Type 2 Diabetes and Biariatric Surgery

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What is Type 2 Diabetes?
According to the Centers for Disease Control (CDC), there are more than 29 million people in the United States who have diabetes, and of those, one in four is unaware that he or she has it.

There are two types of diabetes, both greatly multiplying the chances for a variety of dangerous complications and both types relating to insulin: insulin is a hormone produced by the pancreas gland (controls the way in which your body manages sugar/glucose in your blood). Without insulin, sugar is unable to enter your cells, instead staying in your blood, which results in high blood sugar (diabetes).

When your pancreas stops producing insulin altogether, it is known as Type 1 diabetes. Although Type 1 diabetes is usually seen in children or young adults, it may occur at any age.

Type 2 diabetes is a life-long disease, altering the way in which insulin turns ingested food into energy. In some cases of type 2 diabetes, the body may resist the effects of insulin and in others, may produce less than is needed for a normal glucose level. When this happens, the body attempts to compensate by producing more insulin, which eventually shows up in the blood.

What Causes Type 2 Diabetes?
There are certain factors that increase your likelihood of getting type 2 diabetes, the two most important being genetics and lifestyle, or a combination of both. The more of those listed below that pertain to you, the greater your chances acquiring diabetes becomes:

  • Family history, mother, father, and/or sibling with diabetes
  • Age, 45 or older
  • Race, African-American, Asian-American, Hispanic/Latino, and American Indian at greater risk
  • Weight, overweight/obese
  • Fat stored in abdominal region
  • Lack of exercise
  • Birthing baby weighing 9+ pounds
  • Polycystic ovarian syndrome (in women), typified by erratic menstrual cycles, obesity, and excess hair growth

What Are the Signs of Type 2 Diabetes?
Symptoms of type 2 diabetes, often overlooked because they are so minor or commonplace, include:

  • Extreme thirst
  • Frequent urination
  • Irritability
  • Unexplained weight loss
  • Blurred vision
  • Dark patches of skin
  • Fatigue
  • Numbness/tingling in hands or feet
  • Slow healing wounds or sores
  • Frequent Infections

Complications of Type 2 Diabetes
You may feel normal in the early stages of type 2 diabetes, but uncontrolled blood sugar levels can be the cause of disabling or deadly results by affecting the major organs in your body.

Some of the potential complications of diabetes, which may develop gradually, include:

  • Cardiovascular and blood vessel problems: heart attack, stroke, coronary artery disease, narrowing of arteries (atherosclerosis),and high blood pressure (hypertension)
  • Nerve damage (neuropathy): numbness tingling and/or total loss of sensation in the affected limbs, digestive problems, and for men, erectile dysfunction
  • Kidney damage (nephropathy): affecting the filtering system and leading to kidney failure or end-stage kidney disease.
  • Eye damage: blood vessels or retina, (potentially causing blindness), cataracts, and glaucoma
  • Foot damage: nerve injury, possibly leading to acute infection or amputation of the toe, foot, or leg
  • Skin disorders: bacterial and fungal infections
  • Hearing loss
  • Alzheimer’s disease: precise connection unclear

Treating Type 2 Diabetes
Although there is no cure for type 2 diabetes, in some cases the condition may be managed through lifestyle changes such as a healthy diet, regular exercise, and maintaining a healthy weight.

Your physician may also suggest diabetes medication or insulin therapy.

Being overweight or obese has been shown to cause type 2 diabetes, particularly if the extra pounds are around the middle of the body. Weight loss as modest as 10% of your weight has been shown to cut the risk in half. Type 2 diabetes is, however, complicated when treating someone who is obese, as it has been shown that lifestyle behavioral changes tend not to keep the weight off long-term.

An estimated one-third of American adults are classified as obese, and for many of those, diet and exercise are not enough to cause sufficient weight loss to stem the progress of the disease. For these people, studies have shown that bariatric surgery may be the answer.

What is Bariatric Surgery?
The purpose of bariatric surgery is to reduce the amount of your food intake by making you feel satisfied sooner, thus causing weight loss. Most bariatric surgeries are performed using laparoscopic (minimally invasive) techniques.

The most frequently used bariatric surgeries for type 2 diabetes include:

  • Laparoscopic adjustable gastric band
  • Gastric sleeve surgery (sleeve gastrectomy)
  • Gastric bypass, most commonly used
  • Biliopancreatic diversion with duodenal switch, used less often.

Laparoscopic Adjustable Gastric Band
A ring with an inner inflatable band is placed around the top of the stomach leaving only a small sac for food.

Gastric Sleeve
Most of the stomach is removed, save for a curved section that is stapled shut.

Gastric Bypass
In gastric bypass surgery, the stomach is stapled, and a smaller sac for food is formed in its upper section. Next, the small intestine is cut, and the lower part attached directly to the newly created sac, detouring food away from most of the stomach and upper part of the small intestine, limiting the absorption of calories.

Duodenal Switch
The duodenal switch involves two separate surgeries. The first is much like gastric sleeve surgery, while the second redirects food so that it avoids the larger part of the small intestine. The more complex of the three other surgeries, the duodenal switch allows for greater weight loss but is more likely to produce surgery-related difficulties.

Risks Associated with Bariatric Surgery
Gastric bypass and other weight-loss surgeries present possible health risks, as do all major surgeries; these include both long and short-term complications.

Among the risks associated with bariatric surgery are:

  • Infection
  • Adverse effects of anesthesia
  • Excessive bleeding
  • Blood clots
  • Breathing or lung problems
  • Gastrointestinal leakage
  • Death, though rare

Longer term risks and complications, which vary depending on the type of surgery, are also possible, including:

  • Obstruction of the bowel
  • Dumping syndrome (rapid gastric emptying)
  • Hernias
  • Gallstones
  • Hypoglycemia, (low blood sugar)
  • Malnutrition
  • Stomach puncture
  • Ulcers
  • Death, rare

When Considering Bariatric Surgery

Your doctor will evaluate whether you are a candidate for bariatric surgery for type 2 diabetes based on your weight and the readings of your blood sugar. If bariatric surgery is suggested, discuss the risks and benefits, along with your expectations regarding your outcome with him or her. Your current health will influence the success of the procedure and your recovery.