WLS "excellent treatment for diabetes"

[Webmaster]

Good grief:

New research gives clear proof that weight-loss surgery can reverse and possibly cure diabetes, and doctors say the operation should be offered sooner to more people with the disease -- not just as a last resort.

Read the rest...

Like, how about just killing people? That stops diabetes, too.

[truebebeblue]

I do not agree that wls should be offered to someone simply because they are diabetic many diabetics are thin or even underweight and it would certainly cause death. I can however say I no longer had diabetes after wls as in never had another elevated glucose reading ever... so for me it was a cure also no more high blood pressure and eventually no more sleep apnea. Now they are attributing this in the article to the intestine re routage but I didn't have a WLS that messed with my intestines at all so I think they need to do more research on that. if it works great more people die from Diabetes and complications than WLS by far but assuming it does based on little study is silly and dangerous.

Bad reporting just like most medical stories.

[SparklingBBW]

There are many reasons why people get diabetes. In my case, it was due to my weight. No family history of it whatsoever.

Although I didn't have bypass, I did have a sleeve gastrectomy and in the five months since, my A1c has gone from 7.6 to 6.1 (which is still a bit above normal but obviously on its way down).

Like most fat women know, nothing is truely "one size fits all" and that includes medical treatments. But as one who has been there, when faced with a diagnosis of a chronic disease that will do horrible horrible things to my body and life if not addressed, then I would want to know ALL the possible treatments so I can make the decision that's right for me.

[Miss Vickie]

Yeah, I read the article, and a reference to the study sent to my email via Medscape. They've noticed that people who have had bypass have near immediate reversal of Type II diabetes -- even before weight loss occurs. This has led to a theory that there is something to do with the vagus nerve, or possibly regulation of a hormone related to digestion, which is part of diabetes that wasn't really considered before.

I think any surgical intervention for treatment of a disease should be approached with great caution and undergone only when less invasive alternatives have been utilized and failed. This is no less true of WLS, regardless of why it's done. A patient who is fat with comorbidities who wishes to lose weight and is diabetic is probably a good candidate for the surgery. A thin Type I diabetic obviously wouldn't be a good candidate since they have no endogenous insulin, so the changes in insulin regulation that happen, we think, as a result of WLS would be irrelevant. Plus, they're usually thin to begin with and can hardly safely manage weight loss. But I don't think anyone would recommend that.

What this study did was attempt to quantify what many practitioners are seeing in general practice -- that diabetes just.... evaporates... quickly after WLS, far too quickly for the weight itself to be an issue.

[truebebeblue]

I had the VSG too

Originally Posted by SparklingBBW

There are many reasons why people get diabetes. In my case, it was due to my weight. No family history of it whatsoever.

Although I didn't have bypass, I did have a sleeve gastrectomy and in the five months since, my A1c has gone from 7.6 to 6.1 (which is still a bit above normal but obviously on its way down).

Like most fat women know, nothing is truely "one size fits all" and that includes medical treatments. But as one who has been there, when faced with a diagnosis of a chronic disease that will do horrible horrible things to my body and life if not addressed, then I would want to know ALL the possible treatments so I can make the decision that's right for me.

[moniquessbbw]

Both of my Grand mothers were and my Dad is a diabetic. I seriously doubt my dad would have WLS he isn't even over weight. This story send mixed signals and gives people the wrong idea. From a person who was diabetic and had wls yes it worked but it wouldn't help my dad. What are they going to do for kids who have it who aren't over weight? People just need to be careful before they have any surgery. I sure as hell would not go through what I went through just to not be a diabetic anymore. One day it could come back since it runs on both sides of my family. I do not believe anything can stop it but you can slow it down and wls would not be the best idea to start with.

[cakeboy]

I'm 32 days post-op with a RNY gastric bypass. My rampant, uncontrollable Type 2 diabetes has turned into perfectly normal blood sugar readings already

[imfree]

Originally Posted by Webmaster

Good grief:

New research gives clear proof that weight-loss surgery can reverse and possibly cure diabetes, and doctors say the operation should be offered sooner to more people with the disease -- not just as a last resort.

Read the rest...

Like, how about just killing people? That stops diabetes, too.

Starvation works like that, too. I was in a starvation state when I was so deathly ill a couple+ years ago that I lost 120 lbs in a little over 2 months and during that time my insulin requirement went to near zero. In my opinion, doctors , at times, will declare cure when they've only made the symptoms go away.

[Miss Vickie]

Here's a well-resourced post by the American Diabetes Association about the role of WLS and diabetes. It includes links to lots of articles about the whys and wherefores of how the body's way of metabolizing glucose changes after WLS.

[gangstadawg]

there are thin people with diabetes as well are they going to be able to get WLS as well? if its a "cure" how do you address the smaller diabetics? make em gain alot of wight than get WLS?

[Miss Vickie]

Originally Posted by gangstadawg

there are thin people with diabetes as well are they going to be able to get WLS as well? if its a "cure" how do you address the smaller diabetics? make em gain alot of wight than get WLS?

The process by which thin people get diabetes is different. Weight has nothing to do with it but rather it's an autoimmune disease where the cells are destroyed by the body and no insulin is produced.

(Research, people!)

[Shosh]

The more I think about this, the more I am starting to think that a halt needs to be called to certain types of WLS.

I think that there should not be any procedures that are non reversible.

All patients should have the right to have the procedure reversed down the line if for whatever reason it is not working.

It is not fair to the patient if they do not have that option.

If the initial procedure works for a patient well that is ok, but if not, they should be able to have it reversed.

[Miss Vickie]

Shosh, who would decide which procedures are approved and which are not? The government? People on a web board? When a procedure is being considered, the benefits and risks are discussed between patient and provider and the decision to move forward -- or not -- are decided between the two of them.

I think that decisions regarding a patient's health and well being should be left between the two of them. Even if we all have opinions about the procedures in question -- and ask me someday how I feel about circumcision if you want an example -- ultimately, a legal and sanctioned medical procedure's appropriateness is best left to those who know what's best for the patient. (If you're in any question about my thoughts, this includes the patient and whatever health care providers he or she decides to involve in his or her care.)

No procedure or medication is without risk. In some cases the benefits outweigh the risks. In some, they don't. In some cases we can predict the risks (with WLS they include sequelae of vitamin malabsorption), in some we cannot. In my own case, I'm currently on steroids for my Sarcoidosis and have managed in three months to develop severe bilateral cataracts -- an unexpectedly rare, profound and rapid onset development -- something which is obviously upsetting. However, in my case (and this is where the discussion between patient and provider is critical) the risk was worth it and I have no regrets. Sure I have to have eye surgery but due to the medications, I was able to...you know... breathe.

Medical care is such an individual thing, that we need to be careful about pronouncements such as yours which would remove a potentially beneficial, yet admittedly dangerous, procedure as a treatment option.

[Marie5656]

My husband is Type 2, and on insulin. He is 6'3" and about 350 lbs. His former doctor wanted him to have gastric bypass. He said no way, he had heard too may horror stories.
He is not happy with his weight, and wants to lose because of that, and also, hopefully to see if he can at least get off the insulin. But he wants to do it with exercise and healthy eating.
His current doctor has told him he is not an advocate of WLS for many reasons. He feels it is should not be the first treatment of choice. He has given my husband ways to manage his diabetes in a more realistic way. He also told him that once a month he wants my husband to go out to a restaurant, and have a nice meal, a couple of drinks if he wants..and just have a good time. But just not go nuts.

[Miss Vickie]

Originally Posted by Marie5656

My husband is Type 2, and on insulin. He is 6'3" and about 350 lbs. His former doctor wanted him to have gastric bypass. He said no way, he had heard too may horror stories.
He is not happy with his weight, and wants to lose because of that, and also, hopefully to see if he can at least get off the insulin. But he wants to do it with exercise and healthy eating.

Exercise and dietary changes are always the best and first ways to treat (or even better -- prevent!) diabetes. I treat patients with diabetes, newly diagnosed and long term, and we always talk a LOT about diet and exercise. I haven't mentioned WLS once (though admittedly I'm a new practitioner).

Getting off of insulin and onto oral meds (or even off oral meds!) would be great. It "seems" like WLS does that for some people, but if they can't or won't do the work to adopt a healthier lifestyle, its effects will be short lived.

His current doctor has told him he is not an advocate of WLS for many reasons. He feels it is should not be the first treatment of choice. He has given my husband ways to manage his diabetes in a more realistic way. He also told him that once a month he wants my husband to go out to a restaurant, and have a nice meal, a couple of drinks if he wants..and just have a good time. But just not go nuts.[/b]

I spend a lot of time, as a new practitioner, with evidence based guidelines from various specialty groups and WLS has never been adopted as a first line treatment for diabetes. So it would be odd for someone's doctor or nurse practitioner to recommend them. Here's one such set of guidelines. Others can be found through the ADA, the AAFP. If your health care provider isn't following the latest evidence based guidelines, they're doing you a disservice and should be able to explain why they are deviating from the standard of care.

As it stands now, the standard of care for DM II isn't WLS as a first (or second, or third) option. It is being investigated as a possible treatment for a certain subset of diabetics. Period. It doesn't take a rocket scientist or a PhD biochemist to know that we should always, when possible, make those important first steps to manage our health before calling the cavalry (whether the cavalry be in the form of medications or surgery).

Incidentally, here are the obesity guidelines for bariatric surgery put out by the AACE. FYI.

[Shosh]

Originally Posted by Miss Vickie

Shosh, who would decide which procedures are approved and which are not? The government? People on a web board? When a procedure is being considered, the benefits and risks are discussed between patient and provider and the decision to move forward -- or not -- are decided between the two of them.

I think that decisions regarding a patient's health and well being should be left between the two of them. Even if we all have opinions about the procedures in question -- and ask me someday how I feel about circumcision if you want an example -- ultimately, a legal and sanctioned medical procedure's appropriateness is best left to those who know what's best for the patient. (If you're in any question about my thoughts, this includes the patient and whatever health care providers he or she decides to involve in his or her care.)

No procedure or medication is without risk. In some cases the benefits outweigh the risks. In some, they don't. In some cases we can predict the risks (with WLS they include sequelae of vitamin malabsorption), in some we cannot. In my own case, I'm currently on steroids for my Sarcoidosis and have managed in three months to develop severe bilateral cataracts -- an unexpectedly rare, profound and rapid onset development -- something which is obviously upsetting. However, in my case (and this is where the discussion between patient and provider is critical) the risk was worth it and I have no regrets. Sure I have to have eye surgery but due to the medications, I was able to...you know... breathe.

Medical care is such an individual thing, that we need to be careful about pronouncements such as yours which would remove a potentially beneficial, yet admittedly dangerous, procedure as a treatment option.

Yes, I do understand what you are saying. I am sorry to hear about your latest health setback also. That is tough.
I just think in years to come we will look back on some of these procedures and think it barbaric that a person's intestinal anatomy is changed forever in what is not always successful surgery, with a lifetime of serious issues occuring.

[Miss Vickie]

Originally Posted by Shosh

Yes, I do understand what you are saying. I am sorry to hear about your latest health setback also. That is tough.
I just think in years to come we will look back on some of these procedures and think it barbaric that a person's intestinal anatomy is changed forever in what is not always successful surgery, with a lifetime of serious issues occuring.

I know what you mean -- absolutely. Maybe it's because I'm in the health care system but I see surgeries that change people's anatomy forever that have various levels of success. I know so many women who had unnecessary hysterectomies when they were of childbearing age, it makes me see red. I care for people who have had botched back surgeries who were promised permanent relief from their back pain but instead are in intractable pain. I even know people with permanent issues from a "simple" gall bladder removal.

To me the key is always trying the most conservative treatment first, leaving surgery as a last resort; then, it's about informed consent and choosing a surgeon with a LOT of experience with the procedure.

In my case, with my WLS, I was lucky -- I don't deny it. With my thyroid removal, I wasn't so lucky. Despite my surgeon's great skill and experience i have permanent vocal changes. But that doesn't mean the surgery wasn't an appropriate option for my disease process; I just wasn't as lucky as some (but luckier than others because at least my parathyroid glands weren't destroyed and I have decent calcium metabolism).

I hate to see people having any surgery before trying other options (including cesareans, which many women treat as a simple thing). No surgery is without risk. Not one.