CAN WEIGHT LOSS SURGERY HELP TREAT TYPE 2 DIABETES? A DETAILED GUIDE

The first thing a health professional would tell a person who has just been diagnosed with type 2 diabetes is to change their diet and shed some weight. Although weight loss does not permanently cure or prevent other health-related complications, it goes a long way in managing the disease.

With medical advancements, certain procedures can now stop diabetes from progressing and even reverse its effects. One of these is weight loss surgery. Obesity is a major predisposing factor to type 2 diabetes. Hence, losing some excess weight helps manage the disease. However, it is not as easy as it sounds, especially when significant weight loss is necessary for an overweight or obese patient.

Weight loss surgery is a faster method to lose weight without going through strenuous lifestyle changes. But popular opinion has it that surgery is an extreme option to shed a few pounds. So, is it worth the risk, and is it effective in treating type 2 diabetes? As you read on, we will answer this question and many more.

Weight Loss Surgery and Diabetes

Diabetes is a medical condition characterized by very high blood sugar or glucose levels due to insulin resistance or insufficient insulin production. Insulin is produced by the pancreas. It is a hormone that regulates blood sugar levels by transporting sugar into cells where energy is produced and released.

In overweight individuals, insulin resistance develops due to increased levels of certain hormones and substances. So if there is insufficient insulin secreted, type 2 diabetes develops. This condition presents symptoms such as frequent urination, increased thirst and hunger, slow-healing sores, numbness in hands and feet, and fatigue. It could also lead to other serious health problems affecting the brain (stroke), heart, kidney failure, and even the eyes.

Weight loss surgery is a series of surgical procedures that help the body lose weight by altering parts of the digestive system. Also known as Bariatric surgery, the procedure surgically reduces the size of the stomach to accommodate less food and also adjusts the small intestine to absorb less food. Bariatric surgery can also lead to the release of hormones that help regulate appetite and curb overeating. This is why it is done on individuals with obesity and diabetes who need to lose weight so that the level of insulin resistance in their bodies can be reduced.

How Does Surgery Help Type 2 Diabetes Patients?

There are several body functions this surgery helps in relation to type 2 diabetes; some of them are:

• Increasing fat metabolism
• Increasing insulin utilization in the body
• Improving cholesterol levels
• Regulating high blood pressure
• Improving heart and kidney functioning

Is Weight Loss Surgery a Permanent Cure for Type 2 Diabetes?

Given an option, no one wants to be on medications for the rest of their lives. Hence, a treatment method that eliminates the need for medicine or lessens the use of it with time might be considered.

Weight loss surgery is one of those options, but it does not cure diabetes. It only sends patients into remission, where they would no longer have to take drugs to regulate their blood sugar levels as their bodies will do so independently.

Types of Weight Loss Surgery for Type 2 Diabetes

There are four prominent procedures in weight loss surgery, and research has found them helpful in regulating blood sugar levels. They all aim to alter different sections of the digestive system, especially the stomach, so it only accommodates less food, and the body cannot absorb as many calories as before. It is important to note that they are not designed to remove fat from different body parts like liposuction.

The four different types are described below:

Roux-en-Y Gastric Bypass

This is a permanent procedure where the surgeon creates a small pouch from the upper part of the stomach. In order to prevent ingested food from passing through the lower portion of the stomach and the upper section of the small intestine, the pouch is attached directly to the lower end of the small intestine.

This pouch is way smaller than the stomach, making it unable to hold as much food. So the fewer calories absorbed into the body, the lower the blood glucose level.

Laparoscopic Adjustable Gastric Banding

This surgery involves making small incisions in the abdominal region to insert a laparoscope. Then, a band is used on the upper part of the stomach to create a pouch. With this procedure, food digestion and absorption are the same, but it reduces weight and blood sugar with time.

Laparoscopic Sleeve Gastrectomy

This is easier to carry out than a gastric bypass as it requires a shorter time. It involves removing 80% of the stomach, leaving behind a long pouch. This procedure results in changes in the gut hormones, which reduce hunger, the amount of food consumed, and, in effect, blood sugar.

Biliopancreatic Diversion with Duodenal Switch Gastric Bypass

In this surgery, a small pouch shaped like a banana is formed by removing a part of the stomach. Then, its upper part is divided to bypass most of the small intestine. At the last stage of this surgery, the bypassed part responsible for transporting enzymes for fat absorption is reattached to the last segment of the small intestine. 

This procedure is the most effective for reducing high blood sugar levels and weight loss. The bypass increases the production of some gut hormones, stimulating your pancreas to produce more insulin.

When Is Bariatric Surgery Recommended for Patients?

When it comes to losing weight, surgery should be the last option. This is why medical practitioners always advise their patients to make changes in their diet first, exercise regularly, and sometimes prescribe drugs as conservative approaches. If there is little to no improvement after attempting these measures, bariatric surgery can be recommended.

This procedure is done mainly on obese patients who have been unable to lose weight despite making a conscious effort. Weight loss surgery can also be recommended in severe cases of type 2 Diabetes or metabolic syndrome when a healthy weight cannot be attained even with diet under medical supervision.

Who Is Eligible for Weight Loss Surgery?

Evaluation is done to screen and assess those eligible for this type of surgery, as it is not indicated for just anyone perceived to be overweight. One of the main criteria used to determine the eligibility of patients is the Body Mass Index (BMI). Its value can be obtained using a BMI calculator tool.

The following are situations where an individual is typically eligible:

• The BMI of the individual is greater than 40, even when their condition is being managed effectively
• If the BMI is between 35 to 39.9 and the condition is not well managed with medications
• If the BMI falls in the 30 to 34.9 range and there is poor management with drugs and other co-occurring health-related conditions
• If you weigh over 100 lbs. above your ideal weight

If an individual does not fit the above criteria, weight loss surgery might not produce the desired result or even treat diabetes.

It is also important to note that an individual with any of the following conditions should not have weight loss surgery:

• Serious heart, liver, or lung disease
• A recent history of heart attack or stroke
• Any inflammatory condition of the digestive tract
• Previous bowel surgery or trauma to the abdominal region
• Allergy to any medication or material to be used during the surgery
• Cancer
• Inflammation of the pancreas
• Substance use disorder

Risks and Side Effects of Weight Loss Surgery

As with any surgical procedure, risks and side effects are involved with weight loss surgery. So before opting for it, it is best to be familiar with the pros and cons.

Weight loss surgery carries the following risks:

• Infections
• Damage to surrounding organs
• Bleeding
• Peritonitis - inflammation of the abdominal lining
• Malnutrition
• Death

The side effects of this surgery also include:

• Dumping syndrome
• Bleeding on the surgery site
• Blood clotting
• Hernias
• Anemia
• Formation of gallstones and kidney stones

How to Prepare for Bariatric Surgery

There is a due process that should be followed before undergoing bariatric surgery. First, you will be put on a diet under medical supervision and get the proper diet sensitization for six months before the procedure. You should avoid carbonated drinks and high-sugar and high-fat foods during this period.

You will also be placed on a high-protein, low-sugar diet two weeks before the surgery with lots of fluids and vitamin supplements for nutrition. During this period, there is also the risk of hypoglycemia, especially when diabetes medications are used while on the diet. Hence, speaking with your doctor and having A1C tests done at regular intervals daily is vital.

Aftercare Routine for Bariatric Surgery

Follow-up visits are essential after the surgery. They must be done to check if the individual’s weight is reducing and test for nutritional deficiencies to know how to bridge the gap. It is also crucial to do thorough checks from time to time so the doctor can rule out any complications that might develop post-surgery. Also, as your health condition improves, you might need to adjust your supplements and medications. 

There is still a need to engage in regular physical activities and maintain a healthy, low-calorie diet to see expected and enduring results. In fact, for a while, you might have to persist with the diet that you followed for the six months before the surgery to prevent diabetes from recurring. Carbohydrates and fatty food should be reduced to a minimum while eating balanced meals in small portions.

Other Weight Loss Options to Consider Before Bariatric Surgery

After reading all the risks and implications of this surgical procedure, you might want to consider other alternatives before resorting to bariatric surgery. The other weight loss options include:

Use of Medications

Several medicines formulated for insulin therapy also help with weight loss. Your doctor can prescribe any of these anti-obesity drugs for you. However, it is essential to note that certain diabetes medications also have weight gain as one of their side effects. So, you must be careful when choosing any of these drugs.

Minimally Invasive Devices

Using minimally invasive devices is also an alternative to going under the knife. However, these devices have not been approved as a standard mode of treatment for treating diabetes and obesity in people. One of these devices is an intragastric balloon placed in the stomach through a capsule. This balloon is filled with either gas or saline and then is sealed to take up space in the stomach to delay gastric emptying.

Another is an electric device implanted right beneath the skin of the abdomen. This device sends signals to nerves controlling the stomach and brain to reduce the feeling of hunger.

Use of Superabsorbent Hydrogel Capsules

This weight loss treatment option involves consuming a small gelatin capsule containing hydrogel made from citric acid and cellulose. The capsule absorbs fluid in the stomach and then occupies space, thereby giving the feeling of being full.

Conclusion

In many patients, bariatric surgery has been shown to help with weight loss and improvement or remission of type 2 diabetes. However, weight loss surgery is mainly the last resort to help obese or overweight individuals due to what it entails; after all, no one would voluntarily want parts of their stomach taped off.

Your doctor might even advise you against it due to the risks involved. If you end up settling for this surgery, be ready to commit to a lifetime of dietary change, regular exercise, and routine checks from time to time.

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References:

• https://www.medicalnewstoday.com/articles/bariatric-surgery-type-2-diabetes
• https://www.scripps.org/news_items/4112-can-bariatric-surgery-treat-type-2-diabetes
• https://www.everydayhealth.com/type-2-diabetes/bariatric-surgery-type-2-diabetes/
• https://www.lancastergeneralhealth.org/health-hub-home/2022/august/weight-loss-surgery-can-help-type-2-diabetes
• https://my.clevelandclinic.org/health/treatments/21153-bariatric-weight-loss-surgery-for-treating-diabetes
• https://www.templehealth.org/about/blog/how-bariatric-surgery-can-reverse-type-2-diabetes
• https://www.webmd.com/diabetes/weight-loss-surgery-and-type-2-diabetes
• https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/treating-your-diabetes/weight-loss-surgery

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