1.How does surgery lower blood sugar? ”Diabetes surgery”, in fact, refers to the surgery that can improve the metabolic function of the body. In the 1980s, some doctors found that after obese patients received bariatric surgery, their blood sugar level was also well controlled while their weight was significantly reduced. Subsequently, after many studies and demonstrations, diabetes surgery was gradually used in clinical practice. Specifically, this type of surgery is generally referred to as “gastric reduction” surgery, which is a surgical method to reduce the volume of the stomach or change the direction of the intestine, thereby reducing the digestion and absorption of food, and through the reduction of body weight, inducing changes in gastrointestinal hormones, increasing insulin sensitivity, and ultimately achieving the effect of lowering blood sugar. Surgery for diabetes is the fourth diabetes treatment after lifestyle changes, oral medications and insulin therapy, and studies in recent years have found that it can bring very significant benefits to patients with very clear indications. However, this surgery should not be followed blindly, but should be chosen carefully according to your condition to determine whether you need surgery. When it comes to diabetes treatment, we will first think of diet control, exercise, glucose-lowering drugs and insulin. However, for some diabetic patients, the remission rate of traditional treatment is not high, and the symptoms cannot be well controlled. For example, in some patients with severe obesity, even if they have taken a high dose of insulin or have used three or four drugs in combination with glucose-lowering therapy, their blood sugar is still not well controlled. In addition, diabetes usually goes hand in hand with obesity. “It is easy to become a roadblock and a bottleneck in the treatment process, which is both painful for the patient and difficult for the doctor. At this time, through surgery, on the one hand, the patient can end the “painful” weight loss process, increase confidence in treatment, to avoid the adverse consequences of blind food restriction and fasting for weight loss; on the other hand, also for the doctor to actively carry out glucose-lowering treatment to remove the obstacles, and often receive a multi-benefit effect. 3, which sugar lovers can be operated In March 2011, the International Diabetes Federation issued a statement recognizing bariatric surgery as one of the measures for the treatment of type 2 diabetes, and recommending that patients eligible for surgery should consider undergoing surgery as early as possible. However, special attention should be paid to the fact that diabetes surgery is only suitable for some patients. In the same year, the Chinese Medical Association Diabetes Branch and the Chinese Medical Association Surgery Branch jointly issued the Expert Consensus on Surgery for Diabetes (hereinafter referred to as the Consensus), which clarified the indications for surgery suitable for Chinese patients, mainly including: (1) Patients with type 2 diabetes whose body mass index (BMI, i.e., weight in kilograms divided by the square of height in meters) is ≥35; (2) Patients with BMI between 30 and 35, whose lifestyle and pharmacologic therapy have difficulty controlling blood glucose or complications, especially patients with high risk factors for cardiovascular disease; (3) patients with BMI of 28 to 29.9 and centripetal obesity (waist circumference >85 cm for women and >90 cm for men) who meet at least two criteria for metabolic syndrome (high triglycerides, low HDL cholesterol levels, and high blood pressure); (4) patients with BMI ≥40 or BMI ≥35 but with severe comorbidities and adolescents ≥ 15 years of age with mature skeletal development; 5. Patients under 60 years of age who are in good health and have low surgical risk. Simply put, patients suitable for surgery, the first to be young, the age of the best less than 60 years, not more than 65 years old, and the history of disease within 10 years, more than 15 years will not consider surgery; second must be very obese patients; third to meet the indications, and drug treatment is not effective. 4, which cases do not surgery surgery for diabetes is not suitable for everyone, the “consensus” pointed out in the surgical treatment of contraindications include: patients abuse drugs, alcohol addiction, or suffer from mental illness; patients with a clear diagnosis of type 1 diabetes; patients with type 2 diabetes who have basically lost islet function; combined bleeding disorders or coagulation abnormalities, or cardiopulmonary function can not tolerate surgery; BMI28 and drug Patients with a BMI of 28 and satisfactory control of blood glucose with medication or insulin therapy; patients with gestational diabetes and other special types of diabetes. Therefore, it is important for patients to be examined in the hospital and evaluated by a specialist to determine if the procedure can be performed and how it can be performed. The key principle of selection is to follow the Consensus. Patients who do not meet the indications for surgery or have clear contraindications should not blindly follow the trend. 5, how to do sugar surgery Currently, there are three main methods to treat type 2 diabetes through bariatric surgery. The first is “gastric banding surgery”, which uses an adjustable band tied to the upper part of the stomach to reduce the volume of the stomach. The patient eats less and loses weight. However, this procedure is generally effective and is less commonly used today. The second type is “sleeve gastric surgery”, which is to cut off all the large curves of the stomach, turning the stomach into a tube lumen of the intestine like a sleeve, so that the amount of food is greatly reduced, suitable for patients with simple obesity and early diabetes. The third type is “gastric diversion surgery”, that is, the stomach and small intestine “short circuit”, food does not pass through the duodenum but directly into the lower and middle jejunum. This procedure has the best effect on weight loss and the remission rate of diabetes is about 90%, but the surgery is relatively complicated and the risk is relatively high. 6. How to choose the timing of surgery Generally speaking, patients should start to control their condition by regulating diet and exercise, and then consider medication, and when the above treatment is not effective, surgery can be considered. Of course, the timing of surgery should not be too late. For patients with clear indications, the earlier the surgery, the better. Do not have type 2 diabetes for more than 15 years, and the islet function cannot be completely damaged. If diabetic complications have already started to appear, it is more important to actively consider surgery. 7, how big is the risk of surgery Any surgery is a double-edged sword, there are advantages, but also trauma and risk. The major near-term complications of bariatric surgery include intestinal obstruction, anastomotic fistula, pulmonary embolism, etc. The major long-term complications include gastroparesis, malnutrition, iron deficiency anemia, folic acid deficiency, vitamin B12 deficiency, intractable diarrhea, etc. In conclusion, nutritional deficiencies can occur after any type of bariatric surgery and are best treated with guidance and lifelong follow-up by a dietitian, as well as long-term lifestyle changes after surgery. The long-term effects of the procedure are still being evaluated in academia, and the results vary widely from patient to patient. Therefore, it is important to strictly grasp the indications and slow down the procedure with caution. 8.How long is the tube after surgery The efficacy of diabetes surgery is mainly based on 3 principles: one is to shrink the stomach, reduce the intake and absorption of energy, use the excess energy reserves in the body, and maintain the balance in the body. This is most effective within a year, and after a year of reaching equilibrium, weight loss is no longer possible. Secondly, weight reduction, most of the postoperative patients can lose about 30% of their body weight, and the insulin resistance caused by obesity will also be reduced, and blood sugar will gradually return to normal. Thirdly, after gastrointestinal reconstruction, it can play the role of regulating the intestinal secretion of pro-insulin level, so that the pancreatic secretion level will be improved and blood sugar will be gradually normalized. The above 3 principles make surgery to lower sugar usually work quickly. However, surgery cannot directly repair the metabolic function of the body, stimulate insulin secretion or “bring back to life” the damaged islets. Therefore, it is still necessary to actively treat diabetes after surgery. 9. Can diabetes be cured? So, how good is the effect of diabetes surgery? There is no unified conclusion on this result at home and abroad. Overall, the remission rate of diabetic condition is generally around 80%. Most patients can effectively improve their hyperglycemic condition, and even their blood sugar level can be controlled within the normal range without taking medication or insulin. In addition, patients’ metabolic problems such as hypertension, hyperlipidemia and gout caused by obesity can also be well improved. However, surgery does not benefit all diabetic patients, and the available evidence is not enough to prove that surgery can completely cure diabetes. 20% of poor surgical results may be related to incompatible indications, or patients’ post-operative lifestyle has not changed, leading to recurrence of diabetes. 10. What else should be paid attention to after surgery The Consensus believes that dietary guidance is a crucial part of ensuring the effectiveness of surgical treatment and avoiding long-term postoperative complications, so patients should pay special attention to their diet after surgery. First of all, energy intake should be balanced and not over-eating. Metabolic surgery will make the stomach “smaller”, patients should adapt to their new appetite, do not eat too much, avoid eating too hard food, and chew slowly, you can eat each mouthful of rice for 12 times, and eat 20-30 minutes per meal. Second, the food should be high protein, low calorie, low sugar and low fat, avoid high fat food. Again, it is necessary to properly supplement nutrients and minerals. For example, calcium, iron, various fat-soluble vitamins, etc. Different surgical methods require different nutrients and minerals to be supplemented. Finally, strictly limit alcohol and do not drink carbonated beverages. It is important to ensure adequate daily fluid intake, but not carbonated beverages, to avoid stomach bloating. In addition, the surgery is not a one-time event, and post-operative follow-up visits every three months should be adhered to for life. For women of childbearing age who undergo weight loss surgery, it is best to avoid pregnancy for one year after surgery.