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Diabetes and Weight loss Surgery

Posted On : June 30, 2014

Diabetes should be considered as a family of diseases sharing a common name. They are different diseases because the cause,  pathophysiology, and the treatment options are different for each diseases. This is not to say that there are not  commonalities between them.

  • Type I (Insulin deficiency, Juvenile onset)
  • Type II (Insulin Resistance, Adult onset)
  • Latent Autoimmune diabetes (LADA)
  • Gestational 

Type I  diabetic patients requires insulin for control of their blood sugar. Insulin deficiency is the underlying problem with type I diabetes. The causes of type I diabetes are many and some are poorly understood. It is presumed that viral infections, genetics, infections, chronic pancreatitis and autoimmune conditions may all be potential causes of type I diabetes.

Type II  diabetes is an insulin resistance state. This means that the patients’ body may be making adequate level of insulin however, for a number of reasons, the insulin is not able to normalize the blood sugars. Some Type II diabetic patients may also require insulin during advanced stages, but in most cases the initial treatment is oral medications.

Diabetes Type Blood Sugar Blood Insulin
Type I High Low-absent
Type II High High(early disease state)

The table above summarizes the laboratory findings in a patient who is diagnosed with diabetes. The measured insulin can be distinguished in the labs as being injected or patients own.

LADA is probably a subtype of Type I, with a delayed presentation. It behaves like Type I, with insulin deficiency, yet it is adult onset.

Gestational is more of a high blood glucose state during the pregnancy.

The goal of medical treatment for diabetes has been to normalize the blood sugars. There are no medical treatments regimens that correct any of the underlying causes of the Type I, or Type II.

In the case of Type I, the underlying case is Insulin deficiency. The definitive treatments may include Pancreatic transplantation, and intelligent Insulin pumps.

Surgical treatment of Type II,  by some know and unknown mechanisms, corrects the underlying resistance to the insulin.

Weight loss surgical procedures have been shown to “cure” Type II”.  The “remission” or “cure” rate of diabetes is really different between surgical procedures.  Duodenal switch operation has been shown to have the highest remission-cure  rate of all surgical procedures for the Type II diabetes. The references are available on our website. By definition, Type I can not be corrected-cured with weight loss surgery, since the underlying problem is insulin deficiency. What we have experienced however is that the Insulin requirements significantly decreases and blood glucose control is much easier after weight loss surgery.

There have been a number of articles reporting high relapse rate of Type II in gastric bypass patients. This is why I have always advocated  that the patients with metabolic conditions, including diabetes should only consider the duodenal switch as their only surgical option.

The one study of 4434 patients, 68.2% of those patients who had Type II had remission within 5 years after the gastric bypass procedure.  35% of those patients, however, had a redevelopment of Type II after 5 years. “When the patients that never remitted and those that relapsed were added together, more than half of the patients (56%) did not have durable remission of diabetes.” (Obes Surg 2012 Nov 18:doi 10.1007/s11695-012-0802-1).

An article published in May 2010, reported 24% recurrence or worsening of the diabetes in patients who have had gastric bypass operation. (SOARD Volume 6, issue 3, May 201 249-253).

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