Weight Loss Surgery & Type 2 Diabetes
Type 2 Diabetes Prevention Week runs from the 23rd – 29th May this year and with approximately 13.6 million people at risk of Type 2 Diabetes in the UK, it seems an apt time to speak in more detail about this condition and the preventative impact that weight loss surgery can have.
Type 2 diabetes mellitus (T2DM) is a metabolic disorder that results in hyperglycemia (high blood glucose levels) due to an inability to use the insulin produced by the pancreas effectively. This is also known as insulin resistance.
Type 2 diabetes used to be known as non-insulin dependent or adult onset diabetes and mainly occurred in adults over forty years old. Type 2 diabetes is closely associated with obesity and as obesity levels rise, diabetes is becoming much more common now affecting teens and children too.
Obesity and Type 2 Diabetes
Being overweight or obese is the key risk factors for the onset of type 2 diabetes. In England, obese adults are five times more likely to be diagnosed with diabetes than adults of a healthy weight. 90% of adults with type 2 diabetes are overweight or obese. If the current trajectory for obesity levels continues it is estimated that 1 in 10 people will be diabetic by 2035
With increasing obesity, the illness becomes more difficult to control with complications of the illness occurring which can be life limiting with patients needing multiple medications, including insulin to try to control blood sugar. But in many patients control remains poor, increasing the risk of blindness, sepsis, heart disease, neuropathy and arterial disease that can causes toes and limbs to become gangrenous
What is the link between obesity and Type 2 Diabetes?
It is now known that obesity causes many of the body’s metabolic processes to malfunction. This leads to a number of metabolic problems such as diabetes, high cholesterol, fatty liver and many others. The most damaging condition is usually type 2 diabetes, which acts with the other conditions to damage blood vessels to vital organs like the heart, kidneys and eyes.
Theories of why obesity may lead to type 2 diabetes include:
- Abdominal obesity may cause fat cells to release pro-inflammatory chemicals. These chemicals can make the body less sensitive to insulin it by disrupting the function of insulin responsive cells.
- Obesity may trigger changes to the body’s metabolism that cause adipose (fat) tissue to release increased amounts of fatty acids, glycerol, hormones, proinflammatory cytokines and other factors that are involved in the development of insulin resistance.
Bariatric Surgery & Type 2 Diabetes
Bariatric Surgery is of course a very effective way of losing weight. However, as stated by Diabetes.org.uk, in cases of Type 2 Diabetes, the impact of bariatric surgery extends far beyond just weight loss., such that it is being rebranded by obesity experts as metabolic surgery.
Its effect on metabolic illnesses such as diabetes, fatty liver, raised blood pressure and cholesterol occurs independently of weight loss, with for some patients their diabetes going into remission before they have even left hospital.
Bariatric surgery is now seen as an effective treatment for type 2 diabetes, with the weight loss being a bonus. The surgery helps the body to produce and use insulin more efficiently and effectively.
In a long-term study which tracked 400 people with type 2 diabetes, six years after bariatric surgery, 62% showed no signs of diabetes, with complete remission of the illness. They also had better blood pressure, cholesterol, and triglyceride levels.
How does Bariatric Surgery help Type 2 Diabetes?
Bariatric surgery changes the way the digestive system works, in ways that are beneficial for people with type 2 diabetes. It can:
- make you feel full more quickly, which means you eat less
- change how the hormones in your gut work, which in turn affects how your body makes insulin
- increase the amount of bile acids that your body makes – these make your body more sensitive to insulin
- Improve the way your body uses insulin, leading to lower blood sugar levels.
Types of Bariatric Surgery
The gastric band, the gastric sleeve and the gastric bypass will all help patients to lose weight, but because of an additional gut hormone mediated metabolic effect the gastric sleeve and the gastric bypass are the most effective procedures for type 2 diabetes
A gastric band is an adjustable plastic ring, known as a Lap-Band, that is placed around the top of the stomach, with a very small pouch of the stomach above it. The band is connected to an access port that is placed under the skin of the abdominal wall. This is used to adjust the gastric band.
The gastric band is the least invasive and safest weight loss procedures that has been widely used for over 35 years. Often a Gastric band surgery can be carried out as a day-case.
Once the gastric band has healed in place, the tightness can be adjusted. Saline is injected into the access port to adjust the pressure being applied by the gastric band. By increasing the pressure on the upper stomach it creates a feeling of fullness resulting in a reduction of appetite and weight loss.
The Gastric Sleeve (also known as a sleeve gastrectomy) is an operation which removes about 80% of the stomach. Transforming your stomach from an expandable food reservoir the size of a large grapefruit to a narrow tube the size of a small banana.
The Gastric Sleeve reduces your stomach size, limiting the amount you can eat. It also changes the way your stomach senses and regulates appetite, so you’ll feel full more quickly. Unlike a diet, there isn’t a constant fight against hunger.
A gastric bypass works by creating a narrow pouch from the upper stomach, which is then connected to your small bowel. The food then bypasses the majority of your stomach.
There are several variations of bypass, for example, you may have heard about the mini gastric or loop bypass. Unlike the traditional Gastric bypass, that has two joins between the stomach and the bowel, with a mini (single anastomosis) gastric bypass the pouch is joined directly to a loop of small intestine.
After a Gastric bypass it is difficult to eat quickly or eat too much, reducing portion sizes and requiring you to eat more slowly. There is an additional hormonal effect, that makes you feel less hungry and more easily satisfied with a small portion of food.
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