Diabetes Surgery
Recommended By Physicians
Accross the globe
METABOLIC/DIABETIC SURGERY
In 2009 the American Society for Bariatric Surgery (ASBS) changed its name to the American Society for Metabolic and Bariatric Surgery (ASMBS) to promote information on the beneficial effects of surgeries for weight loss in treating metabolic diseases, especially Type 2 Diabetes Mellitus (T2DM).
Today, the term Metabolic Surgery is used to describe surgical procedures to treat metabolic diseases, especially, type 2 diabetes.
Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes.
A Joint Statement by International Diabetes Organizations….
FAQs
How does diabetes surgery help manage type 2 diabetes?
Bariatric surgery can improve blood sugar control, increase insulin sensitivity, and lead to significant weight loss, which collectively contribute to better management and sometimes remission of type 2 diabetes.
Who is a candidate for diabetes surgery?
Candidates typically include individuals with a BMI of 35 or higher with type 2 diabetes, especially when diabetes is not well-controlled with medication and lifestyle changes. Some surgeries are considered for individuals with a lower BMI if their diabetes is severe.
What are the common types of diabetes surgery?
- Gastric Bypass (Roux-en-Y): Creates a small stomach pouch and reroutes the small intestine, leading to hormonal changes that improve insulin sensitivity.
- Sleeve Gastrectomy: Removes a large portion of the stomach, reducing hunger and improving insulin sensitivity.
- Biliopancreatic Diversion with Duodenal Switch (BPD/DS): Involves significant stomach reduction and rerouting of the intestines, leading to dramatic weight loss and diabetes improvement.
- Metabolic/Bariatric Surgery: Tailored procedures targeting metabolic improvements specifically for diabetes, not just weight loss.
What are the benefits of diabetes surgery?
- Improved blood glucose control and reduced need for diabetes medications
- Potential remission of type 2 diabetes
- Reduced risk of diabetes-related complications, such as cardiovascular disease and neuropathy
- Overall improvement in quality of life and reduction in obesity-related conditions
What are the risks associated with diabetes surgery?
- Risks include surgical complications like infections, leaks in the gastrointestinal system, blood clots, and anesthesia-related issues.
- Long-term nutritional deficiencies may occur, requiring ongoing supplementation.
What is the success rate of diabetes remission after surgery?
Studies have shown that about 60-80% of patients experience remission of type 2 diabetes after surgery, particularly with gastric bypass and duodenal switch procedures.
How do I prepare for diabetes surgery?
Preparation includes medical evaluations, dietary changes, psychological assessment, and often participation in a pre-surgery weight loss program.
What tests or evaluations are required before surgery?
Common assessments include blood tests, heart evaluations, nutritional assessments, and screenings for any endocrine disorders.
Will I need to adjust my diabetes medications before surgery?
Yes, medication adjustments are often necessary under medical supervision to ensure safe glucose levels during the pre-operative phase.
What is the recovery time after diabetes surgery?
Recovery varies, but most patients return to normal activities within 3 to 6 weeks, with full adaptation to dietary changes taking longer.
What dietary changes are necessary after surgery?
Post-surgery, a progression from liquid to pureed to soft foods occurs, followed by a long-term commitment to a balanced, nutrient-rich diet with portion control.
Will I need to continue diabetes medications after surgery?
Many patients see a reduction or complete discontinuation of diabetes medications post-surgery, but this depends on individual outcomes and should be managed by a healthcare provider.
How often will I need to see my doctor after surgery?
Regular follow-up appointments are crucial, usually scheduled frequently within the first year, then annually to monitor weight, nutritional status, and diabetes control.
What long-term lifestyle changes are necessary after surgery?
Commitment to a healthy diet, regular physical activity, and possibly ongoing nutritional supplementation are essential for maintaining the benefits of surgery.
How does surgery affect other diabetes-related conditions?
Surgery often leads to improvement in conditions like high blood pressure, high cholesterol, and sleep apnea, which are common in individuals with type 2 diabetes.
Can diabetes return after surgery?
While many patients experience long-term remission, some may see a recurrence of diabetes, particularly if significant weight is regained.
Is diabetes surgery reversible?
Some procedures, like adjustable gastric banding, are reversible. However, others, such as gastric bypass or sleeve gastrectomy, are typically not reversible.
What psychological support is available for patients undergoing diabetes surgery?
Psychological counseling and support groups are often recommended to help patients adjust to lifestyle changes and manage the emotional aspects of surgery and weight loss.
TYPES OF METABOLIC SURGERIES
- Loop Duodenojejunal Bypass With Sleeve Gastrectomy
- Laparoscopic Roux-En-Y Gastric Bypass (Metabolic)
- Sleeve Gastrectomy With Proximal Jejunal Bypass
- Ileal Interposition With Sleeve Gastrectomy
Loop duodenojejunal bypass with sleeve Gastrectomy (LDJB-SG) was started to achieve Type 2 diabetes remission and to avoid the drawbacks of RYGB. It is safe, feasible, and shows good efficacy in terms of glycemic control or long term remission of type 2 diabetes, due to several hormonal changes such as reduced ghrelin,increased GLPI and peptide YY. Adding intestinal diversion to sleeve increases its efficacy and reduces problem related with gastric bypass.Bilio-pancreatic diversion with duodenal switch is the most effective metabolic surgery since hormonal changes are maximum.
FAQs
How metabolic surgery causes diabetes remission?
LDJB-SG causes neuro-hormonal and absorption changes, which result in long-term control of diabetes.
Sleeve gastrectomy causes caloric restriction and suppresses the anti-insulin effect of ghrelin hormone. Removal of body of stomach alters gastric empting, causing early satiety and also changes energy balance. Reduced appetite, improved satiety, increased energy expenditure and resetting the “set point for food storage” to a lower level result in long-term control of diabetes.
Exclusion of the proximal intestine suppresses the anti-incretin hormones, which are stimulated by presence of food in the duodenum. Swifter delivery of food to the distal intestine stimulates the secretion of incretins like GLP-1 and peptide YY. GLP-1 increases the insulin secretion by enhancing the function of insulin producing beta cells in pancreas.
For metabolic surgery patients are properly screened and surgery is recommend only for patients with uncontrolled Type 2 diabetes on Insulin therapy with C-peptide >1, HbA1c > 7 and BMI > 27.5. Though, metabolic surgery is cost effective, it has minimal complications and mortality. The future of complete remission of diabetes lies in metabolic surgery.
Can the surgery cause hypoglycemia (low blood sugar)?
After the operation, as in every normal human, insulin will increase after eating. The possibility for hypoglycemia occurrence will decrease continuously and be eliminated during the period after the operation.
Is this pancreas surgery?
No. The performed processes are basically a displacement process performed in the small intestine. In addition to this, in situations where it is deemed necessary deemed (depending on the disease level, the hormone levels in the blood and the activity of these hormones), required surgical operations regarding the stomach volume, stomach form and the fatty tissues wrapping the organs in the abdomen are performed.
Will I need to take supplements after metabolic surgery?
To avoid long term micro nutrient deficiency, it is advisable to take regular supplements.
Laparoscopic roux-en-Y Gastric Bypass (Metabolic) is a reversible weight loss procedure that reduces the size of your stomach to a small 30cc pouch and making food bypass the beginning of the small intestine. This reduces your appetite and makes you feel satiated with smaller portions. LRYGB can help you lose up to 60 – 80% of your excess weight in a period of approximately 2 years.
For more information
LRYGB is a mixed restrictive & malabsorptive procedure. In this procedure, special stapling instruments are used to separate about 10% of the stomach to create a new small 30 cc gastric pouch. The remaining stomach is not removed. The outlet from this newly formed gastric pouch is connected to the small intestine (Alimentary limb) so that food empties directly into the lower portion of the intestine (Small Intestine Common Channel) bypassing the stomach. Digestive juices produced by the stomach, pancreas, gall bladder and duodenum are directed by the Billio-Pancreatic Limb back into the common channel in a “Y” shape hookup that gives the technique its name (Roux-en-Y Gastric Bypass). The small gastric pouch causes patients to feel full sooner and eat less (restriction); bypassing a portion of the intestine means the patient’s body absorbs fewer calories (malabsorption).
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FAQs
How metabolic surgery causes diabetes remission?
LDJB-SG causes neuro-hormonal and absorption changes, which result in long-term control of diabetes.
Sleeve gastrectomy causes caloric restriction and suppresses the anti-insulin effect of ghrelin hormone. Removal of body of stomach alters gastric empting, causing early satiety and also changes energy balance. Reduced appetite, improved satiety, increased energy expenditure and resetting the “set point for food storage” to a lower level result in long-term control of diabetes.
Exclusion of the proximal intestine suppresses the anti-incretin hormones, which are stimulated by presence of food in the duodenum. Swifter delivery of food to the distal intestine stimulates the secretion of incretins like GLP-1 and peptide YY. GLP-1 increases the insulin secretion by enhancing the function of insulin producing beta cells in pancreas.
For metabolic surgery patients are properly screened and surgery is recommend only for patients with uncontrolled Type 2 diabetes on Insulin therapy with C-peptide >1, HbA1c > 7 and BMI > 27.5. Though, metabolic surgery is cost effective, it has minimal complications and mortality. The future of complete remission of diabetes lies in metabolic surgery.
Can the surgery cause hypoglycemia (low blood sugar)?
After the operation, as in every normal human, insulin will increase after eating. The possibility for hypoglycemia occurrence will decrease continuously and be eliminated during the period after the operation.
Is this pancreas surgery?
No. The performed processes are basically a displacement process performed in the small intestine. In addition to this, in situations where it is deemed necessary deemed (depending on the disease level, the hormone levels in the blood and the activity of these hormones), required surgical operations regarding the stomach volume, stomach form and the fatty tissues wrapping the organs in the abdomen are performed.
Will I need to take supplements after metabolic surgery?
To avoid long term micro nutrient deficiency, it is advisable to take regular supplements.
Sleeve Gastrectomy with proximal jejunal bypass
In this process bypassing a short segment of proximal intestine directly ameliorates type 2 diabetes, independently of effects on food intake, body weight, malabsorption, or nutrient delivery to the hindgut. These findings suggest that a proximal intestinal bypass could be considered for diabetes treatment and that potentially undiscovered factors from the proximal bowel might contribute to the pathophysiology of type 2 diabetes.
FAQs
How metabolic surgery causes diabetes remission?
LDJB-SG causes neuro-hormonal and absorption changes, which result in long-term control of diabetes.
Sleeve gastrectomy causes caloric restriction and suppresses the anti-insulin effect of ghrelin hormone. Removal of body of stomach alters gastric empting, causing early satiety and also changes energy balance. Reduced appetite, improved satiety, increased energy expenditure and resetting the “set point for food storage” to a lower level result in long-term control of diabetes.
Exclusion of the proximal intestine suppresses the anti-incretin hormones, which are stimulated by presence of food in the duodenum. Swifter delivery of food to the distal intestine stimulates the secretion of incretins like GLP-1 and peptide YY. GLP-1 increases the insulin secretion by enhancing the function of insulin producing beta cells in pancreas.
For metabolic surgery patients are properly screened and surgery is recommend only for patients with uncontrolled Type 2 diabetes on Insulin therapy with C-peptide >1, HbA1c > 7 and BMI > 27.5. Though, metabolic surgery is cost effective, it has minimal complications and mortality. The future of complete remission of diabetes lies in metabolic surgery.
Can the surgery cause hypoglycemia (low blood sugar)?
After the operation, as in every normal human, insulin will increase after eating. The possibility for hypoglycemia occurrence will decrease continuously and be eliminated during the period after the operation.
Is this pancreas surgery?
No. The performed processes are basically a displacement process performed in the small intestine. In addition to this, in situations where it is deemed necessary deemed (depending on the disease level, the hormone levels in the blood and the activity of these hormones), required surgical operations regarding the stomach volume, stomach form and the fatty tissues wrapping the organs in the abdomen are performed.
Will I need to take supplements after metabolic surgery?
To avoid long term micro nutrient deficiency, it is advisable to take regular supplements.
Ileal Interposition is a laparoscopic operation for control of Type-2 Diabetes in which a long segment of last part of small bowel (Ileum) is cut & joined very close to the stomach. This results in several hormonal changes such as reduced Ghrelin, increased GLP1 and Peptide YY. These hormonal changes results in resolution or long term remission of type 2 diabetes (T2D). Undigested food now first enters Ileum to stimulate increased secretion of incretin (gut) hormone called GLP-1, which stimulates beta cells in pancreas to secrete increase amounts of insulin, provided enough Beta Cell mass is still present in pancreas. Persistent increased GLP-1 secretion increases Beta Cell mass in the long term.
Advantage:
- Operation for control of Type-2 diabetes even with normal BMI (Non obese patients)
Disadvantage:
- There is slight risk of vitamin and mineral deficiencies.
FAQs
How metabolic surgery causes diabetes remission?
LDJB-SG causes neuro-hormonal and absorption changes, which result in long-term control of diabetes.
Sleeve gastrectomy causes caloric restriction and suppresses the anti-insulin effect of ghrelin hormone. Removal of body of stomach alters gastric empting, causing early satiety and also changes energy balance. Reduced appetite, improved satiety, increased energy expenditure and resetting the “set point for food storage” to a lower level result in long-term control of diabetes.
Exclusion of the proximal intestine suppresses the anti-incretin hormones, which are stimulated by presence of food in the duodenum. Swifter delivery of food to the distal intestine stimulates the secretion of incretins like GLP-1 and peptide YY. GLP-1 increases the insulin secretion by enhancing the function of insulin producing beta cells in pancreas.
For metabolic surgery patients are properly screened and surgery is recommend only for patients with uncontrolled Type 2 diabetes on Insulin therapy with C-peptide >1, HbA1c > 7 and BMI > 27.5. Though, metabolic surgery is cost effective, it has minimal complications and mortality. The future of complete remission of diabetes lies in metabolic surgery.
Can the surgery cause hypoglycemia (low blood sugar)?
After the operation, as in every normal human, insulin will increase after eating. The possibility for hypoglycemia occurrence will decrease continuously and be eliminated during the period after the operation.
Is this pancreas surgery?
No. The performed processes are basically a displacement process performed in the small intestine. In addition to this, in situations where it is deemed necessary deemed (depending on the disease level, the hormone levels in the blood and the activity of these hormones), required surgical operations regarding the stomach volume, stomach form and the fatty tissues wrapping the organs in the abdomen are performed.
Will I need to take supplements after metabolic surgery?
To avoid long term micro nutrient deficiency, it is advisable to take regular supplements.
