Surgery for Diabetes
Diabetes Surgery (Metabolic Surgery)
In recent years, the term “bariatric surgery treats diabetes” has unexpectedly spread. Opinions come and go, and it is no wonder, since we are dealing with DIABETES, which along with obesity, are considered the giants of diseases in this century, and the number 1 cause of morbidity and death among the population. SURGERY FOR DIABETES Surgery for diabetes, also known as metabolic surgery, is a series of surgical procedures intended for the treatment of diabetes. It includes procedures such as bypass, minibypass, SASI-type bypass, gastric sleeve, among others. Metabolic surgery is a reality based on serious scientific publications and by prestigious institutions in the world. Metabolic surgery is one of the most important medical discoveries of the century. IS THIS SURGERY FOR WEIGHT LOSS OR FOR DIABETES TREATMENT? The concrete answer is that metabolic surgery can act both on weight loss and on normalizing glucose levels. From 1954, when Dr. Linner performed this surgery for the first time, until the early 90s, these surgeries were aimed at treating obesity only. However, in the early 90s, Dr. Pories in the United States and Dr. Scoppinaro in Italy realized that when performing surgery on diabetic patients with obesity, glucose levels were normalized and patients stopped taking medications. At first, it was believed that this effect on diabetes was produced by weight loss, however subsequent research has concluded that the effect that surgery has on diabetes has several explanations and NOT ONLY weight loss, so that diabetes surgery can act on people with or without obesity. HOW DOES METABOLIC SURGERY WORK TO REMIT DIABETES? It is now known that surgery is capable of achieving REMISSION OF DIABETES, even before weight loss occurs. This is due to several mechanisms, some of which are still not clearly explained. Among the most important mechanisms are the following: 1.- It is capable of increasing the production of hormones in the final part of the intestine, such as GLP1, PYY, Leptin, these hormones have an effect on glucose metabolism, in other words, they can make glucose enter the cells, which reduces its levels in the blood. In addition, they also produce the release of insulin in the pancreas and decrease its resistance. In some studies it has also been seen that it can increase the production of pancreatic islets (these are the cells responsible for producing insulin). 2.- Inhibit the production of the hormone Ghrelin, this hormone is produced in the stomach and is considered a pro-diabetic hormone, that is, it increases the levels of glucagon in the blood, in other words, it does not allow glucose to be eliminated from the blood properly. With surgery, Ghrelin levels decrease, therefore, a decrease in blood glucose occurs. 3.- Surgery causes food to not pass, or “skip” the initial part of the intestine, where the largest amount of simple carbohydrates, such as glucose and fructose, are absorbed, this causes the levels of these carbohydrates to decrease in the body. 4.- Surgery has an effect on the microbiota (these are the normal bacteria that live in the intestine) and on the secretion of bile acids, this has an anti-diabetic effect that has not yet been fully explained. 5.- Finally, in patients with obesity, weight loss decreases insulin resistance in the body and improves nutrition, which contributes to the normalization of glucose levels. The above mentioned effects can occur in people with or without obesity. DOES METABOLIC SURGERY CONTROL, REMIT OR CURE DIABETES? Metabolic surgery is capable of not only controlling, but of completely remitting the disease. CONTROL is understood as the decrease or normalization of glucose levels, WITH THE USE OF MEDICATIONS on a continuous basis. Until now, medications such as glibenclamide, metformin, insulin and the most recent ones such as liraglutide, GLP-1 analogues and even insulin, are capable of controlling diabetes. On the other hand, we speak of REMISSION when, after surgery, glucose levels are normalized WITHOUT THE USE OF MEDICATIONS. The word CURE implies that after some treatment, diabetes medications will NEVER be required, that is, it means that the disease, after surgery, will NEVER RETURN. Can metabolic surgery cure diabetes? The answer, in reality, nobody knows. So far we can say that surgery can achieve REMISSION, and not a CURE of the disease, and that so far, it is the most effective treatment that exists for diabetes.
So, if I had metabolic surgery to treat diabetes, what is my prognosis? If you have already been evaluated and are a candidate for the procedure, the prognosis is very favorable. Specifically, the possibility of achieving complete remission of the disease can be up to 95%. This will significantly reduce the risk of complications such as diabetic foot, blindness, diabetic neuropathy, kidney failure and dialysis, among others. Will diabetes remain in remission for life after surgery? We do not know the exact answer, since there are patients who have had surgery for diabetes and after a few years, the disease has returned, however there are others who, after many years, still have diabetes in remission. We know that there are some factors that increase the possibility of diabetes remaining in remission after surgery, here are some of them: 1.- Improve eating habits, 2.- If at the time of surgery, the patient had only a few years of diabetes, that is, the less time from the diagnosis of diabetes to the time of surgery, the better the prognosis. 3.- If the pancreas is functioning well at the time of surgery, this means that the less pancreatic deterioration there is at the time of surgery, the better the prognosis. Pancreatic function can be measured with some blood tests, the best known being peptide C. 4.- Type 2 diabetes has a better prognosis than type 1 diabetes. Remember that not all patients are candidates for surgery, however, for candidate patients, the prognosis, in terms of remission for diabetes or improvement of it, is very good. CAN METABOLIC SURGERY ALREADY BE PERFORMED? AM I A CANDIDATE? Yes, metabolic surgery is already approved in Mexico, however, certain requirements, preoperative studies and evaluations are required. Not all patients are candidates for the procedure. One of the questions we answer very frequently is: If I have diabetes and I am not obese, can I undergo metabolic surgery? The answer is yes, but not in Mexico, not yet. Although it is known that metabolic surgery has a similar effect on people without obesity, it is not yet approved in Mexico. However, in general terms, candidate patients are those with grade I obesity or greater, that is, if you have a body mass index (BMI) of 30 kg/m2 or greater and suffer from diabetes, you could be a candidate for surgery. You can get your BMI here http://obesityhealth.com.mx/en/obesity/ . In Mexico there are already serious surgeons and institutions that perform the surgery. Watch the video interview with Dr. Rey J. Romero here. RISKS OF SURGERY All surgical procedures have a percentage of risks or complications, metabolic surgery is no exception. However, in certified surgeons, with experience and with the appropriate equipment, the possibility of complications is less than 2%. It is also necessary to mention that complications or risks, in the rare case that they occur, can be treated and corrected. The risk of presenting a complication related to diabetes, such as dialysis use, blindness, amputations, heart attacks, among others, is much greater than the risk of metabolic surgery. WHAT OTHER DISEASES CAN BE TREATED WITH METABOLIC SURGERY? The number of diseases that achieve remission or improvement after surgery is very high. Just to name a few, systemic arterial hypertension, obesity, obstructive sleep apnea (snoring), osteodegenerative disease (chronic knee pain), hepatic steatosis (fatty liver), dyslipidemia (high cholesterol and lipids), gout (high uric acid), polycystic ovary syndrome, menstrual irregularities, gastroesophageal reflux, irritable bowel syndrome, metabolic syndrome, depression, anxiety. It is also capable of preventing the onset of diseases such as heart attacks, diabetic foot, kidney failure and some types of cancer such as breast, cervical, colon, among others.
Testimonios Cirugía para la Diabetes
"I no longer take insulin or medication, I invite you to do it, it is your best investment" Norma.
"I had problems with diabetes, blood pressure and fatty liver, 4 months after my Sasi bypass, all of this has been resolved" Miguel.
"I was insulin dependent before surgery" Fernando.
"Yo manejaba niveles de 280 mg/dl, a 5 meses de mi bypass sasi con bipartición, he perdido 43 kg y mis niveles están en 70.80 mg/dl" Oscar.
"My glycosylated hemoglobin went from 6.9 to 5.4 without the use of medication" Rosa.
"One month after my surgery, my glucose has gone from 285 to 90 mg/dl without the use of medication, I feel very well" Blanca.
"I had a metabolic bypass to remit my diabetes. I feel great 24 hours after the surgery." Gerardo.
"I have said goodbye to obesity and diabetes, I am very grateful" Angélica.
"I was taking metformin and insulin, since I left the surgery I haven't taken any, I'm already at grade 2 obesity, I'm halfway there" Bea.
"Venimos desde Chicago a realizarnos las cirugía para la diabetes con el Dr. Rey, la atención es de primera, yo se los recomiendo" Romeo.
"I was taking 3 medications a day, I had a glycosylated hemoglobin of 9.6 and currently I have a glycosylated hemoglobin of 5.2 and I do not take any of the medications" Imelda.
"We are diagnosed with diabetes, but this surgery is something they don't tell us about, it's something that changes your life" Erbey.
