Diabetes continues to be one of the largest global public health concerns. Out of the two major types, type-2 diabetes accounts for around 95% of all the cases. While type 1 diabetes is an autoimmune disease, type 2 diabetes occurs mostly due to poor eating habits and an unhealthy lifestyle. Obesity is one of the primary reasons for insulin resistance in people diagnosed with type 2 diabetes. Studies have shown that obese people have a 10 times higher risk of developing diabetes as compared to non-obese people. If not managed, the excess weight can result in various diabetes-related complications including kidney damage, heart disease and stroke.

What is bariatric surgery?

Also known as weight loss surgery, bariatric surgery is an invasive procedure where the doctor medically carries out a procedure to facilitate weight loss by restricting the amount of food the stomach can hold or by reducing the absorption of nutrients. This surgery helps in managing various obesity-related conditions such as type 2 diabetes and hypertension.

How does bariatric surgery benefit a diabetic patient?

It has been reported that around 33% of diabetic and obese people do not require diabetes medication after surgery. Within 2 years of bariatric surgery, about 85% of the patients do not require any diabetes medication. The other benefits of bariatric surgery include:

• Significant weight loss.
• A drop in blood sugar levels within a few days after surgery.
• Reduced or complete elimination of diabetes medications.
• 50% to 80% of weight loss within 18 to 24 months after the surgery.
• Reduced levels of cholesterol.
• Improved blood pressure.
• Reduced risk of heart diseases (heart attack and heart failure), stroke, and kidney failure.
• Improved sleep apnea and fatty liver.

Who can opt for bariatric surgery?

Bariatric surgery is not recommended to everyone but some people who are advised to undergo this surgery include:

• People with a body mass index (BMI) of more than 40 (extremely obese)
• People with a body mass index of 35 (obese) along with other medical conditions such as diabetes and hypertension.
• People weighing 45 kg over their ideal body weight.
• Those who are not being able to achieve a healthy body weight even after following all medical advice and lifestyle changes.
• Those who have not been able to achieve normal fasting blood sugar (less than 125 mg/dl or HbA1c less than 7%).

Are there different types of bariatric surgery?

Different types of bariatric surgeries can be performed depending on the case. The most common ones include:

1. Gastric bypass: Also called Laparoscopic Roux-en-Y Gastric Bypass, gastric bypass is a procedure where the doctor re-routes the food by creating a small pouch in the stomach and attaches intestines to this pouch. This small pouch accommodates less food, thus the person feels full sooner and absorbs lesser calories. It is one of the most recommended surgical options that help in weight loss and sugar control.

2. Sleeve gastrectomy: Also called Laparoscopic Sleeve Gastrectomy (LSG), sleeve gastrectomy is a procedure in which, the surgeon removes a part of the stomach but does not re-route. This smaller sized stomach fills sooner allowing the person to eat less. This surgery is apt for people with a heart or lung condition.

3. Duodenal Switch (DS): DS is the combination of gastric bypass and LSG, where the surgeon creates a small pouch in the stomach and connects it to the farthest part of the small intestine (duodenum). This surgery is usually performed for people who have a BMI higher than 50 (morbidly obese).

4. Gastric band: In this surgery, the surgeon places an inflatable band around the upper part of the stomach, making the person feel full without eating too much. which means that they will feel full quicker when eating.

Are there any risks associated with bariatric surgery?

Bariatric surgery does carry some risks, which include:

• Reaction to the anaesthesia
• Internal bleeding
• Damage to the surrounding organs
• Formation of blood clots, which can block the blood vessels of the brain, heart or lungs
• Inflammation of the peritoneum (peritonitis), the outer tissue covering the abdomen
• Potential infection
• Slipping of the gastric band out from its place, resulting in leaking of food between the stomach and small intestine or blocking of the gut.

What are the side effects of bariatric surgery?

After the surgery is over, potential side effects can include:

• The person may suffer from blockages in the intestines.
• Risk of gallstones or kidney stones.
• The connection between the stomach and the intestine may get narrow (anastomotic stenosis).
• Nausea, vomiting and stomach pain after eating (known as dumping syndrome).
• Risk of malnourishment due to the lack of absorption of nutrients.
• Presence of excess folds of skin, which may require another surgery for removal.

What to expect after the surgery

People who have undergone bariatric surgery may witness improvements in their blood sugar levels right after the surgery. The doctors would reduce the dose of medication or stop them completely, depending on the level of blood glucose.

The person may need to follow strict dietary instructions on when, how and what to eat to maintain the lost weight. The recovery may take 3 to 4 weeks. Meanwhile, the person would have to undergo routine follow-ups.

When to contact a doctor

Once the surgery is done, the person may experience pain and discomfort for a while. However, they must contact a doctor if they develop or experience:

• Increased pain or sudden pain
• Fever
• Vomiting
• Infection, redness, itching or pus formation near or at the site of the incision (cut)
• Constipation.

Conclusion

Excess fat in the body which gets built up in the liver and the muscles not only restricts the pancreas from making insulin but also reduces the ability of the body to utilise that insulin. Multiple studies have concluded that weight loss can help in the remission of type-2 diabetes. In one of these studies, including 400 participants with type 2 diabetes, it was found that six years after bariatric surgery, 62% of the participants experienced better cholesterol and blood pressure levels with no signs of diabetes.

People must eat foods low in fats and carbohydrates and exercise regularly to maintain a healthy weight. Significantly obese who have tried all other remedies without positive outcomes must consult a diabetologist to discuss alternative therapies to manage their diabetes and live a healthy life.

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