How does Weight Loss Surgery Help?
Bariatric surgery has been proven by many studies to be the most effective method to achieve long-term weight loss. Not only that but 83% percent of Type 2 diabetic patients undergoing weight loss surgery find improvement or remission of diabetes. Improvements in blood sugar levels and reduction in the need for medication often occur immediately after surgery, even before significant weight loss is achieved. These quick improvements are not fully understood. There may be several factors involved:
- A very low calorie intake – especially right after surgery.
- Hormonal changes increase the production and release of insulin by the pancreas.
- Hormonal changes improve insulin sensitivity—moving more sugar out of the blood and into the cells where it can be used for energy.
- Changes in bile acid composition and flow.
- Modifications of gut microbiota (the type and number of bacteria that live in your intestine).
- Intestinal glucose metabolism.
- Increased brown adipose tissue metabolic activity.
My surgery was almost canceled because my blood sugar was too high. I ran consistently in the 300’s with spikes in the 500’s. Surgery was 3 months ago. I’m down 36 pounds so far and eating right. Blood sugars of 80 to 90 are my new norm! –Lori B.
Type 2 Diabetes – A Broken System
Type 2 diabetes is basically a broken system that develops over time and results in high levels of sugar in the blood. For most, it starts in adulthood, but children and teens are also affected. The first thing that goes awry is the cells of the body become resistant to insulin–the hormone that regulates the movement of blood sugar from the bloodstream into cells where it is converted to energy. With the cells not responding to insulin as they should, sugar builds up in the bloodstream. That’s not a good thing. The pancreas goes to work and produces more and more insulin to help move sugar into the cells. But because the cells are insulin resistant, no matter how much insulin the pancreas produces, it is never enough. Eventually, the pancreas “wears out” and reduces its output of insulin. The strained blood sugar regulation system becomes broken.
Who is at Risk?
Many Americans are at high risk. About 10% of adults have full-blown diabetes, a higher percentage than ever before. But, even more concerning is the epidemic that is about to unfold. One third of adults have pre-diabetes. Their sugar regulation system is strained, but not yet completely broken. Because pre-diabetes has few symptoms, most don’t realize it is only a matter of time before their blood sugar skyrockets and they need to deal with the realities of diabetes.
Pre-diabetes will develop into diabetes within 5 years if not treated. The following factors increase the risk of type 2 diabetes:
- Excess Weight.Carrying around excess weight, especially in the abdomen, is a main risk factor.
- Low Activity Level. The less you move throughout the day, the greater your risk. Regular movement and physical activity helps you control your weight and increases insulin sensitivity.
- Family history. You’re more likely to develop type 2 diabetes if a parent or sibling has it.
- Ethnicity. Black, Hispanic, American Indian and Asian-Americans are more likely to develop type 2 diabetes.
- Age. Risk increases as you age, but it is now developing in younger people at an unprecedented rate.
- Pre-diabetes. In prediabetes, blood sugar is higher than normal, but not high enough to be classified as diabetes. If not treated, prediabetes is likely to progresses to type 2 diabetes. There are 2 tests easily done to diagnose prediabetes, 1) fasting blood sugar of > 100 and <126 and 2) A1c, a test that measures blood sugar over a period of time >5.7 and <6.5.
- Gestational diabetes. Having gestational diabetes (diabetes during pregnancy) or giving birth to a large baby (more than 9 pounds) ups your risk.
- Polycystic ovarian syndrome. Women with polycystic ovarian syndrome (PCOS) — a condition characterized by irregular menstrual periods, excess hair growth, and obesity are at greater risk.
- Areas of darkened skin. Darker areas of skin, typically in the armpits and neck indicates insulin resistance.
Impact on Body/Quality of Life/Lifespan
The day-to-day management of diabetes can be challenging. And long-term complications of diabetes, those that develop gradually over years as elevated blood sugar damages the body’s organs, impact quality of life. Some complications can be life-threatening. Good blood sugar control can help prevent or delay many of these complications.
Type 2 diabetes leads to an increased risk of the following complications:
- Damage to blood vessels, high blood pressure, heart disease, and stroke.
- Nerve damage affecting the fingers, toes, feet, legs and other areas of the body.
- Kidney failure or disease.
- Eye damage resulting in cataracts, glaucoma, and even blindness.
- Compromised healing and increased risk of infection.
- Hearing problems.
- Bacterial and fungal infections of the skin.
- Alzheimer’s disease.
How to Prevent Type 2 Diabetes
The American lifestyle puts us all at risk for developing type 2 diabetes and the complications that come along with it. We all have friends and family members who are affected. What can we do? Healthy lifestyle choices are important to minimize your risk:
- Choose fresh, unprocessed foods that are low in added sugar and fat and rich in fiber. Keep calories in check.
- Move more and avoid sitting for long periods of time. Try to move for a few minutes every ½ hour and include 30-60 minutes of moderate exercise most days.
- Ideally, reaching and maintaining a healthy weight is best, but even modest weight loss can help. Easier said than done, right? Non-surgical weight loss attempts most often result in regain that exceeds the weight lost, increasing the risk for type 2 diabetes. Don’t despair; this is where bariatric surgery comes in.
Who Benefits the Most?
Why do some experience total remission in diabetes and others only an improvement in blood sugar control after weight loss surgery? It seems that age, body mass index (BMI), C-peptide levels (how much insulin the body is producing), and the number of years a person had diabetes all impact how quickly and how completely diabetes goes into remission.
- Because body systems do not function as well as we age, younger people undergoing bariatric surgery will respond and recover more quickly and completely from type 2 diabetes.
- Those with lower body mass index at the time of surgery can expect more complete remission.
- Because, over time, type 2 diabetes damages the pancreas cells that produce insulin, the shorter the duration of the disease, the better the improvements will be that are seen after bariatric surgery.
- Those with lower HbA1c levels and those who require less medication to control blood sugar prior to surgery, typically see faster and more complete resolution.
Bottom Line
The incidence of Type 2 diabetes and pre-diabetes is at an all-time high in the United States. Damage to the body tends to increase as the disease progresses, even with the use of medication. Type 2 diabetes improves dramatically after bariatric surgery. The sooner a person undergoes bariatric surgery, the more likely their body will recover fully and see type 2 diabetes go into remission.
Resources:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5331470/
Kassem, Mahmoud Attia Mohamed et al. “The Impact of Bariatric Surgery on Type 2 Diabetes Mellitus and the Management of Hypoglycemic Events.” Frontiers in endocrinology vol. 8 37. 1 Mar. 2017, doi:10.3389/fendo.2017.00037
