How Does Bariatric Surgery Reverse Diabetes?

Obesity is the root cause of diverse diseases such as Asthma, sleep apnea, cardiovascular problems, Type 2 Diabetes Mellitus, joint pains and most important some forms of cancers.

Obesity increases insulin resistance in the body leading to Type 2 Diabetes Mellitus, and also results in Metabolic Syndrome.

There are various ways to deal with these problems which include changes in the lifestyle and modification in the eating habits and use of certain drugs. But almost all of the studies conducted have come to the conclusion that these therapies are not effective in providing a sustained weight loss. Bariatric surgery has been the most effective treatment option till date which results in effective and sustained weight loss along with resolution of the other problems associated with obesity.

There are various bariatric and metabolic surgical procedures available which can be done by Laparoscopic Techniques as well as with Robotic assistance. They include Sleeve gastrectomy, Roux-en-Y gastric bypass, Mini Gastric Bypass, Ileal Interposition, Duodeno-Jejunal Bypass and so on.

Mechanism of resolution of Diabetes Mellitus:
Intestine is now considered as a metabolic organ and this new insight can be utilized for the treatment of Diabetes. Bariatric and metabolic surgery leads to changes in the anatomy of the gastrointestinal tract resulting in the treatment of obesity and diabetes mellitus. The quick lowering of blood sugar after bariatric surgery is due to hormonal changes after re-routing of the small intestine and not purely do the restriction of the calorie intake. It has been proposed and proved that after bariatric surgery there is an augmented release of certain hormones like GLP-1 and PYY from small intestine that leads to improvement in the high blood sugar levels.

These hormones not only decrease the cellular resistance to insulin, they also increase the efficiency of insulin. There is also decreased production of glucose from the liver due to their effects.

After surgery, long term follow up for the best results is a must. It’s a complete life style change. One must follow instruction carefully for optimum results.
There are absolute guidelines decided by international diabetes federation for selection of the patients who can be benefitted from surgery.

These surgeries must be done at the best bariatric and metabolic surgical centers doing these surgeries routinely and under expert care and experienced hands. Although hospital stay remains from 2 to 3 days, a strict and regular follow up is a must.

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Deep Vein Thrombosis

Yesterday I had a surprise visit from my childhood friend Anna. Two years have passed since the day Anna had a close brush with death. Her story, in her own words goes like this.

‘’I woke up with a start around 3 am, with heaviness in my chest.I sat up and noticed my heart was racing, I could hear it thumping, and it was becoming harder for me to breathe. I stood up and started to walk, but after a few steps I was dizzy, and was back on my bed. Now my heart was racing even faster. I lied down wondering what was happening to me, I picked up my mobile, and thought of calling emergency. My husband was out for an offsite and my two children were asleep, I hesitated, decided to wait and went back to sleep. I woke up again hours later with breathlessness and chest pain. Then I called my primary doctor’s office and spoke to her nurse. Her triage questions saved my life, she said,” you might have a blood clot in your lungs”. Suddenly I remembered that I had undergone a knee surgery for fracture three weeks back. She asked me to rush to ER.  At ER a nurse took my pulse and hooked me up to IV line and cardiac monitor. I felt so relieved when I received oxygen. My doctor came in ordered a CT scan of chest, and the diagnosis of pulmonary embolism was confirmed. I was shifted to intensive care unit, further tests confirmed a blood clot in my legs. My husband rushed back and he was informed that I needed surgery to have an IVC filter to prevent more clots in my legs from moving in my heart. I was given clot dissolving medications. I came back home 6 days later”.

I am now on blood thinners, may be for life. I have to wear my compression stocking all the time. I got my IVC filter removed after 6 months.

DVT and PE was a huge emotional setback for me, it took me many months to come out of it.

MEASURES TO PREVENT DVT/PE are:

  • Quit smoking
  • Exercise regularly
  • Using compression stockings
  • Lose weight
  • Avoid long periods of physical inactivty
  • During long flights, walk up the aisle every hour, drink plenty of fluids.
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