Bariatric Surgery and Diabetes

About 90% of individuals with Type II Diabetes acquired the condition from excessive body fat associated with obesity. This is a condition where your body no longer utilizes insulin properly. This is a life changing condition that requires you to consistently manage blood sugar levels through diet, exercise and medication. 

Bariatric surgery, commonly referred to as weight loss surgery, can be performed as a treatment for Type II Diabetes resulting in improvement and even remission. 

This article will assist you in understanding how bariatric surgery works and if it is something you should consider to treat diabetes. 

 

How Bariatric Surgery Works to Treat Diabetes

Bariatric surgery aims to improve diabetes by lowering blood sugar levels, reducing medication dosing, and improving diabetic related health conditions. 

Remission of diabetes can occur if weight loss surgery reduces blood sugar to normal levels and also eliminates the need for diabetic medications. 

These procedures involve surgery of the upper gastrointestinal tract and include shortening or altering parts of the stomach and/or small intestine in order to restrict caloric intake and cause malabsorption of some nutrients. 

Bariatric surgeries have also been seen to alter the secretion of certain hormones and gut microbiota which play a role in the regulation of glucose-control systems. 

After gastric bypass, food will bypass certain parts of the gastrointestinal tract and directly enter the small bowel. This can change gut function and production of hormones, which can then influence glucose regulation and blood sugar levels. 

Improvement or remission of diabetes can occur shortly after bariatric surgery and even before significant weight loss occurs due to the changes in gut hormones.

The anesthesia for bariatric surgery is relatively simple and low risk. Most patients who receive this surgery do well under general anesthesia. However, the anesthesiologist will consider any existing conditions before deciding the route of anesthesia before surgery. 

It may be necessary to receive epidural anesthesia if local anesthesia is not suitable for an individual.  

 

Types of Bariatric Surgeries

Roux-en-Y Procedure

Many different kinds of bariatric surgery procedures can be performed to treat diabetes. Although, the most commonly used is the Gastric Bypass procedure, also referred to as the Roux-en-Y procedure. 

Remission rates of type II diabetes is about 80% in gastric bypass patients. 

This procedure reduces stomach volume by making a smaller stomach pouch to restrict caloric intake. This procedure also includes anatomical changes to the intestinal tract resulting in malabsorption of some nutrients resulting in significant weight loss.

The surgeon will cut the upper section of the stomach creating a small stomach pouch that is sealed off from the rest of the stomach. 

Then, part of the small intestine will be cut and attached to this smaller stomach section. 

It is referred to as gastric bypass because the food you consume will flow into the smaller stomach that was created and continue directly into the intestine,  skipping most of your stomach. 

Gastric Band Surgery

Another intervention is the placement of a band around the top portion of the stomach that can be inflated to restrict the volume of food entering the stomach. 

The silicon band can be inflated and deflated through a port that is placed under the skin of the upper body. The surgeon can then inflate the band by injecting a saline solution into the tube. 

This has been shown to result in diabetic remission for at least 45% of patients. Improvement of diabetes comes secondary to weight loss in this procedure, so there is a lower rate of remission. Remission rates are lower since some individuals may be unsuccessful in losing an appropriate amount of weight after this procedure. 

Gastric Sleeve Surgery

This procedure involves the removal of a majority of the stomach, creating a longer and thinner tube-like stomach. This will limit the amount of food that can be consumed in a given time. 

It differs from a Roux-en-Y procedure in that there is no cutting and reattachment to any part of the small intestine. 

With changes to the size of the stomach, there is still evidence of changes to gut hormones that can effect blood sugar control and diabetes, as well as weight loss benefits

Remission rates after gastric sleeve are similar to gastric bypass with about 60% remission

Who Will Benefit?

Patients with type II diabetes who are moderate to morbidly obese would benefit the most from bariatric interventions. Bariatric surgery in children and adolescents is an option for those who suffer from obesity-related diabetes. 

This is especially true for a patient who has tried non-surgical weight loss interventions without obtaining satisfactory results.

Associated Risks

When considering bariatric surgery, it is clear that the benefits substantially outweigh the risks. 

Complications may vary based on the bariatric procedure performed. 

The complications of bariatric surgery may include the following: 

  • Gastrointestinal leakage
  • Blood clots
  • Bowel obstructions resulting in constipation or internal hernias
  • Stricture

Even with the possible complications, the long-term risk of continued obesity-related diseases, like type II diabetes, outweighs the surgical risk of bariatric surgery. Bariatric surgery can provide improvements in quality of life and obesity-related health conditions. 

With increased medical technology and improved patient follow-ups, bariatric surgery has been deemed successful and safe for those looking for treatment of obesity-related diseases. 

 

Postoperative Outcomes 

Weight Loss

The most important outcome of any bariatric procedure is weight loss. Regular monitoring of weight loss, as well as BMI, will be important to assess progress in diabetes and obesity management. 

The amount of weight loss will depend on the bariatric procedure and the adherence to lifestyle change after surgery. 

In general, weight loss after bariatric surgery can range from 50 to 70 percent reduction in excess weight. These weight loss surgeries have also been associated with improvement in sleep apnea, which is commonly associated with obesity. 

Insulin Monitoring

You should continue at home insulin monitoring even after the operation is performed. 

Other Medical Conditions

Other medical conditions that may need to be managed after bariatric surgeries will need to be considered. 

This would include:

  • Acid Reflux
  • Nausea
  • Vomiting
  • High risk of vitamin and mineral deficiencies

Follow-Ups

Regular follow-ups with the surgeon or practitioner should be emphasized.

Follow-ups should include an assessment of the healing progress and potential complications, including deficiencies. Weight loss progress will also need to be closely monitored to ensure that target goals are reached. 

Depending on the surgery performed, it may also be necessary to have follow-up surgeries after a month, 6 months, or a year. 

 

Changes in Diet

Once you have been discharged, you will likely be instructed to consume a liquid diet for a period of time. This liquid phase would include bariatric protein shakes and other full liquids that fit into this category. Then, you will slowly progress to soft foods and eventually solid foods. 

Food intake will be greatly reduced within the first 3 months, and therefore the glycemic load will also be reduced significantly. 

You should also make sure that you are drinking enough fluids to prevent dehydration. 

Once you are fully in remission, you are encouraged to consume well-balanced and nutritionally adequate meals, including a variety of vegetables, fruits, and protein. You must also consume smaller, and more frequent meals to help control blood glucose levels. 

The slow consumption of food will prevent some GI complications, as well as prevent overconsumption that can eventually lead to weight regain.

Bariatric surgery is only a tool for weight loss. It does not guarantee long term weight loss. It is merely a step in the right direction, and lifestyle changes are imperative to keep weight off.

It is recommended to seek the advice from a clinical dietitian for the months following the procedure. 

 

Insurance Matters

Most insurance providers do not cover cosmetic weight-loss surgeries. Although, depending on your current BMI, you may qualify for benefits.

If your BMI is over 35 and you have other weight-related conditions, or if your BMI is over 40, then your insurance provider will most likely cover bariatric procedures.

If you have a BMI of 35 or higher, without weight-related conditions, insurance may not cover bariatric procedures. In the case where non-surgical weight loss interventions have not been successful, insurance may cover the costs with proof of previous attempts at weight loss. 

Check with your service provider on their terms to determine whether or not this surgery will be covered for you. 

 

Common Misconceptions

“It will leave a large scar” 

Bariatric surgeries are relatively non-invasive and medical equipment is more advanced than in the past.

Surgery is performed through a small incision, with minimal blood loss and scarring when compared to open surgeries. You can discuss any scarring concerns with your surgeon beforehand. 

“You cannot have children after bariatric surgeries”

Pregnancy should be avoided for at least 12-18 months after surgery or when deemed safe by your bariatric team and OBGYN. This should not affect your chances of becoming pregnant beyond this time frame. Weight loss surgery has actually been shown to increase fertility rate. 

It is recommended that pregnancy be avoided due to rapid weight loss and potential micronutrient deficiencies that may follow after the procedure. 

“The recovery process is long and painful” 

The average recovery period for these surgeries is between 3-4 weeks. With an increase in medical technologies, it is now safer than ever to have this surgery. Recovery time frame can be based on the individual and other medical conditions they may be managing.

You should be back to your normal day-to-day activities within 3 to 5 weeks. 

There are a variety of bariatric surgery aids to help with recovery like gastric sleeve pillows. 

“This surgery will leave me with lots of loose hanging skin” 

The main goal of this surgery is to initiate weight loss. If the weight loss is significant, the patient may be left with some excess skin. It is not unmanageable. 

Chafing, rashes, and infection are a primary concern of excess skin, but this can be avoided by wearing clothes that don't rub against the skin. 

It can also be minimized through exercise and a healthy skincare routine. Keeping the skin folds clean and dry will minimize your risk of infections and irritation. 

Cosmetic surgery can also be considered for the removal of excess skin after bariatric surgery.

 

**This blog is for information and education purposes only. This information is not intended to substitute professional medical advice, diagnosis, or treatment. Please consult with your physician or another qualified health provider with any questions in regards to a medical condition.