Diabetes

[conceit]

Liz, so glad you are getting control with only metformin and that it is already dropping.
Thank you for sharing with those of us who had diabetes prior to DS. I understand Marceau in Canada is accumulating 30-year post-op data. In their 20-year data of more than 2,000 patients, they have seen a slight relapse rate over decades in previously diabetic patients (4%), but not a single case of newly developed diabetes after DS. There's a reason for new patients to get the DS before they develop diabetes. Like you said, once it is totally exhausted, the pancreas can only run so long. You have an enlightened doctor. Mine always scolded me, despite my overwhelming family history.

The long term relapse rate of diabetes in those who get the 200+ cm common channel will be something to watch.

It's great to hear Marceau is accumulating 30 year post Op data. Would you have any more information on when this study might be published? I'd be curious to learn the relapse rate at 30 years post Op, as someone getting the surgery at 30. A remission that long would be a dream come true. I am focusing on really preserving beta cell function by strictly low carbing and not taking any meds that make the pancreas secrete more insulin. My A1C fell from 7.1 at diagnosis to 4.9 (slightly artificially lower because of anemia but my meter average was 5.3%), without medication. I am now on the lowest dose of metformin. My fasting stays below 100, seeing 80s and even a few 70s. Post meal numbers are in the 80-110 range 2 hour pp and no higher than 126 1 hour pp. I am very strict with the keto and know that the second I start to go lax, the numbers will creep back up. Glucotoxicity hurts beta cells. So I try to keep numbers close to non D levels, as per Bernstein's recommendations.

I am very interested to see how younger t2ds do over the course of 30, 40 years after surgery. I imagine the relapse rate would likely go up, because insulin sensitivity and beta cell mass go down even in people with no history of diabetes.

I did read the paper on 200 cm cc. Regain was significant. The average A1C for the 200cm group was 5.6, which is really close to pre-d numbers. For the 100 cm group, it was 5.1 The sample size was small though, and it was mentioned that people with the longer cc were generally older. The higher A1C may also be from people having had diabetes for a while, so the A1C might be a tad higher even if still normal. I am very interested in cc lengths, not just for t2d resolution but also concerns surrounding long term malabsorption. I'll probably start a thread about that some time.

Thanks for this post. I didn't know about marceau's study and am excited about it.

 

[Munchkin]

It's great to hear Marceau is accumulating 30 year post Op data. Would you have any more information on when this study might be published? I'd be curious to learn the relapse rate at 30 years post Op, as someone getting the surgery at 30. A remission that long would be a dream come true. I am focusing on really preserving beta cell function by strictly low carbing and not taking any meds that make the pancreas secrete more insulin. My A1C fell from 7.1 at diagnosis to 4.9 (slightly artificially lower because of anemia but my meter average was 5.3%), without medication. I am now on the lowest dose of metformin. My fasting stays below 100, seeing 80s and even a few 70s. Post meal numbers are in the 80-110 range 2 hour pp and no higher than 126 1 hour pp. I am very strict with the keto and know that the second I start to go lax, the numbers will creep back up. Glucotoxicity hurts beta cells. So I try to keep numbers close to non D levels, as per Bernstein's recommendations.

I am very interested to see how younger t2ds do over the course of 30, 40 years after surgery. I imagine the relapse rate would likely go up, because insulin sensitivity and beta cell mass go down even in people with no history of diabetes.

I did read the paper on 200 cm cc. Regain was significant. The average A1C for the 200cm group was 5.6, which is really close to pre-d numbers. For the 100 cm group, it was 5.1 The sample size was small though, and it was mentioned that people with the longer cc were generally older. The higher A1C may also be from people having had diabetes for a while, so the A1C might be a tad higher even if still normal. I am very interested in cc lengths, not just for t2d resolution but also concerns surrounding long term malabsorption. I'll probably start a thread about that some time.

Thanks for this post. I didn't know about marceau's study and am excited about it.

The first article on DS for T2D was authored by a doc named Noyes. The study is still out there somewhere. Sorry, I don't have it. Maybe DianaCox does. His take on it was the best results are with a short CC. I believe he went with 50CM. This study was published in the early 2000's.

 

[southernlady]

We transferred back to the PCP we had in NC. He pulled an A1C as part of my visit. It’s a 6.2!!!

 

[JackieOnLine]

It’s a 6.2!!!

what was it before?

 

[southernlady]

what was it before?

Last fall it was 6.4

 

[JackieOnLine]

oh, good! I was hoping it was good news!

mine has been stuck at I think 5.6, or whatever is RIGHT below pre-diabetes so I am working on not pounding sweets because I was scared of the weight loss. today, for example, a friend is coming to help me get ready for the moving sale and I will make her take the chocolate covered raisins with her!

 

[conceit]

6.2 is excellent! are you low carbing Liz?

 

[Georgepds]

Saw a new PCP yesterday here in FL. Based on my readings, he’s doubling my metformin from 1000 to 2000 mgs. But we are splitting it into 4 doses to avoid the extended release metformin.

What's wrong with the extended release?

 

[southernlady]

6.2 is excellent! are you low carbing Liz?

Not as low as I could but I’ve made enough changes to help. I’d like to see it below 6.0 tho.

What's wrong with the extended release?

Nothing for normal people. However, extended release (the coating) makes it an issue for those if us who malabsorb, like the DS, not all of us but enough to suggest not using extended release. I wasn’t sure how I would handle the coating on the 1000 mg tablets that are extended release so I got the doc to write it for the 500 four times a day. I take one at breakfast, one at dinner, and two at bedtime. I have issues with Dawn Phenomenon.

 

[Sheanie]

Not as low as I could but I’ve made enough changes to help. I’d like to see it below 6.0 tho.

Nothing for normal people. However, extended release (the coating) makes it an issue for those if us who malabsorb, like the DS, not all of us but enough to suggest not using extended release. I wasn’t sure how I would handle the coating on the 1000 mg tablets that are extended release so I got the doc to write it for the 500 four times a day. I take one at breakfast, one at dinner, and two at bedtime. I have issues with Dawn Phenomenon.

So do you also notice night sweats or flashes if you eat carbs before bed?

I was told by a 90 yo woman that hot flashes could be minimized by avoiding sweets late in the day.

I know this is different from dawn phenomenon, but very interesting.

 

[southernlady]

So do you also notice night sweats or flashes if you eat carbs before bed?

I was told by a 90 yo woman that hot flashes could be minimized by avoiding sweets late in the day.

I know this is different from dawn phenomenon, but very interesting.

No, my core gets warm but it does that all the time. It doesn’t help that most of my weight is still in my core area.

 

[southernlady]

I forgot to update this thread back in Nov when my a1c went back above 7. I went in to see my PCP with a question/possible game plan. I had done research on the maximum dosage of metformin which is 2550 mgs (3 of the 850 mg tablets). I asked if we could try adding one more 500 mg tablet, making it a total of 2500 mgs per day. He was willing to let me try after I had my kidneys checked for health. Then a month later, I had to repeat the blood work to make sure my kidney numbers had not gone up. They didn’t and I’ve been doing that ever since. I don’t have a recent a1c as I was going to change doctors this summer and get a new set of labs.

 

[southernlady]

Good luck... back when my T2 was active, I also had a good response from once per week GLP agonists (eg trulicity, by injection)

IRRC, the maximum dose for time release metformin is somewhat less than metformin alone (~ 2000 mg vs 2500 mg)

That’s my next step if I go back up. It was in the long term plan when I first added the metformin. I simply do not want to keep throwing pills at it. I did that once before (before going on insulin) and hated all the side effects they caused. Metformin was/is a known entity and one I knew I could tolerate.

 

[southernlady]

Update....finally got labs. My A1C is....wait for it....5.9!!!

 

[JackieOnLine]

that's wonderful news!