Of course HbA1c and fasting glucose tests aren’t a good indication of whether one’s type 2 diabetes has been “cured” by WLS. What most people don’t realize about the HbA1c test is that it is basically an average, over 3 months, of your blood sugar. So if you’ve had highs and lows in there along with a lot of numbers that show up as average, you’re going to come out with an average HbA1c that shows you’ve been “cured”. However, if most type 2’s who have had WLS kept on testing their blood sugar after they had their WLS, they would see those highs and be rightly worried (most don’t have to test to know that they’ve gone low, symptoms alone will tell them that, testing only confirms how low they’ve gone). And it is possible to have high blood glucose numbers after WLS. As Richie said, WLS messes with what foods one can eat, and high fiber foods are not usually on the list of edibles (and fiber slows down the absorbtion of carbs, which lowers their effect on blood sugar) because they’re harder to digest, fill you up faster, and can make you vomit more often (been there done that).
As you said, deeleigh, while they’re running a calorie deficit, they’re not going to be using some energy and storing some energy, they’re going to be using their fat stores and not adding to them. But as soon as their weight loss stops, and they start the using/storing cycle again, then the insulin resistance problem comes back into play and their type 2 diabetes is out of remission (because that’s what it is – it’s in remission, it’s not “cured”) and needs to be treated again. Only now, it’s going to be more difficult to treat with oral medication because you’ve added malabsorbtion issues to the mix, and that malabsorbtion doesn’t apply just to nutrients from food, it also applies to medications – something people don’t consider when they have WLS is how it’s going to affect them when they have to take antibiotics or other oral medications. Those medicines don’t do you much good if you can’t absorb them and they pass right out of your system. Which means type 2 diabetics who were controlling their t2d with diet, exercise, and oral meds are now going to need insulin, an added expense, on top of all the other possible added expenses of WLS.
As a footnote: I wonder if the Buchwald involved in the meta-analysis is the same Buchwald at the U of M who did my VBG (and the 2 VBGs on my best friend, the latter of which killed her). The Buchwald at the U of M used to teach doctors how to do VBGs (seeing how mine failed, and my friend had to have 2 of them, I’m not so sure that’s a good recommendation).
WLS – Sorry, not my preferred way of dying. *glares at doctor recommending it*
