For people with type 2 diabetes, weight loss surgery can lead to great improvements, and in some patients who undergo surgery, blood sugar levels return to normal and diabetes is treated, which means that patients can reduce or even stop taking their medications.
Studies have shown that people with type 2 diabetes can improve after weight loss surgery, and in a long-term study that followed 400 people with type 2 diabetes, 62% of patients did not have a recurrence of diabetes symptoms 6 years after undergoing weight loss surgery. In addition, patients’ blood pressure, cholesterol, and triglyceride levels improved, compared with only 6 to 8 percent of patients who took medication but did not undergo surgery, who achieved similar results.
If you are considering weight loss surgery and are ready to treat your diabetes with surgery, then you will want to know if this procedure is right for you.
Is the patient a good candidate for the procedure?
First, your doctor will consider two things:
- Does the patient have a body mass index (BMI) of 35 and above?
- Has the patient tried to lose weight?
- Has the patient tried to lose weight and maintain it, but was unsuccessful?
If the answer is yes, the physician will perform a detailed examination and ask questions to confirm that the patient is physically and psychologically ready for surgery and to determine which areas of the patient’s life need the most improvement and that the patient needs to significantly reduce the amount of food eaten and maintain a healthy diet and exercise for life.
Depending on the patient’s specific situation, other physicians may also be involved in the surgical decision; for example, cardiac patients need permission from their cardiologist to undergo weight loss surgery.
Types of bariatric surgery
There are many types of weight loss surgery, from those that reduce the amount of food eaten and increase satiety to achieve weight loss by shrinking the stomach, to those that change the way the body absorbs calories, nutrients, and vitamins, to those that combine the two.
Learn about each type of surgery:
Gastric bypass
This type of surgery involves separating the upper part of the stomach from the rest of the body to create a small gastric sac, and when the patient eats, food goes into the small sac and bypasses the upper part of the small intestine.
Effect: Patients will feel fuller more easily and will also absorb fewer calories and less energy.
Gastric reduction surgery (sleeve gastrectomy)
This surgery cuts out most of the stomach, making it easier for patients to feel full because there is less room for food, and it also reduces the amount of gastric growth hormone-releasing hormone (the hormone that triggers hunger) that is produced.
- Benefit: More than 60% of patients lose their diabetes symptoms after surgery. In addition, patients typically lose 50% of their extra weight after surgery.
- Downside: The procedure is not reversible, and in addition, the patient’s body absorbs fewer vitamins and minerals, which can lead to health problems.
Adjustable gastric banding
The procedure will tie an adjustable band around the upper part of the stomach so that a small sac is created for food to pass through, and the sac will fill up quickly, so the patient will feel fuller more easily.
- Benefits: The surgeon does not have to remove the stomach or move the small intestine as in other surgeries, so there are fewer complications with this procedure.
- Disadvantages: Sometimes there are problems with the band, and it can slip or wear off, in which case a repeat procedure is needed to secure the band, and the procedure is slightly less effective than other procedures for weight loss (about 40% to 50% weight loss).
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There is also a type of gastric banding called “vertical banding gastroplasty” that is less commonly used today because new, more effective procedures have been developed.
Biliopancreatic shunt with duodenal transposition
This is the most complex and therefore less commonly performed procedure, in which the surgeon removes most of the stomach and alters the path of food transit to the small intestine.
- Benefits: It is the most effective procedure for people with diabetes, and patients typically lose 60 to 70 percent of their excess weight after surgery.
- Disadvantages: The procedure has a high complication rate, patients have to stay in the hospital for many days after the procedure to recover, and it is most likely to cause health problems because it is harder for patients to digest food and absorb calories than other procedures.
Like any major surgery, all bariatric surgery (also known as “metabolic and bariatric surgery”) carries risks, including bleeding, infection, and leakage of digestive contents through the surgical incision.
Electronic device implantation
The procedure implants an electronic device under the skin of the abdomen that helps control signals in the vagus nerve that connect the stomach to the brain to reduce hunger.
- Benefits: The implantation of the device is a minor procedure and can be easily removed once the weight loss goal is achieved, plus the device can be remotely controlled.
- Cons: Patients may experience pain, heartburn, difficulty swallowing, belching, nausea, and chest pain.
Post-op
The best way to maintain weight loss results is to stick to a diet and exercise plan.
Patients must eat small meals, consuming half a cup to a cup of vegetables and protein-rich foods with lean meat, fish, beans, low-fat cheese and yogurt at each meal.
In the process of improving dietary habits, especially if the patient is not absorbing nutrients as well as before surgery, it is best for the patient to work with a dietitian to make sure the patient is consuming adequate amounts of the various vitamins and minerals needed.
After significant postoperative weight loss, patients may consider undergoing reconstructive surgery to improve loose skin, which is a separate procedure from weight loss surgery, and the patient and physician may consider whether reconstructive surgery is needed.