Bariatric Surgery - How It Can Prevent Type 2 Diabetes?

Diabetes is a serious health problem that affects millions throughout the world. It is a disorder that has almost no cure and can lead to serious problems related to vision, kidney failure, gangrene of the toes and feet, tingling numbness and loss of sensation in the lower extremities and many more. While currently available medication tries to regulate your blood sugar levels, it fails to control damage on various organs listed above in the long term. Furthermore insulin can lead to further weight gain and worsening of diabetes in the obese people.

Bariatric Surgery has now been recognised as a treatment option for the obese diabetics by most major diabetic associations across the world, the ADA (American Diabetic Association) the IDF (International Diabetes Federation) etc. 

So how exactly does Bariatric Surgery work?

Diabetes can be of three basic kinds;

1. Type 1 diabetes in which the pancreas produces no insulin and insulin requirement is mandatory.
2. Gestational Diabetes which occurs during pregnancy and usually disappears after it
3. Type 2 diabetes or adult onset diabetes that usually comes around middle age and is associated with weight again in atleast 80% of people. However type 2 Diabetes is now even seen in adolescence and is a cause for worry.

 Bariatric surgery proves to be most beneficial for obese patients with early Type 2 diabetes.

Insulin is produced by the beta cells of the pancreas to control glucose levels from the food we eat but fat cells are insulin resistant and do not allow insulin to act to its normal capacity therefore in a type 2 diabetic the pancreas produces more insulin but it never seems enough and eventually the pancreatic cells burn out. Another cause is that the liver in an obese individual has decreased insulin sensitivity further compounding the problem.

Bariatric Surgery firstly works by decreasing the calorie intake, this in turn leads to weight loss which also means fat loss so decreased insulin resistance, it also decreases fatty liver, NAFLD (Non Alcoholic Fatty Liver Disease) and this I turn improves liver insulin sensitivity.

• It further increases gut hormones like GLP1 and PYY good for the diabetics and decreases those hormones, which are not good for the diabetics.
• Bariatric surgery also exercises a control over cholesterol, blood pressure and triglyceride levels all of which along with high sugars can lead to higher incidence of a sudden heart attack (Acute Coronary Syndrome)
• Bariatric Surgery causes long term remission of the disease in type 2 diabetics decreasing damaging effects on the kidney, eyes and feet giving patients a chance to live better healthier lives with lesser complications.

What is a Bariatric surgery?

• Bariatric surgery doesn't refer to a single operative method. It involves a host of surgical procedures conducted on a person to rid him or her of obesity.
• It might include reduction of the size of your stomach, removal of a portion of the stomach, or even bypassing portions of the stomach and intestine.

The commonest Bariatric Surgeries performed are

• Laparoscopic Sleeve Gastrectomy: Where the stomach is converted into a thin tube of about 100 ml capacity producing early satiety. About 2/3rds of the stomach is surgically removed, removing a major part of the cells producing the hunger hormone ‘ghrelin’ thus decreasing craving for food.
• Gastric bypass surgery: This process involves dividing the stomach into a tiny pouch at the upper end of about 30 ml capacity and connecting it directly to the middle portion of small intestine thus bypassing about 90% of the stomach and the first part of the small intestine. The food you eat going directly from the top part of the stomach into the intestine.
• There are other surgeries as well that bypass major portions of the small
• Intestine but are usually reserved for extreme cases.

Do I need to take multivitamins and proteins for life after this surgery?

• Most Bariatric surgeries necessitate you to take multivitamins for life. Vit B12, Calcium and Iron being the common ones, one may also need Vit D supplements. This is necessary as your food intake comes down and some surgeries bypass absorptive areas of the stomach and small intestine.
• Protein supplementation may be needed in the early stages but not in the long term in most surgeries except in the extreme cases as recommended by your surgeon.

In case you have a concern or query you can always consult an expert & get answers to your questions!