I just ordered the book, so I haven’t read it yet. About six months ago, my doc began a strong push for me to have bariatric surgery to manage my diabetes. I am fat, yes, but the real driver was diabetes.

So I have the bariatric consult and was rapidly engulfed in prepping for surgery. EVeryone in the bariatric surgery system takes surgery for granted. But one thing ’saved’ me. My surgeon said I had to lose 26 pounds.

This program puts everyone on the same diet: tightly restricted carbs — post-surgery if you eat sugar, you get really sick so you have to be able to stop doing sugar and processed flour. The pre-surgery diet is very similar to the post surgery diet and with the surgery you literally have to eat that way the rest of your life cause the surgery permanently alters your disgestive track.

Bariatric surgery causes your body to PERMANENTLY fail to absorb nutrients properly so you have to take lots of nutrition supplements and eat tons of protein and with the stomach the size of a walnut, you have to sip water all day every day sip sip sip, no end, to get enough water.

I have already stopped drinking anything but water: everything else has carbs I don’t want to deal with. And I love drinking water but after surgery, geez, even that pleasure would be gone, I could not drink four ounces of water, only sip sip sip. I worried about not being able to drink water, not being able to enjoy food.

The pre-surgery diet, the ideal one — some folks just can’t manage it — is two protein shakes a day, and one meal of 3 ounces lean protein and low carb vegies. At first on this diet I was starving all the time and the nutritionist suggesting increasing my carbs a little — so I added some frozen fruit to the protein shakes.

My longwinded point: in three months, eating the way I would have to eat the rest of my life if I had the surgery, I had lost 45 pounds.

So I start thinking, gee, if I can lost 45 pounds eating this way and if I have to eat this way post-surgery, why permanently alter how my body absorbs nutrition .. .forever? Do I trust the medico-pharmacological industry more than creation? What is creation created a pretty good body for humans? I don’t trust the medico-pharma industry. I do trust creation.

And it kept drumming in my head: I have to eat carefully for the rest of my life with or without permanently altering my body.

So I decided not to have the surgery and I continue to lose weight. I am losing pretty rapidly. I have no illusions. I’ve lost lots of weight before and regained some — I am now 130 pounds below my all time high — yeah, I got very morbidly obese but I have kept about 100 pounds off now for several years and I have about 70 to go to be healthy according to height-weight charts. And I know it will be hard to keep the weight down . . . I have read of studies about how my body’s hormones change with big weight loss and the hormonal changes sorta pressure me to gain.

But I have to eat healthfully for the rest of my life to be healthy, with or without surgery.

Anxious? Yes I am. Unsure? Yes I am.

It is very hard to find doctors or nurse practitioners or, esp., nutritionists that actually understand the nutritional needs of diabetes. My doc’s clinic has a diabetes educator. She mouths formulaic tripe from the American Diabetes Association (ADA) — if I ate the way she told me to eat, my sugars would skyrocket. First time I saw the ADA diet, the day I was first diagnosed eight years ago, I said ”If I ate this way, it would be bad for me” — and this is the official good diet offered by the ADA who, I am sure, gets lots of funding from drug companies who sell insulin, glucose test strips, insulin needles (how is it they manage to keep exclusive patents on something as simple as a needle?!!!) . . .

I am eating well, only real food. I do a green raw smoothie daily, I eat high quality protein, count my carbs carefully . . . . and the weight is falling off . .

so what is on my mind? ketoacidosis. I just had a very frightening episode: walking home from my farmers market, a 3 block walk, loaded with kale, spinach, blueberries, eggs, fenugreek, cilantro, garlic . . . all the goodies I need to eat well . . . but carrying, in two bags, maybe 10 pounds, I became too weak to stand up, woozy, my vision blurred. I could not walk. I stopped to rest and when I stood up I couldn’t make my arms and legs work.

An ambulance came, I declined to go to the hospital — for gross reasons. First I had some frozen food (frozen salmon and turkey burgers from Trader Joe’s where I had gone before the market — walked a total of 8 blocks before I got weak) and I had vomited. When a diabetic vomits for no reason, it is serious and often folks are urged to go to ER. I had done a ketone strip that morning and knew I had trace ketosis, and I had a mildly elevated glucose fast reading — 158. I put half a banana in my morning protein shake but I did not do any insulin. I take Lantus, a long-acting insulin and I rarely need the other fast-acting kind. I see, in hindsight, I should have givenmyself some insulin when I saw the trace ketosis . .. but I didn’t. I thought I’d get to the market — I was out of greens and lean protein (other than protein powder) and I figured I’d run my few block errand then pay attention to my insuliln when I got home.

When I vomited on the street the second time, I moved my bowels. And that’s mainly why I didn’t go to the hospital. I wanted to get home and clean myself. And I knew what to do: closely monitor my sugar, inject insulin as needed, rest, eat well. I was so weak that it took me a couple hours to clean up, put away my food.

I’m scared. I don’t know how to get professional help. I am sure there are some very good diabetes educators, esp. ones in private practice that consult. But I am poor. I can’t pay for anything that my health clinic, covered by my insurance, has and the diabetes educator, although a sweet young woman, is useless.

There is a nurse practitioner, who happens to be male, who is also supposed to be an expert on regulating insulin and diet so I met with him. After he talked to me about a minute, he radically changed my insulin dosing, asked nothing about my diet and that was it: changing my insulin dosing solved my problems.

No health care professional I have access to has any interest or expertise in helping me lose weight — have surgery is my doc’s advice.

Ketosis in a diabetic is dangerous. Eating high protein low carb is tricky for a diabetic. I feel all alone. And see no way to get support.

And this forum looks nice enough but let’s face it, it is really to sell books and classes. I need support from other diabetics who are making serious effort to eliminate their diabetes through diet and exercise — I am doing all the right things. I eat so carefully and I am so proud and I have learned so much. Whoda thunk I would do a raw green smoothie daily?!! I can tell you the carb, fat and cal count of anything and I eat with rigid, careful attention. And I exercise — swim a mile daily and walk a lot daily.

I am going to get to my weight goals. And sooner or later my insulin needs will go down. I need help figuring out how to reduce my insulin dependency without triggering episodes like I had the other day that ended with me in an ambulance. I feel despair and all alone. No friends have diabetes.