To the Overweight Type 1 Diabetic Considering Weight Loss Surgery

Dear Type 1 with weight issues (like me),

I don’t know your history with diabetes or with your weight, but mine is something like this: I was always healthy and active as a kid, and even into my late teens and early 20s. I didn’t become diabetic until I was 21 years old and in college (after having been on Accutane for a year and also having my tonsils taken out. Did one of those things cause/trigger my diabetes?? The world may never know.) It was crazy and crappy. I initially lost, then gained, then lost weight right after diagnosis. But then I maintained a healthy weight for at least a decade. And then came my 30s. A sedentary job, years spent on birth control pills, and then getting married and having fertility issues (inject tons of stress, hormone shots, hormonal imbalances, you name it ) all led to a sharp incline in weight gain, and also a sharp incline in insulin resistance. With insulin resistance, I had to take more insulin. Taking more insulin, I gained more weight. Gaining more weight, I had to take more insulin. My endo basically told me I had become a Type 1 who also had Type 2 diabetes, and I was put on Metformin to help combat some of my insulin resistance. It helped, but didn’t fix the underlying issue. It was a vicious cycle that I couldn’t seem to break with any amount of dieting and exercising. I had all sorts of back pain, plantar fasciitis in my feet, and barely had enough energy to get through most days. I needed a dramatic change, and I needed it fast.  I was in my 40s, with a 3 year old child that could out-run me. How could I protect her if I couldn’t even protect myself anymore?

So, I did my research. Talked to other friends who had some type of bariatric surgery. Joined a couple of Facebook groups to talk about it. Searched and searched for other T1s who had the surgery, but came up short. I had decided against the more complex gastric bypass (where they reroute all sorts of things) and chose the sleeve (VSG) because it was easier to comprehend how my digestion would change post-surgery, the weight loss would be more gradual, and I felt I could manage my diabetes (and health) better in the long run with this surgery.

Now, I am almost 8 months out from surgery. I finally have energy and can eat (more or less) regular foods. I eat FAR less than ever, focus on eating my protein first, then keep to a minimum amount of carbs over the course of the day.  My goals each day are to eat at least 70g of lean protein, drink 64+ ounces of water, take all my various chewable vitamins and supplements (there are quite a few) and to keep sugar and fat intake around 5g at each meal/ eating time. In order to consume just what I need to consume, but not overfill my “sleeve” stomach, I have to eat several small meals – I am basically “snacking” all day long. I have lost 70 lbs total, and am currently in a “stall” so now I need to switch it up, exercise more, and really work to get the weight to come off. But get this: My insulin requirements went from over 100 units per day, down to about 50 units per day now (that’s meal boluses and basal rate combined.)  I no longer take Metformin. My A1c is sitting pretty & playing nice at 6.1. I’m down 2-3 sizes in most clothes. I can sit comfortably in those super-close stadium seats. I can chase after my daughter. I can play with her on the floor, and then stand up without groaning. My feet don’t hurt nearly as much any more. I’m ready to join the local swimming pool this summer and enjoy it with my family and friends. I *feel* better than I have in YEARS.

This has been a tough road, and it remains challenging. With diabetes, LIFE ITSELF is challenging – we know that. There are days when I have low blood sugars and shake my fist in the air that I am forced to go off my diet plan and eat when I don’t want to. There are days of unexplained highs that send me into a spiraling fatigue, just like before. Juggling exercise and blood sugars and my teeny stomach is even more challenging. Having a crashing low, cramming my face full of an apple and then having my stomach feel like it’s going to explode is NOT fun. But would I say this surgery was a success for me? Even though I still have at least 50-60 lbs left to lose? YES. Every time I will say YES.

But you – all the other overweight Type 1s out there with BMIs in the “morbidly obese” category like I was – you have to make the decision on your own. Every surgery comes with it’s risks and potential complications. For me, the results I’ve had so far, even though I’m not “at goal” have been SO worth it.

Happy to have my life back —

Before-AfterJan2015

Love Rescued Me, too

Here’s a post from a fellow schnauzer lover (remember, I may have Type 1 diabetes, but my mini schnauzer Xena stole my heart forever, and she will  always be the best dog ever 🙂 )This fundraiser only runs through the end of this week, so please order a t-shirt TODAY at https://www.habitbrands.com/c1890_north-carolina-schnauzer-rescue !!!

Love Rescued Me

As you well know, Miss D wouldn’t be the crazy, silly, absolutely adorable doggie I am if not for my furever mommy and her friends at NCSR. Now they are asking for our help!

PLEASE RE-POST AND SPREAD THE WORD

Just in time for Christmas gifts, or even a gift to yourself! NC Schnauzer Rescue (NCSR) is excited to partner with HABIT brands and will receive $10 for every “Love Rescued Me” t-shirt sold!

For 10 days only, starting November 10th, get your t-shirt here, $10 will be donated, and you will love a rescue at the same time. 

love rescued me..#8
$10 can go a LONG way for a rescued dog, and can help fund:
  •  a month’s worth of heartworm protection
  •  needed vaccines like rabies & distemper
  •  spaying or neutering
  •  dental care
  •  medications for special needs rescues
NCSR is a 501c3 non-profit, all-volunteer rescue group.
Together, even more dogs can be rescued by love!!!love rescued me...women's long sleeve love rescued me...junior cap sleeve love rescued me...women's short sleeve love rescued me...men's short sleeve

4 Months Out with Stats and Goals

The last 4 months since my gastric sleeve surgery seem to have gone by in a blink, but also lasted forever. I MEANT to blog more, share more thoughts, daily challenges and such that I have gone through juggling Type 1 diabetes and having a new stomach through VSG, but wow – it’s like, I have 3 full-time jobs now…..1) The one that makes me money, 2) Type 1 diabetes, and 3) Learning how to eat/drink/take insulin/exercise/function normally with a stomach 1/4 of the size it used to be. And I still have a family and social life, and try to volunteer with JDRF and NC Schnauzer Rescue. It’s a LOT, and my brain hurts a little thinking about it.

I don’t have a ton of time to even write this, but wanted to sum up some current stats, accomplishments, results, and goals, in no particular order:

  •  I’ve lost 50 lbs, gone down 2 pant sizes, and at least 1 shirt size, maybe more (I tend to wear stuff a little loose anyways.)

    Cheese

    Happy me, with my ticket to see Duran Duran Unstaged (a concert film, of sorts) at a local movie theater. Sporting my FitBit, new hair-do, and go-get-em attitude.

  • My plantar fasciitis has improved 110% – I actually get out of bed in the mornings & put my feet on the ground *without pain*, and I only notice it if I’ve walked or stood still a lot throughout the day.
  • I need to exercise more, and build muscle – my energy level is still pretty low (only eating about 1,000 calories per day now), so I’m worried some of my weight loss is muscle.
  • My OB/Gyn recently diagnosed me with adenomyosis. We’ve got a treatment plan in place to hopefully correct it and allow me to remain fertile (and potentially have another baby sometime in the near future?)  Of course, the treatment involves progesterone, which tends to cause insulin resistance.
  • Speaking of insulin resistance, I’ve been taking less and less (and sometimes none) of my Metformin. I feel like my insulin resistance is starting to wane, but if the progesterone I start taking ends up raising my blood sugars, I may tweak things and take the Metformin along with the progesterone and see if they can cancel out each other.
  • I’ve gone from taking 100+ units of insulin per day – about 50 in basal and 50 in boluses – to around 50 units total per day (with 29 of that being in basal.) That should tell you how dramatically I’ve changed my eating habits & caloric intake. Low, low carb, baby.
  • Recent endocrinologist appointment yielded these results: BP = 124/72 – Back to normal for me, but right after surgery I had some serious *low* blood pressure.
    • A1C = 6.6 – Grrrr, it was 6.5 right before surgery, so it went up a smidge. BUT, I have ran high more than low recently, since I’m still tweaking basals and have had several days where I got dehydrated, or didn’t eat enough, and those tend to raise my blood sugar. Also, not many lows to bring down that number (which is a good thing!) I’m still working on getting into this new groove with my stomach, so I’m not going to beat myself up about this too much.
    • Cholesterol = 169, Triglycerides = 69, HDL = 56, LDL = 99.  LDL/HDL Ratio = 1.8. !!! ROCKED it, since I’ve been hanging out with a cholesterol of around 200 for years now.

GOALS for the upcoming next 6 months:

  • Exercise, exercise, exercise. I’ve been pretty good about walking a lot, using my exercise bike, going to the gym, and am way more active than before, but still have to get in a groove for strength training. I’ve GOT to build more muscle, but the challenge is still feeling like I have enough energy.
  • Lose 30-40 more pounds. I’m trying to be realistic here. Even though in 4 months I’ve lost 50 pounds, the weight loss is already slowing down. It is the nature of this surgery. It is a “tool”, not a forever fix. I still have work to do.
  • Drink more water, eat more vegetables. I know that sounds simple, but when you get full really fast, and thus, feel like you’re eating all day long just to get in enough protein, it’s hard to work in vegetables and also fluids, since I am not supposed to drink for 30 minutes before or after eating.

Next blog post will hopefully be soon, and will be about recent bloodwork (a comprehensive panel of about 8,000 things)  done by my surgeon. I am suspicious that I have low vitamin D, and possibly low Iron (hence, the fatigue and lack of energy.) I am taking vitamins and supplements out the wazoo, but still, I just feel lacking the majority of the time, and desperately want to feel more energetic. I’m sure it’s partially due to the minimal carbs and calories I consume, but it would be nice to know if there are any other underlying reasons.

Fun for the day = WordCloud

It’s been showing up in my friend’s Facebook feeds all day today, so thought I would share my WordCloud here:

A little about me...

I’m really not sure where/how they are getting these words out of my Facebook feed, because I swear this is a mish-mash between my personal account, and my account as 15wait15. It also does NOT include several of my most-used words, like my daughter’s name, diabetes (hello!?!) etc. Maybe it’s only for the last few days? I dunno. Anyways, you can try out your own (if you’re on Facebook) at: https://apps.facebook.com/my_wordcloud/

(I know, I know….I need to do a proper informative blog post soon and give another post-surgery update, but I am just too distracted with everything else right now. Lots of life going on! But good news, I’ve moved on to eating regular food now! Not without it’s challenges, but I’m surviving and doing well!)

Don’t Jinx It #dblogcheck

NEVER say, “lows have not been an issue,” or by gosh you will immediately have them EVERY. SINGLE. DAY. I’ve been fighting late day-into-the-night crashes every day since Saturday. I know exactly why – ye olde monthly female visitor has whacked out my hormones, and gone overboard with reducing my insulin resistance. Yay, for reducing insulin resistance! Boo, for causing me to have to drink milk and juice boxes at the most inopportune of times. The female reproductive system just adds even more of a juggling act into the work I’m already doing to manage blood sugars and food intake with this new stomach of mine.

Last week, I was just swimming along, started into being able to eat a “soft, mechanically altered” diet (yum!!), and have been so happy to get to eat the most extensive variety of foods that I’ve had in the past 5+ weeks since before prepping for sleeve surgery. (It’s still not a full regular diet, but I’m getting there!) However, the added tastes and nutrition have not come without their challenges.

Last night's dinner

Last night’s dinner – a couple tablespoons of hummus, and some Trader Joe’s Wine Country Chicken Salad with Cranberries and Pecans. (I tried to avoid the pecans, since technically, they are not “soft food.”) DELICIOUS! And I still didn’t finish all of this…..

Because I’m not relying as heavily on protein shakes and mixes in order to get in protein now, I have to work REALLY hard to make sure each meal has a high % of lean protein as my primary source of nutrition. Then, I also need to add in some soft vegetables, and a teensy-weensy bit of fruit here and there.  I track everything in MyFitnessPal, so I can see how many grams of protein I get in a day (needs to be between 60-120g), how many carbs, calories, etc. I also look at vitamins and minerals, and 2 places where I continue to struggle to get in enough is Iron and Vitamin C. With the Iron, I’m sure it’s because I’m still not consuming as much pure meat as I used to. And with the Vitamin C, I limit my fruits SO much because of the sugar spikes I will inevitably get, so I know I’m lacking there. I have been drinking a lot of Vitamin Water Zeros to try to add in more Vitamin C, AND it helps keep me hydrated as well because I’m supposed to be drinking 64 ounces+ of fluids everyday. It’s a LOT to juggle, just making sure I’m getting nutrition, fluids, taking all my vitamins and supplements each day, keeping my blood sugars in check, and oh yeah – shouldn’t I be exercising?

Argh. My energy level is still so low, but in my follow-up visit with my surgeon last week, he said it was necessary for me to start doing some strength training now, so I don’t waste muscle instead of burning fat. And more muscle will help me burn more fat. I want that, for sure! Went last night with a friend, and signed up for a local “anytime” gym, so that I can find the best time of day to go that works for me. Probably mornings, if I can drag myself out of bed. More on the exercise topic (and challenges) in a later post.

So far, I’ve lost a little over 25 pounds since starting the liquid diet before surgery. I don’t want to jinx it! Every day, I see the scale move just a little more, and it is very motivating. But in order to keep up the momentum, I HAVE to exercise, whether I have the energy or not. Most days, I’m only getting in 600-700 calories, but I will need to up that when I exercise, I’m sure.

I will carry juice boxes everywhere.

(Today is #dblogcheck day!  http://tobesugarfree.com/2014/07/21/dblogcheck-is-tomorrow/)

 

 

Medical History? Say What?

I’ve gotten pretty lax over the years at asking my various doctors about seeing my records. Not just for lab work, but with their notes, commentary, etc from various visits. After my follow-up visit with my bariatric surgeon, I think I need to start checking up on them again….

The surgeon’s office just implemented some nifty electronic patient records system called “Epic,” so now I get these pretty detailed print outs at the end of each visit. Here’s an excerpt from the one I got from yesterday:

Say what?

 

Line by line, I have my own commentary for this list of my supposed “Current Health Issues”:

  • Unknown cause of morbidity or mortality = whose morbidity or mortality? Wait, are they saying I’m a mortal, and they don’t know what caused that? Say what?
  • Family history of breast cancer = true.
  • Type 2 diabetes = really? You put this BEFORE my Type 1 diabetes?
  • Female infertility = oh, so true 😦
  • High Blood Pressure = absolutely FALSE. I distinctly remember telling them that the only time I EVER had high blood pressure was when I was pregnant, and only in the last 3 weeks before I had my daughter. That is not “current” by a stretch.
  • Low back pain = true.
  • Generalized muscle weakness = um, sure, I guess? I said I was exhausted and tired all the time right now (mayhap because I’m not able to consume more than 600-700 calories per day and I’m not getting quite enough nutrients yet??)
  • Polycystic ovaries = true.
  • Blood clot in leg = FALSE. I have no clue where this came from. I have never had any blood clots, but perhaps this partially explains why they gave me 2 doses of Lovenox after my surgery?
  • Severe obesity = painfully true, hence, the sleeve surgery.
  • Family history of prostate cancer = FALSE. I told them my birthfather had some sort of testicular cancer at one point, so I’m not sure how that translates to prostate cancer.
  • Type 1 diabetes = true, ding ding ding, you’re a winner and got this one right!

Getting 7-8 out of 12 right isn’t bad….???? They at least have about a 60% chance of treating me properly, right?

 

 

E…a…t…i…n…g………S…l…o…w…l…y

I’m still alive! One month now post-gastric sleeve surgery, and I’m taking it day-by-day, meal by meal, ounce by ounce. I keep thinking back to all my fears with blood sugars and blood sugar management around this whole “changing my digestive system from what I knew before,” and now I can’t understand why I was so worried about lows. Honestly, lows have NOT been an issue. I’ve had the occasional, “Oh crap, my Dexcom shows 70 and a down arrow!” but I would take a few sips (literally) of a juice box, and things leveled out almost immediately.

One of the most interesting things about my “new” stomach that is taking some getting used to….food/drink hitting my system literally seconds after I consume it. I spent years figuring out when and how to take my insulin in order to have it be most effective at the time when my food would be digesting. I used square wave and dual wave boluses on my pump like it was my job (well, because diabetes IS like another job, after all.) I rarely pre-bolused before meals…I would wait until right before I ate, and then take insulin in a manner befitting what kind of food I was eating. You know, like for pizza – you take some, square or dual wave some over the next 2-3 hours, then take some more a little later, still go high, correct a bit, and then hope and pray you don’t over-correct. Stuff like that. That system and way of insulin-taking? Gone.

Now, I have to think ahead once again…take little bits of insulin (depending on what I plan to eat or drink) a good 15-20 minutes ahead of time. And I CAN’T forget to eat. I need all the nutrition I can get, and don’t want to waste an eating opportunity on scarfing down a juice box. Because, even though before this surgery, I planned my entire day around eating/insulin/exercise/diabetes, I STILL have to do that now, only adding in the caveat that my stomach will-not-allow me to consume more than a small amount of anything at a time. I get a full feeling very quickly. I cannot really “scarf” down semi-solid foods (I’m still in the pureed stage right now, so things like runny scrambled eggs are a staple.) If I try to take several bites one after the other, it feels like it gets “stuck” somewhere in my upper chest, and is VERY uncomfortable. The other morning, I was in a hurry, and ate my eggs too fast. Big mistake. I saw those eggs again very quickly when I vomited. Lesson learned, but still hard to adhere to.

Eggs and decaf coffee, breakfast of champions

Decaf coffee with Stevia & a little protein powder added into it, and a serving of an egg/egg substitute mixture with a smidge of bacon salt in them. I have to drink my coffee either 30 minutes before or 30 minutes after I eat the eggs. And I’m LUCKY if I can eat as much of the eggs as you see in this picture.

This is my biggest challenge at present: Eating slowly. I know I have to, I know it’s better for me, I know it will help me feel fuller longer (and also cue in faster to when my new stomach is getting full)…..but for years, I’ve been a “get the food in while it’s hot and while you can because your kid is going to need something soon, and then you won’t eat and then your sugar will crash, and then….” kind of person. That habit is really hard to break. But like a lot of things in life now, I’m working on it!