Gastric Sleeve Surgery and Blood Sugars

I’ve had a handful of surgeries in the past 20 years since being diagnosed with Type 1 diabetes, and there are a few tips and tricks I’ve learned that have helped immensely:

  1. I want to be the FIRST surgery of the morning. Since you’re supposed to stop eating/drinking anything at midnight the night before, it’s much easier to manage blood sugars for a short amount of time in the morning before a surgery rather than attempt to manage sugars all day on an empty stomach, risk potential lows you might have to treat with food/drink, thus negating the whole not-eating-after-midnight thing.
  2. Better to risk running high than running low. The night before surgery, I usually cut back my basal rate to about half of what it normally is. I don’t do any corrections for high blood sugar unless it starts running over 200. Then, I very conservatively correct – again, give myself about half of what I normally would to correct it.
  3. FILL OUT PAPERWORK ahead of time that says YOU take responsibility as soon as possible after surgery for your own diabetes/insulin/blood sugar management. No nurse or doctor knows how to work my insulin pump and CGM better than I do, and I had no desire to go back to getting injections at the whim and on the time-frame of nurses who don’t understand MY diabetes.
  4. Take at least 1 brightly colored piece of paper with you that states you are type 1 and notes your management regimen. For example, mine said, “TYPE 1 DIABETIC, on Insulin Pump and Continuous Glucose Monitor (CGM.) Please NO acetaminophen – it disrupts my CGM.”  This worked very well for me during this stay – had several nurses comment that it was very helpful for them to see that in my chart and know it immediately when they were treating me. (It also led to several educational moments where nurses had never seen a CGM before, so of course, I showed them and explained the whole she-bang.)
  5. Ask if it’s OK for that surgery to keep on your insulin pump port-site, and/or your CGM sensor. For my c-section, my OB preferred I didn’t have anything foreign on my skin or body, but for this surgery (since it was obviously way higher up on my torso), every nurse, doctor, and anesthesiologist I talked to said I could keep them on.

Now, onto gastric sleeve surgery …..that morning of surgery, I kept my pump hooked up  – running on 1/2 my usual basal rate – and also kept my CGM sensor on and the receiver with me until the very last minute when they were going to wheel me back to the operating room. Then, I relinquished my pump and CGM receiver to my husband for safe-keeping.

IV, Pump, and CGM, oh my!

I was running in the 180s right before surgery, which was perfectly fine with everyone involved.
Immediately post-surgery in recovery, I have no idea what my blood sugars were there – I was just trying to get reoriented and awake from anesthesia, and make sure they gave me some more pain meds. Thankfully, they got enough pain meds into me fast enough so I wasn’t very uncomfortable for long. Waking up from a surgery – always surreal for me.

Once I was in my own room and my husband gave me back my CGM and pump, I fingerstick tested (just to calibrate the CGM for good measure), and I was somewhere around 270. I knew I wouldn’t be eating or drinking anything for the rest of the day, so I wanted to be very careful about correction bolusing. I gave myself about 1/2 of what I thought I needed to bring it down to 150. Waited a couple hours. I had a decently steady downward-heading arrow on the Dexcom, so I just kept doing little correction boluses until I got down to 150, then I stopped.

Amazingly, for the next 24 hours, I had steady and decent blood sugars. Of course, I consumed literally NOTHING on the day of surgery – not even a sip of water (thank goodness I was on IV fluids, but my mouth felt like a desert.) And the following day, I could start on clear liquids, but that meant broth, water, sugar-free lemonade, and the like that had zero carbs and minimal calories. You can see my Dexcom graphs below, but it doesn’t show what I was doing with my insulin and boluses. Short answer = I kept my basal rate at close to 1/2 of what it used to be (for me, that is 1 unit per hour), and made only teeny tiny correction boluses here and there (of like, 0.5 unit)  if my sugar started sneaking upwards.

Day of surgery graph

Day of surgery blood glucose graph, from 12 midnight to 12 midnight. NO food or drink.

Day after surgery graph

Day after surgery blood glucose graph – on clear liquids only.

Now, the 3rd day after surgery, I was allowed to start on “full” liquids again, which meant the nasty protein shakes, 1% milk, sugar-free Jello, chicken broth, sugar-free Popsicles, and all that sort of stuff.
That is when blood sugar management got….interesting. The second I had a protein shake that morning with milk in it, my blood sugar RACED up to the  mid-200s. Seriously, it was like dawn phenomenon, the breakfast spike, and who knows what else all came into play at once.  You know how many carbs were in that shake? Like, a measly 13g. And the spike happened after I’d taken only maybe 2 or 3 sips, so I’d be surprised if I had consumed 1g of carbs at that point.

Spikey spikey

On full liquids, “breakfast” spike and subsequent calm-down over the course of each day. My graphs looked like this for several days, until I let the Metformin kick in again AND started bolusing at least a little something well-before I started sipping on my breakfast.

  • Note: I had not returned to taking my Metformin, but decided to start back after a couple of days of these spikes. Realization? My insulin-resistance wouldn’t just suddenly disappear after surgery, it would take time to lose some weight and hopefully get it down that way.
  • Another note: On all liquids, whatever I intake now hits my system *almost immediately*, and I had gotten into the habit of bolusing right when I eat, using dual-wave boluses, etc. Nope, NOW I need to bolus well *ahead* of eating/drinking, so that the insulin has some time to get into my system before I consume something that takes zero time to digest.
  • Crap, one more note: I waited a couple days post-surgery before I reset my basals back to the rates they were before surgery. With the weird spikey spikey happening, I guessed (correctly) that I needed a higher basal rate back again, regardless.

I hope this is all making some sort of sense. Today, I’ve actually had a pretty decent blood sugar day, and my spike this morning was not nearly as bad! I am hoping I’ve turned a corner in understanding how fast my stomach is digesting things now, and can take insulin accordingly/ahead of time to help stave off that spike. BUT, I know things will be changing in the weeks to come as I introduce “regular” food back into my diet. For reference, here is the upcoming schedule of how I am working up to eating regular food again while my stomach heals from surgery:

Bariatric diet stages post-surgery

It’s going to be a wild ride on the roller coaster of blood sugars, I’m sure! 🙂

Even more notes: I am NOT a doctor or medical professional of any kind, and am just sharing my personal experience. Individual bodies are different, and just because this is how MY body is working as a Type 1 post-surgery for gastric sleeve, it doesn’t mean that everyone else’s will work this exact same way! Your Diabetes May Vary. 

 

Quick Post-Surgery Update

I finally had gastric sleeve surgery (aka VSG) last week, and said goodbye forever to about 75-80% of my stomach.

Desperate times call for desperate measures (I think my next blog post should be called that) – I have TONS of material to share surrounding my surgery, hospitalization, and the recovery challenges so far) and having something like this done is no true “quick fix” to losing weight. It is a process, and a very tough one, especially when you add in Type 1 diabetes to the mix. Each day right now is an exercise in counting all the little victories. I WILL get there…..

Victory in a bottle!

See that empty bottle? THAT is my victory this morning. I drank *all 8 ounces* of that protein drink within the span of 3 hours as my breakfast. This is a GOOD thing – yesterday, it would have taken me at least 4 hours, or I would have given up and just started on the lunch one without finishing the breakfast one. My stomach is still swollen and inflamed from surgery, so it’s even smaller than it will eventually be once it’s settled down and healed completely. Getting in enough fluids each day, nutrition in the form of high protein shakes & drinks, and eating/taking all of my chew-able vitamins and minerals is yet another job on top of the other health-job I have in taking care of my diabetes. I wish I could tell you, “my blood sugars have been fantastic since the surgery!!!”….but they haven’t been fantastic. They are manageable, sort of, but running way higher on average than I like.  I have a whole new “normal” to get accustomed to, and so does my body and all it’s inter-working parts. I’m getting there, slowly but surely, and promise I will have an upcoming post on blood sugar management pre-, during, and post-surgery.

Another victory to note? NO blood sugar crashes, at least! Dealing with potential low blood sugars was one of my primary concerns around the surgery and recovery time, and so far, I haven’t had to scramble and test the limits of how-much-apple-juice-I-could-consume-how-fast to bring up a low, because I haven’t had any. Whew. Knock on wood, fingers crossed, and all that jazz.

The biggest challenge I am having right now is that I have ZERO energy. Mainly because, I’m lucky if I consume 500 calories per day. (MyFitnessPal keeps telling me I’m not consuming enough calories – like, I didn’t know that already??) I have some kind of protein drink, water, sugar-free popsicle, soup, sugar-free Jello, etc. in my hand all day long, and I literally just can’t consume more – my stomach says, “enough!” and I listen to it, or else pay the consequences in pain/burping, or potential vomiting. (Again, a victory I hope to maintain – no throwing up.)  I had my first post-surgery followup appointment yesterday, and my PA said I am doing great. I’m getting in a good amount of protein, and she says the calories and ability to consume what I need will come with a little more time – my stomach still has to heal.

And you know what? Here’s a pretty big victory. In the last 2 weeks, since I started on the pre-surgery all-liquid diet, I have lost almost 20 pounds. T-W-E-N-T-Y. It has not been an easy 20 pounds, but I am owning it, and it’s giving me even more motivation to keep on doing whatever I have to in order to use this tool of weight loss to make my life better and healthier. My stomach will never be the same again, and neither will I. I am committed, and I will do what I need to do in order to be healthy – for myself, and for everyone I love. And you know what I’m really looking forward to? Hiking long distances. Running and being carefree. Doing cartwheels with my daughter. So many things that I used to love to do, but couldn’t because of the weight. I WILL do them again, and soon!!!

 

3 Days In

In preparation for surgery (and the life I’ll have for several weeks after), I’ve survived 3 days of a mostly all-liquid diet. I am allowed to eat a couple of sugar-free Jello gelatin cups per day & sugar-free popsicles, and then the one true thing I can chew on is a special protein bar I can have 1 time per day, so I’ve been saving that as my “special treat” at night after my dinner shake. I thought it would be the best thing to do in order to help my sugars even out overnight, hopefully not allowing any weird crashes, and to also help stave off any possible over-the-top dawn phenomenon. The jury is still out on whether or not nighttime is the best time to have this so-called treat, that kind of tastes like flavored cardboard.

My Fitness Pal.

My Fitness Pal display of Nutrition for the day. Not too shabby.

A few notes and observations about this dramatic change in my eating habits:

  • I started using the My Fitness Pal app on my phone again to track what I’m eating, and assure I’m staying within the guidelines of calories, proteins, carbs, etc. I really like how it syncs up and works in tandem with my FitBit Flex. (Note: I am also taking a slew of special chewable bariatric vitamins – a multivitamin, Calcium, B12, a probiotic and iron. I will take these the rest of my life.)
  • In getting back into logging food and such, I realized I’ve gone from consuming between 100-150 carbs per day down to around 45-60 carbs per day these last 3 days. No wonder I could barely drag myself out of bed this morning.
  • I have not been exercising, and while I feel bad about that, I’d rather NOT exercise and NOT crash than to have to fall off the wagon and consume too much sugar trying to bring up a low blood sugar. The point of this liquid and reduced carb diet before surgery is to help my body go into ketosis (NOT ketoacidosis), and burn off some of the fat surrounding my liver so that laproscopic surgery on my stomach will be easier. Also, in preparation for having a similar low carb/higher protein diet post-surgery as well.
  • I miss coffee. I mean, I’ve been drinking some decaf here and there, but it’s just not the same. One day, in the far distant future, I’ll be able to drink it again, but only in small amounts. You don’t want caffeine to make you dehydrated, or interfere with vitamin/nutrient uptake.
  • Blood sugars have been…..weird. You’d think with the greatly reduced amount of carbs (and the ones I’m having aren’t the spikey ones) that I’d have perfectly straight Dexcom lines within range. NOT. After my morning shake breakfast, I will slowly creep up to the 150-180s, and stay there almost all day. When I eat lunch, and then dinner shakes, my sugars will briefly go down,
    FitBit Flex display

    The lack of exercise pains me, but check out the calories in versus out. I certainly should lose SOME weight before surgery, at this rate, assuming my body doesn’t go into starvation mode and shut down my metabolism.

    and might hang out in the 120s or 130s. Except for the 1st night on this diet (where I had a low in the 50s that I treated with 1 cup of 1% Lactaid milk. It barely kept me within the required amounts of sugar for the day), my overnight sugars have all been within range, 90-120 or so. Now, as this week wears on, maybe my body gets more “used” to it and will level things out? I’m afraid to change my basal rates on the pump, because I really think they are not the issue – I think it is my liver getting all riled up at not having as much sugar coming around, it thinks I’m starving (which, I do feel like that, occasionally), and it wants to spit out some to make itself feel better. Stupid liver.

While NOT getting to eat foods and things I’m used to eating is really, REALLY, tough sometimes (I almost swiped my daughter’s sausage out of her hand this morning. It smelled SO GOOD) I am OK. I just keep thinking of the end goal – losing weight, being healthier, and feeling better – and I can turn my head away, and go eat my sugar-free Jello gelatin in relative comfort. This is my new normal, at least for a few weeks. Once I am able to consume “normal” foods again post-surgery, I’m sure it will be a whole new ball game.

Liquid, It’s What’s For Lunch

Mmmmmm good?I started my all-liquid special high-protein-shake diet in preparation for surgery. This is what I had for lunch: a protein broth shake thingy. That’s it. I know it doesn’t look like much, but compared to breakfast – an “iced latte” flavored protein shake that was THE MOST HORRIBLE THING I HAVE EVER TASTED THAT WAS SUPPOSED TO TASTE LIKE COFFEE BUT DIDN’T – this chicken soup-flavored protein drink was deeeelicious.

Now, I can have the occasional snack of a sugar-free jello gelatin cup, sugar-free Popsicle, plain chicken broth, all the water I want, and moderate amounts of decaf coffee and tea (but only with stevia sweetener in them, no cream or milk.) But really, this is hard core dietary limitation in my book. And I am preparing myself mentally and physically  to do this for at least the next 3-4 weeks. Wish me luck!

Note to self: Never ever ever again consume anything with a coffee “flavor” that isn’t coffee. Except for Coffee Nips – I will always love you.