Type 2 Diabetes

What is Type 2 Diabetes?

According to the American Diabetes Association:

In type 2 diabetes, either the body does not produce enough insulin or the cells ignore the insulin. Insulin is necessary for the body to be able to use glucose for energy. When you eat food, the body breaks down all of the sugars and starches into glucose, which is the basic fuel for the cells in the body. Insulin takes the sugar from the blood into the cells. When glucose builds up in the blood instead of going into cells, it can lead to diabetes complications.

Type 2 diabetes can manifest itself in many ways including:excessive thirst, which develops because hyperglycemia, or high levels of glucose in the blood, acts to pull fluid out of the body’s tissues. This leads to dehydration, extreme thirst, and frequent urination. This also draws fluid away from the eyes, resulting in blurred vision.

People with type 2 diabetes may feel fatigued because the body’s cells aren’t able to get the glucose they need for energy. In addition, without the proper energy supply for the cells, they may feel very hungry, and weight loss may result because the body has to use other sources for energy, such as burning muscle and fat stores. High levels of sugar in the blood make it more difficult for the body to resist and fight infections and to heal, resulting in frequent infections, especially skin infections and open, slow healing sores.

High amounts of glucose in the blood can also lead to other complications such as kidney failure, blindness, skin infections, gangrene, cardiovascular disease, stroke, coma, shock, and death.

What traditional treatments are available for type II diabetes?

Traditional treatments for type 2 diabetes include lifestyle changes such as: diet, weight control, and physical activity. If blood glucose levels remain high despite these measures, then medication to reduce blood glucose levels is usually advised. Insulin injections are needed in some cases if blood glucose levels remain too high despite medication. Treatments for other related problems may also be advised.

Is there a surgical option for Type II Diabetes?

Surgeons have noticed for years that bariatric surgery was reversing type II diabetes symptoms even before weight loss had begun, and they weren’t sure why. There is emerging evidence that hormonal and metabolic changes caused by the surgery are responsible for the nearly 90% success rate in reversing the disease.

In terms of surgical options, it seems that mini gastric bypass offers the best balance between diabetes resolution and minimization of complications. Although duodenal switch also offers excellent results, the surgery complication rate is much higher. Gastric banding does not provide the same immediate impact on the disease and seems tied to weight loss from the procedure.

Unfortunately, the mini gastric bypass surgery is not an option for many in North America as, like other bariatric procedures, this surgery is only performed for those with a BMI >35.

Articles such as the following shed light on the effectiveness of gastric bypass for reversing type II diabetes.

What are the benefits of this surgery?

90% of patients have resolution of their diabetes symptoms
Remaining 10% will require less medication to treat symptoms
90% of patients experience resolution of high blood pressure
70% experience significant reduction in cholesterol and triglyceride levels

Are there any potential side-effects of this treatment?

Some patients experience weight loss (on average 30-40 lbs) which is usually regained after six months
Patients will need to take vitamins long term

Who is a candidate for this treatment?

The following people are candidates for this treatment:

Between 20 and 60 years old
BMI between 25 and 35
Taking oral agents to control T2DM for a maximum of eight years
Glycosylated hemoglobin Index (HbA1c): more than 6.5
Patients with a BMI over 35 can have traditional gastric bypass surgery which offers similar benefits with regards to diabetes resolution

Who is not eligible for this treatment?

Patients with diabetes Type I
More than 10 years of T2DM diagnosis
Previous abdominal operations above the navel
Present or previous history of ventral hernia
History of gallbladder disease
Present or previous history of duodenal ulcer disease
Any terminal Illness
Coagulopathy
Hepatitis C
HIV
Significant medical comorbidities that preclude a surgical procedure
Pregnancy
Liver cirrhosis

Is this surgery available in North America?

In North America, bariatric surgery for type 2 diabetes is typically only considered for those with a BMI >35. It is covered, in these instances, under some insurance plans in the United States. In Canada, again, it is only considered for those who are considered morbidly obese, but there are very long wait times.

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