My mercifully boring bypass story - M34, diabetic, lower BMI

[modymatey 33]

I relied so heavily on this forum and others in the months leading up to my procedure that I promised myself I would provide a 12 month update, FAQ and experience summary for others planning the same thing for the same reasons. I recently posted this to Reddit and bariatricpal rounds out the plan.

My story is positive – overwhelmingly positive – but I think most importantly my story is not emotional. I don’t have a psychological problem with food. I was never tormented or made to suffer for my weight (beyond finding flights uncomfortable and shirts being too short). I made this choice on statistical grounds – it would extend my life on average and go a long way to improving my diabetes. I wanted to provide a vanilla story to remind everyone this pretty survivable and the majority of people have non-descript and unexciting recoveries. My lift is pretty much the same - I just eat a lot less, dont shoot insulin and hopefully will live longer. Forums tend to have an over representation of negative outcomes - that makes perfect sense and it's absolutely fine for people to use them to get some reassurance and communicate with people in the same situation. For everyone else - just remember you're less likely to jump on a forum and tell your story if nothing went wrong or it wasn't any different from other people and as a result it can seem like a higher proportion of people are suffering than maybe is the case.

I was a lower-BMI diabetic, not quite type 1 or type 2, but insulin dependent nonetheless. My BMI was 31, my surgeryweight was 126kg (277lbs) and I’m 196cm tall (6’5). I was diagnosed at 100kg (220lbs) but assumed type 1 as I wasn’t visually overweight. However in the 5 years since diagnosis I’ve continued to produce some insulin suggesting I’m not a pure type 1 or 2 - but closer to type 2. I gained 26kg in a year after diagnosis once i started on insulin. I’m broad shouldered/chesty with skinny legs - like an apple jammed on some chopsticks. Maybe like the fat Mr Incredible. My intention for having the bypass was not solely weight loss – I suspected that my diabetes was closer to type 2. I suspected the improvements people see immediately in diabetes management post bypass may apply to me. It was a gamble that paid off, My decision making process was quite straight forward – I had a young daughter at the time (now have a son too) and had lost my father to a heart attack when I was 7. He was fit and not diabetic but had a heart condition. I new statistically I was due for a similar fate carrying excess weight plus diabetes onboard. This was the best way to knock out one of those (the weight side) and hopefully improve the diabetes. I went from 126kg to 83kg (180lb), my BMI is low end of healthy. My biggest positive is my immediate cessation of insulin shots and a current HBA1c of 5.8 with oral meds only. It took about 6 months to get to my goal weight of 90kg. I'm still slowly losing and need to stop.

Lead-up and Prep

I was not obese to look at visually. The majority of healthcare professionals I spoke to did not think surgery, let alone Gastric Bypass, was necessary. In the end – my PCP, endo and surgeon all agreed that, while not essential, bypass was a prudent decision with potentially long-term benefits. The surgeon did not want me to bother with a gastric sleeve – if the endgame was diabetes improvement then the gold standard was a bypass. In Australia you need to be over 35 BMI or over 30 with a comorbidity to be eligible. I had slightly elevated Blood Pressure - that plus the diabetes made me eligible. I paid $2000 out of pocket, my private health insurance paid the rest. No psych required, I had a few meetings with a nutritionist and everything was greenlit. From first enquiry to surgery was four months. The fee I paid includes lifetime consults with the surgeon.

I did not need a pre-op diet as i was not that overweight and my liver was not a concern.

Surgery

My procedure was in June 2018. My anaesthetic recovery was rough, but otherwise the process was fine. The most discomfort was immediately in the 12 hours following – in part due to surgical site pain but mostly because the bed could not accommodate my height so I was forever crossing my legs or scrunching them up, only to have a nurse slap them and wake me up for fear of DVT. Nurses kept promising to find a bed extender - eventually I lashed out in a post-anaesthetic haze at a nurse who slapped my feet - she took the end off the bed with a flourish. My feet shot out, I cried in relief, apologised profusely and slept for eight hours. Day two was stiff and sore but i was mobile, able to shower and sipping fine. I went home the morning of day three. I had PHENOMENAL life ruining headaches from day two. I went home with some serious opiates because I lived 90 minuts from my surgeon and couldn’t drive to get a script if they hit again. On day four my dietician cleared me for coffee and it immediately wiped out the headache – turns out I’d been in caffeine withdrawal. So I really recommend you taper that off in advance if you have a problem with coffee like i do.

If you're diabetic then buy a freestyle libre glucose monitor for the procedure if you dont have a CGM. They want hourly blood glucoses, instead of being woken and pin pricked every hour I could just show them how to use the scanner and they'd take it while i slept.

I had some minor aches 6 weeks out and one of the surgery sites oozed a little clear Fluid. It subsided immediately.

I was home for two weeks. I could have gone back at one week. I'm an accountant though and my starting weight was comparatively low so i was mobile quick. I completely understand if you're starting form a heavier weight then you should plan to take the full time.

Food/Eating

The normal progression of foods was fine and unremarkable from what is described on most forms. I graduated to solids a little earlier than I should have. I cheated like mad and was feeling fine, it was only when I snuck a tiny piece of casserole beef and vomited violently did I start to behave myself. I was vomiting once or twice a week from eating too much or too fast. Savoury ricotta bake, hearty Soups and coconut Water were my saviors. The vomiting subsided, 18 months out I vomit maybe once every two or three months and only when I do something stupid. My problem before surgery was eating very fast and taking large bites – that has been hard to deal with post surgery. In fact I tend to still eat large bites and then sit unable to eat for extended periods. I was very sensitive to sugar post-op and frequently had dumping. That subsided in a month with changes in eating, changes in my appetite and better food/liquid rules. I currently only get dumping in the morning, and only if I eat something sugary. I do get nauseous easily in the morning too – it’s something I’m working with my nutritionist on to find out why. Otherwise I can eat whatever I want within reason. I don’t drink soda, but had quit it before my procedure. Milky Protein makes me nauseous too (any type of creamy protein really) so I use a water protein additive from costpricesupplements. This helps me hit 2L fluids daily.

I can eat about a cup and a half food. Liquidy foods – stews, soups, casseroles – I can eat a lot more than that. Tougher foods like steak or dry chicken much less. I gulp liquids.< /p>

I had a sensitive stomach before the surgery and took Metamucil religiously to keep my gut regular. I have not had any issues post op with flatulence but have had looser bowels. Metamucil still helps – but no worse or in any way less manageable than pre-op.

Diabetes

I went off insulin immediately after my surgery. It wasn’t a cure – I’m still diabetic – but metformin and trajenta keep me in an aggressively managed hba1c. I have a so-so diet – I eat too much sugary junk food and carbs. I could go without diabetic meds I believe but my diet would be depressing so ive truck a compromise.

On this basis alone this was the best decision I could have made for my physical wellbeing. My blood pressure is fine, my cholesterol is non-existent and I'm able to even job a moderate distance without discomfort.

Random observations

• I’m cold. So cold. It’s 35 degree outside where I am (90’s Fahrenheit) but as soon as I go into any office I need a sweater. I really became dependant on sweaters, long johns and socks this last winter. Im not cooler in summer – just as hot and bothered as before. Maybe a better way to describe it is that I feel the temperature more in general, like I lost my insulation.

• I am too skinny. Clothes don’t fit that great – most men this tall have a bit more chest/gut on them. Australia has limited/no tall clothing ranges domestically so I’m importing loads of stuff from the UK/USA. i still think i look fat when i look in the mirror.

• My bum is bony and I need cushions to sit comfortably. I also had a cyst on a butt cheek I didn’t know about – now im so bony there I’ll need to get it removed so I can sit on kitchen chairs comfortably again.

• I gained about 1.5” of penis length. It was a welcome addition. I needed to learn how to be more gentle and patient using it. With a young family and little sleep it's yet to be fully road tested – but I’ll be ready when we start to sleep again.

• I have a little loose skin. nothing dramatic. mostly around the gut and love handles.

• I am very sensitive to meds and drugs. I'm not much of a drinker but i like weed edibles - what would give me a mild buzz before gets me quite high now. I sober up quicker now too. I take xanax on flights to help sleep - i take a quarter of the dose now.

• I drink red wine socially and now cannot really get drunk. I sober up quite fast but get a mild buzz pretty quickly too.

• Dumping sucks but it should not be a discouraging factor. Its not life ruining – anyone who’s had a hypo as a diabetic it’s a bit like that with some gastro thrown in. It resolves pretty fast (30ish minutes for me) and is a self-reinforcing feedback loop for shitty food behaviours. For this reason alone I consider the bypass as the better choice for me.

• I’ve lost a fair bit of muscle tone and will need to somehow up my protein and start some weight training to recover it. This needs to be balanced with not losing for further weight.

• I have to remind myself to eat. Not just because of low appetite, but because once my pouch shrinks for a day then eating again can be uncomfortable and time consuming. As long as I eat fairly frequently my pouch is all good and I can eat quite a lot pretty fast – forget about it for 2 or 4 hours and I’ll need to take some time to eat a bit and get my appetite back.

• I was hungry for 33 years and bordered on a pathological inability to waste food. I ate my meal and anything my wife or kid didn’t eat. I’d eat a meal out, go home and have a sandwich. We ate at bars and pubs because the servings were larger. I would eat until I was very uncomfortable if the portion was large enough. Now I still can’t bring myself to leave food – so I have this silly aversion to ordering anything more than something off the appetisers list. I don’t like asking for to-go containers (it’s an Australian thing – it’s really stupid because we pay so much for food out we should keep every bloody morsel) but have started to now order what I actually want instead of what I think I can finish. It’s funny – I went from ordering what I thought would be the biggest portion so I didn’t feel hungry (instead of what I thought looked good) to ordering what I thought I could finish and not waste.

Regrets?

None to speak of specifically. In a very minor way travel is less fun. I looooove travelling to southeast asia and the USA and love eating all the different things. My appetite is so low now, and eating can be so inconvenient, that I don’t get to eat anywhere near as much variety when I travel. I was recently in SE Asia and looking forward to a huge array of currys. I ate only two in five days as I had no appetite at all. I just need to travel differently now - actually plan to stop for meals instead of just charging all over a city and snacking on the way.

I wish id been more sensitive to my wife's emotional processing of the scenario. She's gone from having the tall, chubby guy that was the physical build she was attracted to, to having a skinny beanpole. This was while she was having our second kid and all the very natural weight gain associated. She's not overweight and is, objectively i reckon, absolutely gorgeous but definitely feels marginalised by the process and is quick to colour me as vain or obsessed with my image now I am buying new clothes. I think i could have been more mindful of what I said or did. She was overwhelmingly supportive though and agrees this was worthwhile.

Closing thoughts

If you are considering this process and maybe you're on the margins of eligibility my experience would say go for it. my hope here was to give a vanilla experience to the mix, unique only in my taking the more permanent bypass on despite my lower starting weight.

Sent from my SM-A705YN using BariatricPal mobile app

[GreenTealael 25,378]

💜CONGRATULATIONS 💜

WE NEEDED THIS

[Kimberly3 71]

Thank you for sharing your story. It's nice to hear about a calm no drama experience. Congrats on your success!

[Frustr8 7,886]

And if I HAd a calm peaceful surgery/recovery I WOULD shout it from the Rooftops. I did not have the one spoke,of in the pamphlets, books or verbalize by my SURGEON- it was bumpy, weird and beyond what I was prepared for- but ITS STILL GOOD- and even beat-up old jalopies like ME, we still make it over the Finish Line, we just chug- chug loudly but our horn still goes Beep Beep as we Travel Along. And,i would,NEVER Go back to pre- SURGERY AGAIN- it was much more sorrowful, painful and simply than anything RNY COULD throw My Way!

[Orchids&Dragons 9,047]

Thank you for sharing! You're correct that many people who had relatively easy surgeries/results don't come to the forums and share their stories so the boards are disproportionately negative.

[DeanaNJ 25]

Your comments about what type 1 and 2 diabetics are inaccurate! You are either a type 1 or a type 2. Type 1s are dependent on insulin. Type 2s in many cases can control the disease without insulin - diet, exercise, lifestyle choices. Someone who is a type 1 is always a type 1. I found your lack of knowledge on this quite disturbing.

Congratulations on your weight loss success.

[modymatey 33]

Your comments about what type 1 and 2 diabetics are inaccurate! You are either a type 1 or a type 2. Type 1s are dependent on insulin. Type 2s in many cases can control the disease without insulin - diet, exercise, lifestyle choices. Someone who is a type 1 is always a type 1. I found your lack of knowledge on this quite disturbing.

Congratulations on your weight loss success.

This is absolutely not the case and reckless for you make ignorant and generalised statements in a forum format. What you say is generally true -but hopelessly ignorant or disregarding of the nuance and complexity of diabetic causes and diagnoses. Diabetes is high heterogeneity. This sort of waffle is misleading but also offensive to people that are trying to get a better diagnosis to manage their condition. I mention in my post how I wanted to address the lack of positive stories - I should also mention how over-represented ignorant and unnuanced opinions are on WLS forums about chronic diseases and comorbidities.. I'm a layperson but I know better than to repeat unhelpful or reductionist statements in an authoritative way in case it impacts another readers decision making or understanding.

Anyone still reading - this is a perfect example. Work with your medical team. Challenge the assumptions. If you are diabetic and not well managed or not confident in your diagnosis then talk with your team about MODY, LADA or the other monogenic forms of diabetes. Each presents different clinically and can respond better to certain treatments. The presenting issues are the same - the underlying mechanisms are different. The outcomes for not aggressively managing it are the same.

Diabetes is increasingly treated as a multimodal or spectrum disease. It is a group of metabolic disorders. Every year more genetic markers for monogenic types are identified - it's led to some countries to move to a 5 type scale, excluding gestational. When I was diagnosed they did genetic testing for four MODY genes - they now test for over 200 and each presents.clinically in unique ways and each benefits from different treatments. That is 200 unique genetic causes of insulin deficiency - not type 1 and not type 2 either.

Anyone interested in why the above dingus is wrong and harmful to broader discourse on diabetes should look at the Lund Centre research by Dr Leif Groop. I don't have the title to hand but it's published in Lancet. There is excellent layperson summaries around and even better examples of how a nuanced and inquisitive approach to the broad spectrum of diabetic disorders leads to better diagnoses, better treatment and improved long term health outcomes. If it wasn't for my endocrinologists open mindedness and a willingness to not accept I was neither type 1 or 2 I would still be injecting insulin.

Sent from my SM-A705YN using BariatricPal mobile app

[modymatey 33]

I want to add to why this is an unhelpful and reckless opinion. It's got to do with context. In a normal setting what Deana said may be informative - if the broader conversation still thinks diabetes is fat people deserving what they get then explaining the 1990's distinction is fine.

This is a forum of largely overweight and inquisitive people. Diabetes will be disproportionately represented here - a much higher percentage of people here will be pre or full-blown diabetic. If that's an underlying factor in their consideration then we owe it to them to not ignore how complex and dangerous the disease is and encourage people to get a better understanding of what might be contributing to their particular metabolic disease and whether WLS would be a helpful or warranted part of their plan to manage it.

Sent from my SM-A705YN using BariatricPal mobile app

[minimamaz00m 61]

I’m a type 1.5 diabetic too. I looked through @modymatey ‘s story twice and I can’t figure out which WLS he had. I’m deciding between bypass and sleeve and I’m worried about if I go severely hypoglycemic and need to ingest sugar to bring up my blood glucose l might dump if I get the bypass. Can anyone speak to that? (Type 1.5 diabetes is when you have both issues... your pancreas won’t make insulin (type 1) and you are insulin resistant (type2)).

[New&Improved 1,780]

32 minutes ago, minimamaz00m said:

I’m a type 1.5 diabetic too. I looked through @modymatey ‘s story twice and I can’t figure out which WLS he had. I’m deciding between bypass and sleeve and I’m worried about if I go severely hypoglycemic and need to ingest sugar to bring up my blood glucose l might dump if I get the bypass. Can anyone speak to that? (Type 1.5 diabetes is when you have both issues... your pancreas won’t make insulin (type 1) and you are insulin resistant (type2)).

I was on medication for type 2 and soon as I had bypass I was off meds and normal blood glucose levels since then