma and keep a small capacity.

Remember, I ASKED my surgeon to revise me.  He said no.  Now, to be fair, I believe I asked for a DS, because I thought that would help me.  And, then I asked for anything that would help.

 
 Revising to gastric sleeve, has a chance at helping stop whatever is triggering my seizures.  Again, I have no evidence that my seizures are AT ALL RELATED.  But, if I keep my blood sugar STABLE, perhaps my seizure threshold wouldn't be so low.  And, if it STOPS THEM?  Perhaps it will keep the scalpel out of my BRAIN.

Dr. G offered to do the revision.  I am going to give it serious consideration.