Diabetes Metabolic and Bariatric Surgery - medECUBE
Diabetes Metabolic and Bariatric Surgery

Diabetes Metabolic and Bariatric Surgery

Diabetes is a group of metabolic diseases in which a person has high blood sugar, either because the pancreas do not produce enough insulin, or because cells do not respond to the insulin that is produced.
There are largely 2 types of Diabetes:

  • Type 1 results from the body’s failure to produce insulin
  • Type 2 results from insulin resistance, a condition in which cells fail to use insulin properly, sometimes combined with an absolute insulin deficiency.

Acute & Serious long-term complications include cardiovascular disease, chronic renal failure, and diabetic retinopathy (retinal damage).

Medical Treatment

  • Controlling blood sugar (glucose) levels is the major goal of diabetes treatment, in order to prevent complications of the disease.
  • Type 1 diabetes is managed with insulin as well as dietary changes and exercise.
  • Type 2 diabetes may be managed with non-insulin medications, insulin, weight reduction, or dietary changes.
  • The choice of medications for type 2 diabetes is individualized, taking into account:
    • the effectiveness and side effect profile of each medication,
    • the patient’s underlying health status,
    • any medication compliance issues, and
    • cost to the patient or health-care system.
  • Medications for type 2 diabetes can work in different ways to reduce blood glucose levels. They may:
    • increase insulin sensitivity,
    •  increase glucose excretion,
    • decrease absorption of carbohydrates from the digestive tract, or
    • work through other mechanisms.
  • Medications for type 2 diabetes are often used in combination.
  • Different methods of delivering insulin include:
    • syringes,
    • pre-filled pens, and
    • the insulin pump.
  • Proper nutrition is a part of any diabetes care plan. There is no one specific “diabetic diet” that is recommended for all individuals.
  • Pancreas transplantation is an area of active study for the treatment of diabetes

Metabolic and Bariatric Surgery and Type 2 Diabetes

Nearly all individuals who have bariatric surgery show improvement in their diabetic state. Bariatric surgeries performed in more than 135,000 patients were found to affect type 2 diabetes in the following ways:

Improves type 2 diabetes in nearly 90 % of patients by:

  • Lowering blood sugar
  • Reducing the dosage and type of medication required
  • Improving diabetes-related health problems

Surgery causes type 2 diabetes to go into remission in 78 % of individuals by:

  • reducing blood sugar levels to normal levels
  • eliminating the need for diabetes medications

 

Types of Metabolic and Bariatric Surgeries

 

  1. Roux-en-y Gastric Bypass:

 

Roux-en-y Gastric Bypass is a surgery that alters the GI tract to cause food to bypass most of the stomach and the upper portion of the small intestine. The operation results in significant weight-loss and causes remission of Type 2 DM in 80% of patients and improvement of the disease in an additional 15 % of patients.

 

Improvement or remission of diabetes with gastric bypass occurs early after surgery and before there is significant weight-loss. The weight-loss independent mechanisms of diabetes improvement after gastric bypass are partially explained by changes in hormones produced by the gut after the surgery.

 

  1. Sleeve Gastrectomy

 

Sleeve Gastrectomy (Vertical gastrectomy) is an operation that removes a large portion of the stomach and, in doing so, causes weight-loss. The remaining stomach is narrow and provides a much smaller reservoir for food.
Sleeve gastrectomy also appears to have some weight-loss independent effects on glucose metabolism and also causes some changes in gut hormones that favour improvement in diabetes. Diabetes remission rates after sleeve gastrectomy are also very high (more than 60%) and, in some studies, similar to results seen after gastric bypass.

 

  1. Adjustable Gastric Band

 

The Adjustable Gastric Band is a weight-loss procedure that involves the placement of a band around the upper portion of the stomach.
Remission of diabetes occurs in approximately 45-60 percent of patients. The remission or improvement of diabetes, however, is secondary to the weight-loss produced by the procedure, and there does not appear to be any other mechanism for diabetes improvement in band patients. In other words, patients who have diabetes and who are unsuccessful in losing weight with the AGB will unlikely see any improvement in the diabetes.

 

FAQs

How long after metabolic and bariatric surgery will I have to be out from work?

After surgery, most patients return to work in one or two weeks. You will have low energy for a while after surgery and may need to have some half days, or work every other day for your first week back. Your surgeon will give you clear instructions. Most jobs want you back in the workplace as soon as possible, even if you can’t perform ALL duties right away. Your safety and the safety of others are extremely important – low energy can be dangerous in some jobs.

Many patients are worried about getting hernias at incisions. That is almost never a problem from work or lifting. Hernias are more often the result of infection. You will not feel well if you do too much.

 

 

When can I start exercising again after surgery?

Right away! You will take gentle, short walks even while you are in the hospital. The key is to start slow. Listen to your body and your surgeon. If you lift weights or do sports, stay “low impact” for the first month (avoid competition, think participation). Build slowly over several weeks. If you swim, your wounds need to be healed over before you get back in the water.

Can I have laparoscopic surgery if I have had other abdominal surgery procedures in the past, or have a hernia, or have a stoma?

The general answer to this is yes. Make sure to tell your surgeon and anaesthesiologist about all prior operations, especially those on your abdomen and pelvis. Many of us forget childhood operations. It is best to avoid surprises!

Sometimes your surgeon may ask to see the operative report from complicated or unusual procedures, especially those on the oesophagus, stomach, or bowels.

 

Does type 2 diabetes make surgery riskier?

It can. Be sure to follow any instructions from your surgeon about managing your diabetes around the time of surgery. Almost everyone with Type 2 Diabetes sees big improvement or even complete remission after surgery. Some studies have even reported improvement of Type 1 Diabetes after bariatric procedures.

 

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