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

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.

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?

 

 

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!!!