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  Chat Transcript
Open Q & A and Gastric Bypass Surgery  - Sharon Spear, C.D.E. and Dr. Pasquale Iannoli, General Surgeon, Westside Surgical Associates - August 20, 2013

 
Sharon@Unity:  
 Welcome to the Unity Diabetes Online Community! I’m Sharon Spear, a certified diabetes educator at Unity Diabetes & Endocrinology Services, and I’ll be hosting today’s chat. We have a special guest tonight: Dr. Pasquale Iannoli, a General Surgeon from Westside Surgical Associates. I’m glad you could join us today. We’re excited to answer all of your questions. 
Sharon@Unity:  
Before we get started let me just tell you how I’ll address your questions and comments today. I answer questions one at a time, in the order that they are posted to the site, and there might be a slight delay as I respond to each question. It may take a few minutes for me to type answers to your questions, so please stay logged-in to the chat to see my response, even if it takes a few minutes. And you might need to refresh every few minutes to keep up with the latest posts in the chat. Let's get started.
Sharon@Unity:   
Hello Dr. Iannoli. What is gastric bypass surgery and how is it done? 
Dr. Iannoli: 
Good evening, Sharon. Gastric bypass is an operation designed to help control body weight. It is typically a laparoscopic operation. The stomach is made smaller and part of the small intestine is short-circuited. This leads to weight loss. 
jack34: 
Hi doctors – I have Type 2 diabetes (for about 5 years now). My fasting blood glucose readings have been averaging about 144 over the past 2 1/2 months. They have been creeping up to that average, and I am concerned. Should I be? 
Sharon@Unity:    
Hello jack34 The American Diabetes Association recommends your fasting blood sugars be 70-130mg/dl, Diet, exercise and monitoring your blood sugar help manage it. Good for you in tracking your blood sugars.
 lucyblue:
Dr. Iannoli, I have heard there is a connection between diabetes and gastric bypass surgery – that blood sugars can go back to normal after surgery. Is this true? 
 sassy35:
Dr. Iannoli – how does someone know if they should consider gastric byspass?
Dr. Iannoli:  
Yes, gastric bypass surgery is associated with improved blood glucoses. In many cases, diabetes is either greatly improved or "cured". We don’t understand the exact reasons for this improved blood glucose, but it is NOT just related to weight loss. There is a hormonal component involved immediately after surgery.
lucyblue: 
Wow – that's incredible, are the low blood sugars sustained over time? 
Dr. Iannoli:
Deciding to pursue gastric bypass surgery is an important decision that a patient makes after consulting with their primary care doctor, surgeon, endocrinologist (diabetes doctor) and other specialists. Generally speaking, patients need to have been "morbidly obese" for about 5 years, and tried non-surgical means of weight control for about 2 years.
lucyblue:  
How does one prepare for gastric bypass? Is there a special diet to follow before/after? 
Dr. Iannoli:  
Blood glucose (sugar) can be controlled long-term, assuming proper diet, exercise and weight management. Not every patient achieves normal blood glucose with surgery alone, and some require ongoing medication. 
Sharon@Unity:   
Before a person has gastric bypass surgery they need to meet with the nutritionist for 4 to 6 months to follow a low-fat low-sugar meal plan and then be aware of the transitional diets after surgery. Exercise is also important. 
Dr. Iannoli:   
The process to be considered for gastric bypass generally involves: 1) recommendation by YOUR doctor or endocrinologist; 2) evaluation by a bariatric surgeon (surgeon who performs gastric bypass surgery); 3) psychiatric evaluation; and 4) participation in a "weight loss surgery support group." 
 sassy35:
What is the recovery time for the surgery?
Dr. Iannoli:    
 I agree – the nutritionist is critical in learning how to maintain a proper diet after gastric bypass surgery. Generally speaking, 1000 calories/day, low carb, low fat, high protein.
 Jane@Unity:
What is considered morbidly obese? 
 jack34:
 Last week I had my highest reading ever. It was 244 and it was taken 2 hours after starting a meal of chicken parmesan sandwich, two bread sticks and a salad. Again, should I be concerned?
 Dr. Iannoli:    
 Recovery time...3 day hospitalization; no driving for 1 week; no heavy lifting or straining for 4 weeks; walking for exercise immediately and daily.
Sharon@Unity:    
 You may want to let your primary doctor know your numbers, and sometimes taking a walk after a meal may help lower your blood sugars.
 Dr. Iannoli:    
Morbid obesity means that your body weight is literally leading to medical problems, such as high blood pressure, diabetes, high cholesterol, etc. Generally, its means that you weigh about 100 pounds more than you should.
jack34:  
OK. Many thanks for your help. 
 Jane@Unity: 
Thank you! Our class enjoyed your answers. 
lucyblue:  
 Thank you for such good information, Dr. Iannolli and Sharon. Very interesting.
 Dr. Iannoli:    
My pleasure...I look forward to participating again. Thank You! 
Sharon@Unity:  
That’s all the time we have for today. I’ve really enjoyed our conversation and hope that I was able to provide some insight for you. If we didn’t get to your question today or if you think of another question later on – feel free to jump into the conversation in the forum, or submit a question using our “Ask an expert” feature. Be sure to join us for our next chat Tuesday, September 10 at 8 p.m. with Elva Parker, C.D.E., Elissa Rowley from the National Kidney Foundation, and Dr. Amol Shrikhande, a Nephrologist from The Nephrology Associates. They will offer an open Q&A session and offer tips on keeping your kidneys healthy.
 
 
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