Type 1 and gastric bypass

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christmasfairy1

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Type 1
I have recently been diagnosed as type 1, really struggling at the mo. Had a gastric bypass 13 years ago and so struggle with the amount and frequency of food that the nurses are telling me to consume.
I'm not managing 3 meals a day currently as if I do eat more than 2 I'm physically sick which obv has implications on insulin injected and bs.
Is there anyone in a similar situation or who had experience with bypass and insulin please ?
 
christmasfairy1 said:
I have recently been diagnosed as type 1, really struggling at the mo. Had a gastric bypass 13 years ago and so struggle with the amount and frequency of food that the nurses are telling me to consume.
I'm not managing 3 meals a day currently as if I do eat more than 2 I'm physically sick which obv has implications on insulin injected and bs.
Is there anyone in a similar situation or who had experience with bypass and insulin please ?
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Christmasfairy1, I haven't had personal experience of a gastric bypass, but I do appreciate it radically changes how you take on board nutrition.

Have you feed your struggle back to your diabetes nurse, and asked for an alternative plan? It seems contra-logical that they would be happy for your vomiting on anything other than a rare basis. Are you on a fixed dose regime where you take the same amount of insulin with eat meal, plus your long acting doses?

Over time, most T1s learn to carb count, which usually allows a lot more flexibility for eating and dosing insulin, but depending on when you were diagnosed and other factors that may be a bit of a stretch for you at the moment.

Good luck moving forward, but in your shoes, I'd be trying to ask for feedback on how they will help you move forward to a better place.
 
You probably need some more input from your specialist diabetic team, as your body will handle food differently from the normal. Getting your basal insulin dose correct will be important but if you are only having 2 meals then you would only need to inject for the meals you have or carby snacks.
You may have justification to be pressing for a pump and certainly a Libre or similar if you haven't already got them.
These things are something you should be discussing with your nurse which I hope will be at the hospital clinic not the GP who likely will not have the experience in your situation.
 
Type 1 is rare enough; Type 1 with a previous gastric bypass must be very rare indeed.

Like Leadinglights, I hope you are being treated by your hospital diabetes clinic, not your GP practice. You are a very special case, and you need and deserve specialist help.

Ideally, the hospital's diabetes team could liaise with the hospital's bariatric-surgery team to make sure you were getting the most appropriate advice. All best wishes, and fingers crossed!
 
Hi and welcome.

Sorry to hear about the difficulties you are experiencing and agree that you need to be giving feedback to the specialist nurse that the regime he/she is suggesting is causing you additional problems both with your diabetes and general health.
If you are not being treated by a specialist nurse at a diabetes clinic then you should be.

Which insulins have they given you and what dosing regime are you following at the moment. A basal/bolus insulin regime should allow you to just have 2 meals a day if that works well for you. Do you snack in between or are 2 meals enough?
They really should be adjusting your insulin to what suits your body and lifestyle, not trying to make you conform to some norm. Diabetes is very individual in how it affects all of us and ultimately it is about us learning to adjust our insulin doses and timing to what suits us as individuals but in the early days when we don't have enough knowledge, we are reliant on the nurses and consultant to help us find a "near enough" regime until we are confident and experienced enough to fine tune it for ourselves. It is very normal to give feedback to your nurse and for him/her to make adjustments according to that feedback in the early weeks and months after diagnosis, so don't suffer in silence, get back in touch and explain the problem.
 
Thanks for replying , tbh I've not had much input from the diabetic team at the hosp. There's been 2 occasions I've called ( as advised) and they are meant to call back to get readings and they haven't. I do however have an appointment with the CNS on Thursday morning which I really hope will bring more clarity and understanding as I really feel like a fish out of water at the moment.
BTW I am on Detimir x2 a day and novarapid and was hospitalised and diagnosed on 26th March so it's very early days.
 
Unfortunately the diabetes clinics are pretty overstretched as a result of Covid, but it is shocking that they are not supporting newly diagnosed patients. Sadly we do hear this quite a lot on the forum.
Do you have Freestyle Libre sensors? If not, then apply for the free 14 day trial through the website. It will give you a little more information about what your BG levels are doing and you will eventually be prescribe it or similar system as you are Type 1.
What doses of Novo Rapid have they put you on? What sort of things would you normally eat in a day. Are your 2 meals a day usually breakfast/brunch and evening meal?
With the insulin regime that you have, if you don't want to eat a meal, then simply don't inject any insulin. Keep a food diary along with your readings but you should not feel obliged to eat if you don't want to or your body cannot cope with it and is rejecting the food. Some days I just have one meal a day, sometimes 2 and sometimes 3. The important thing is that you don't inject mealtime insulin (NovoRapid in your case) if you don't eat anything. But do record that you didn't have a meal in your diary. The nurse/consultant will need this info to be able to see how your body is responding and adjust your doses. It is your body and your diabetes, so don't feel you are obliged to do something which is making you ill and potentially unsafe in this situation if you are being sick after a meal that you have injected for.

Good luck and let us know how you get on.

If you have any questions then do ask. The forum is a gold mine of practical experience and I have learned most of what I know from the good people here over the last 4 years. It might not all be relevant to me but it gives me ideas of what to try when things are going wrong and then I learn what works for me and what doesn't. As a result I become the expert in my individual diabetes and I don't think I am being egotistical to say that I know more about that than my consultant or nurse now.... because I live with my diabetes day in and day out and meal by meal and night by night rather than the 10 mins I spend on the phone to them once or twice a year. I hope you will gradually reach a point where you feel equally confident in managing YOUR diabetes. Remember, they are there to support you, not dictate to you.
 
christmasfairy1 said:
Thanks for replying , tbh I've not had much input from the diabetic team at the hosp. There's been 2 occasions I've called ( as advised) and they are meant to call back to get readings and they haven't. I do however have an appointment with the CNS on Thursday morning which I really hope will bring more clarity and understanding as I really feel like a fish out of water at the moment.
BTW I am on Detimir x2 a day and novarapid and was hospitalised and diagnosed on 26th March so it's very early days.
Click to expand...

Little tip & this also includes waiting for other department consultant appointments, if you know the name of who your meant to see ring hospital switchboard & ask to speak with consultants secretary, done this numerous times & it always gets you seen sooner than waiting for a letter to drop through door..
 
Sorry to hear you aren't getting much in the way of support @christmasfairy1 :(

The good news though, is that the combination of Levemir (detemir) and Novorapid should give you a fully flexible insulin management system which you can adapt to suit the needs of your gastric bypass through carb counting.

Your basal (background) insulin detemir will need to be adjusted to keep your glucose levels as steady as possible through the full 24 hours when you aren't eating anything. You can find how to check your basal doses and adjust them here:
https://www.mysugr.com/en/blog/basal-rate-testing/

Then your novorapid doses will only be needed when you are eating carbohydrates, and would be adjusted to match the size and timing of the meal using carb counting.

The nuts and bolts of carb counting

When you live with type 1 diabetes, carb counting is a great way of managing your blood sugar or glucose levels. It can give you more freedom and flexibility in what you eat when you're preparing meals at home, grabbing food on the go or eating out. Carb counting does take some time and effort...
www.diabetes.org.uk www.diabetes.org.uk

There is a free online course to help you learn more about intensive insulin therapy
www.bertieonline.org.uk

Or you might find Gary Scheiner's book 'Think Like a Pancreas' helpful
Think Like a Pancreas

Good luck! And let us know how you get on 🙂
 
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