One of the most important causes of Type 2 diabetes, which usually occurs after the age of 40, is undoubtedly excess weight. The classical treatment method is aimed at improving the results of Type 2 diabetes, not the disease itself. Diabetes surgery treats the disease itself.
What is Diabetes Surgery?
Type 2 diabetes, which accounts for about 95 percent of all diabetes-related cases, is a chronic metabolic disorder that occurs when the body does not produce enough insulin or cannot use the insulin it produces effectively. Current treatment for type 2 diabetes includes lifestyle intervention and anti-diabetes medication. Whereas, diabetes surgery is a form of treatment for the permanent solution of diabetes. Diabetes surgeries performed keep the patient’s blood sugar level under control. With this treatment method, it is aimed that the patient continues his life without medication or being less dependent on drugs.
What is the difference between diabetes surgery and bariatric surgery?
Diabetes surgery, unlike bariatric surgery, focuses on controlling metabolic diseases, not just overweight. Our clinic also pioneers many treatments in the field of diabetes surgery.
What is Type 2 Diabetes?
It is a condition in which blood sugar rises due to the inability of the pancreas to secrete enough insulin. Obesity and physical inactivity, especially genetic predisposition, are among the factors that trigger Type 2 diabetes.
There are two causes of high blood sugar in type 2 diabetes. These are insulin secretion deficiency and insulin resistance. Insulin resistance is the condition in which there is enough insulin in the blood, but doesn’t effect. However untreated type2 diabetes affects various organs and tissues, including the heart, kidneys, and eyes.
Unfortunately all of the type 2 diabetes patients are not candidates for surgical treatment. A number of tests are required to determine whether patients will benefit from surgical treatment. Surgical treatment is decided by the team after evalution of results. If the results are suitable for the surgical treatment of diabetes, the patient is prepared for surgery. On the other hand, the duration of diabetes, BMI, the patient’s age, and the C-peptide levels are most important factors on succes of surgical treatment.
Purposes of Diabetes Surgery
Purpose of Diabetes Surgery is to increase the quality of daily life releiving joint pain, sexual and psychological problems. The advantages of diabetes surgery, especially in morbidly obese individuals, are as follows:
- Controlling diabetes with less or without medication by significantly lowering blood sugar levels
- Improving metabolic disorders such as hyperlipidemia, hypertension and sleep apnea,
- Reducing the possibility of cancer formation and prolonging life expectancy
- Improving erectil dysfunction according to the diabetes.
Although oral antidiabetic or insulin using, uncontrolled diabetes can be treated with diabetes surgery.
Our team help you make the right surgical procedure choice and pre and post operative dietary choices for them and provide the necessary psychological support for the clinical treatment process.
Type 2 Diabetes Surgery:
The combination of type 2 diabetes mellitus (T2DM) and obesity is increasing to epidemic proportions. Effective medical management of diabetes mellitus requires changes in lifestyle and diet, coupled with good compliance with medication regimens and close monitoring. However over time, pancreatic B cell function deteriorates and this may lead to increased requirement of medications and introduction of insulin based therapy.
Bariatric surgery performed as a treatment for morbid obesity is associated with improvements in blood glucose control and resolution of T2DM, along with significant weight loss. The mechanisms for these improvements are under investigation and include caloric restriction through behavioral and hormonal changes, alterations in gut hormone release and gastrointestinal physiology and through malabsorption. For non-obese patients with T2DM, the standard bariatric techniques may not be applicable, given that malabsorption and significant weight loss is not a desired or acceptable side effect in this patient group.
Mechanisms of Action: The anatomical modifications after diabetes surgery are thought to lead to resolution of T2DM through multiple actions, postulated in both foregut and hindgut theories. Changes occur in gut microbiota, bile acid absorption and gut hormone release. Increased post prandial glucagon like peptide-1 (GLP-1) release is thought to be a major factor responsible for the same.
What is Diabetes Surgery?
Sleeve gastrectomy removes 75% of the stomach resulting in a reduced capacity to eat and a reduced level of ghrelin, the hormone which causes hunger. Intestinal bypass involves joining the bottom part of the stomach (antrum) to the lower part of the small bowel (ileum).
This results in food bypassing part of the small intestine which causes a reduction in the absorption of fats, sugar and calories that are consumed. The amount of small bowel bypassed can be varied depending on the desired weight loss. And changes occur in gut microbiota, bile acid absorption and gut hormone release as mentioned above.
Selection of Patients:
The indications for diabetes surgery include
- Worsening T2DM of more than 1 year duration, with or without additional risk factors and comorbidities (microvascular or macrovascular complications)
- Diabetes with mild to moderate complications like nephropathy/retinopathy/nonhealing ulcers -Diabetes with strong family history of complications
- Poor glycemic control despite optimum medical management
- Age between 20 and 70 years -Stable weight for last 3 months (variation in weight less than 3 %) -BMI more than 30 kg/m2
- Fluctuating glycemic control with comorbidity despite good HbA1c levels
- Stimulated C-peptide level more than 1 ng/mL.
- Type 1 diabetes mellitus, latent autoimmune diabetes of adult (LADA) or maturity onset diabetes of the young (MODY) – through estimations of glutamic acid decarboxylase (GAD) antibody/islet cell antibody (ICA)/insulin auto-antibody (IAA2) and clinical course evaluation by the endocrinologists -Undetectable fasting C-peptide and stimulated C-peptide less than 1 ng/mL
- Positive urine ketones
- Coexisting severe hepatic, pulmonary, renal (glomerular filtration rate (GFR) less than 30 mL/min), cardiovascular, neurological and psychiatric diseases
Following the surgery, you will spend three days in the hospital and will be administered pain-controlling medications to keep you comfortable. For the first three weeks following your surgery, you will be kept on a liquid diet. The surgeon and dietician will give you a specific diet program and instructions to follow after this. It is important to drink plenty of fluids at least 2-3 liters throughout the day to avoid dehydration.