Re: Diabetic pt and trouble with weight loss prior to surgery

[Guest guest]

Hi Jenifer,How low are her blood sugars? Maybe she is overcorrectingHer blood sugars and therefore eating more calories than what she thinks. Make sure you ask her how often she has low blood sugars and what does she eat to correct them.I had a similar case and she was taking 12-18 oz of juice daily to correct her low's. Also maybe her insulin/carb ratio needs to be corrected.Just a thought!Sent from my iPhoneOn Aug 2, 2011, at 8:04 AM, "sharonbachman" <sharonbachman@...> wrote:

Hi all,

I was hoping someone could shed some light on a patient of mine. I have a 72 year old female who is diabetic and has an insulin pump. She is unable to do much exercise and completes her food diaries every month. Her average intake is roughly 700-900 calories per day and I had recommended for her ~1200-1500 calories. She has lost a total of 3 pounds over 7 months. She states her doctor said it would be difficult for her to lose weight due to her DM. I'm guessing she is under reporting her intake but she adamantly sticks to her intake being so low. I keep asking her how the lap band surgery will benefit her if she is already eating so little and she hasn't been able to provide me with a good answer. Is there something here that I am missing? Her thyroid levels haven't been checked in about a year but the levels were fine then. Her last HgbA1C was 8.6 back in Jan 2010 but has been experiencing some low blood sugar levels lately. She states her clothes are fitting better and doesn't know why she isn't losing any weight.

Thanks,

Sharon Bachman

[Guest guest]

I have had patients like this before and surgeon placed band and they lost very

little weight afterward. It sounds like her physical inactivity and her

undereating are the reason for her minimal success with wt loss, so, making sure

she knows that the band will not help her is the right approach. Also, do you

have a MedGem? If so, maybe you could do this IC on her and show her what she

truly needs to be eating?

In my experience bands do very little in this type of patient and it is sad to

see it still placed sometimes! Good luck!

Missy Bizzarro

Re: Diabetic pt and trouble with weight

loss prior to surgery

Hi Jenifer,

How low are her blood sugars? Maybe she is overcorrecting

Her blood sugars and therefore eating more calories than what she thinks. Make

sure you ask her how often she has low blood sugars and what does she eat to

correct them.

I had a similar case and she was taking 12-18 oz of juice daily to correct her

low's.

Also maybe her insulin/carb ratio needs to be corrected.

Just a thought!

Sent from my iPhone

On Aug 2, 2011, at 8:04 AM, " sharonbachman " <sharonbachman@...> wrote:

Hi all,

I was hoping someone could shed some light on a patient of mine. I have a 72

year old female who is diabetic and has an insulin pump. She is unable to do

much exercise and completes her food diaries every month. Her average intake is

roughly 700-900 calories per day and I had recommended for her ~1200-1500

calories. She has lost a total of 3 pounds over 7 months. She states her doctor

said it would be difficult for her to lose weight due to her DM. I'm guessing

she is under reporting her intake but she adamantly sticks to her intake being

so low. I keep asking her how the lap band surgery will benefit her if she is

already eating so little and she hasn't been able to provide me with a good

answer. Is there something here that I am missing? Her thyroid levels haven't

been checked in about a year but the levels were fine then. Her last HgbA1C was

8.6 back in Jan 2010 but has been experiencing some low blood sugar levels

lately. She states her clothes are fitting bett! er and doesn't know why she

isn't losing any weight.

Thanks,

Sharon Bachman

[Guest guest]

I agree with Missy. I have had patients who claim these very low calorie levels prior to surgery. I always tend to think they are under reporting calories as well, but you obviously cannot prove that. I have always emphasized that if this is all you are eating now, a band is not going to change that at all and you will probably be very disappointed in your results post-operatively. I feel like this puts the ball in the patient's court---to either opt out of surgery, choose a different surgery, or get real about what they are actually eating if they are being untruthful. Kirkpatrick, RD, LD----- RE: Diabetic pt and trouble with weight loss prior to surgeryDate: Wed, 3 Aug 2011 10:07:22 -0400

[Guest guest]

Thank you so much for your feedback. This particular patient is in her 70's and

the doctors won't do a bypass here due to her age. I will definitely bring up

some of your suggestions to my patients.

I've tried to get a MedGem here but they are expensive. I try to refer the

patients to a gym but most never go to get it done due to the cost.

Thanks,

Sharon

<br><br><br><br><br><br>Hi all,<br>I was hoping someone could shed some

light on a patient of mine. I have a 72 year old female who is diabetic and has

an insulin pump. She is unable to do much exercise and completes her food

diaries every month. Her average intake is roughly 700-900 calories per day and

I had recommended for her ~1200-1500 calories. She has lost a total of 3 pounds

over 7 months. She states her doctor said it would be difficult for her to lose

weight due to her DM. I'm guessing she is under reporting her intake but she

adamantly sticks to her intake being so low. I keep asking her how the lap band

surgery will benefit her if she is already eating so little and she hasn't been

able to provide me with a good answer. Is there something here that I am

missing? Her thyroid levels haven't been checked in about a year but the levels

were fine then. Her last HgbA1C was 8.6 back in Jan 2010 but has been

experiencing some low blood sugar levels lately. She states her clothes are

fitting bett! er and doesn't know why she isn't losing any weight.

<br>Thanks,<br>Sharon

Bachman<br><br><br><br><br></p></div><!--~-|**|PrettyHtmlStart|**|-~--><div

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[Guest guest]

Dear All,We at CODS (center for obesity and diabetes surgery,Mumbai,India.) are organising a conference on 8th oct 11 at Amritsar,Punjab mainly on nutrition only .The agenda is strictly on bariatric nutrition ,complications and its management .We would be inviting speakers as well as would be giving certificates for the same . There would be a minimal registration fees . If any one of you are interested please get in touch with me on miloni@... so that I can forward you the forms to be filled . Its a one day conference on 8th Oct 11,saturday from 1pm to 4 pm.Thanks.Best regards,MiloniBariatric Nutritionist Follow us on facebook and twitter . Sent on my BlackBerry® from VodafoneFrom: "Bizzarro, A Civ USAF AFMC 88 DTS/SGQD" <melissa.bizzarro@...>Sender: Date: Wed, 3 Aug 2011 10:07:22 -0400< >Reply Subject: RE: Diabetic pt and trouble with weight loss prior to surgery I have had patients like this before and surgeon placed band and they lost very little weight afterward. It sounds like her physical inactivity and her undereating are the reason for her minimal success with wt loss, so, making sure she knows that the band will not help her is the right approach. Also, do you have a MedGem? If so, maybe you could do this IC on her and show her what she truly needs to be eating? In my experience bands do very little in this type of patient and it is sad to see it still placed sometimes! Good luck!Missy Bizzarro-----Original Message-----From: [mailto: ] On Behalf Of KatzSent: Tuesday, August 02, 2011 6:32 PM Subject: Re: Diabetic pt and trouble with weight loss prior to surgeryHi Jenifer,How low are her blood sugars? Maybe she is overcorrectingHer blood sugars and therefore eating more calories than what she thinks. Make sure you ask her how often she has low blood sugars and what does she eat to correct them.I had a similar case and she was taking 12-18 oz of juice daily to correct her low's. Also maybe her insulin/carb ratio needs to be corrected.Just a thought!Sent from my iPhoneOn Aug 2, 2011, at 8:04 AM, " sharonbachman " <sharonbachman@...> wrote:Hi all,I was hoping someone could shed some light on a patient of mine. I have a 72 year old female who is diabetic and has an insulin pump. She is unable to do much exercise and completes her food diaries every month. Her average intake is roughly 700-900 calories per day and I had recommended for her ~1200-1500 calories. She has lost a total of 3 pounds over 7 months. She states her doctor said it would be difficult for her to lose weight due to her DM. I'm guessing she is under reporting her intake but she adamantly sticks to her intake being so low. I keep asking her how the lap band surgery will benefit her if she is already eating so little and she hasn't been able to provide me with a good answer. Is there something here that I am missing? Her thyroid levels haven't been checked in about a year but the levels were fine then. Her last HgbA1C was 8.6 back in Jan 2010 but has been experiencing some low blood sugar levels lately. She states her clothes are fitting bett! er and doesn't know why she isn't losing any weight. Thanks,Sharon Bachman