Surgery as a treatment for diabetes

========================== Despite the various treatment methods to control diabetes, in some cases, these methods are not enough and patients need other treatment options. Metabolic surgeries and gastric bypass, especially in type 2 diabetes, have been considered as an effective treatment option. In metabolic surgery, the goal is to modify the metabolic pathways of the body to improve the production and function of insulin in the body. Surgery is considered as a treatment option for diabetes when the patient is unable to control his blood sugar through other methods. Surgery can help with weight loss, which is associated with obesity in many type 2 diabetics. In some patients, surgeries can improve blood sugar levels immediately and eventually eliminate the need for diabetes medications. In fact, metabolic surgeries cause changes in the intestines and body metabolism that improve insulin sensitivity and reduce glucose production in the liver. This treatment is especially useful in patients who are insulin resistant and do not respond to medications. Surgery as a treatment for diabetes The use of surgery in the treatment of diabetes, especially type 2 diabetes, has a relatively long history. In the past, surgeries were considered more of a last resort when medication and lifestyle changes failed to control a patient's blood sugar. But with scientific and medical advances, metabolic surgeries have been increasingly proposed as an effective option in the treatment of diabetes. Initially, surgeries such as gastric bypass surgery were performed to treat obesity, but over time, doctors realized that these surgeries have significant effects in improving blood sugar control in patients with type 2 diabetes. The first scientific reports on the effect of gastric bypass surgery in improving diabetes were published in the 1980s. Early studies showed that many patients did not need diabetes medications after this surgery, and in some cases even their blood sugar returned to normal levels. Until the early 2000s, the use of surgery to treat diabetes was considered a new and research method. During this period, doctors and researchers focused more on metabolic surgeries and their effects on diabetes control, and more studies were conducted in this field. At this time, new concepts such as intestinal rerouting and metabolic surgeries were introduced in an attempt to improve insulin sensitivity and reduce glucose levels in the body. Introduction of various surgeries used to treat diabetes Today, there are several types of surgery to treat diabetes, especially type 2 diabetes, which we will explain below: - **Gastric Bypass Surgery:** Classical gastric bypass surgery is one of the most common surgeries to treat obesity and type 2 diabetes. In this surgery, a part of the stomach and small intestine is removed from the digestive tract, which changes reduce calorie absorption and improve blood sugar control. This surgery is effective in many patients with type 2 diabetes due to its effect on weight loss and improving insulin sensitivity. - **Gastric mini bypass surgery** **(Gastric mini Bypass):** The biggest difference between this surgery and classic bypass is the smaller size of the surgery. Also, the small intestine undergoes less changes in this method compared to the classical method. The duration of the surgery is shorter than the classic type. - **Roux-en-Y Gastric Bypass Surgery** **(Roux-en-Y Gastric Bypass):** This type of surgery is one of the gastric bypass methods that specifically focuses on changing the path of the intestines. In this surgery, a part of the small intestine is directly connected to the stomach, which leads to a reduction in calorie absorption and improved metabolism. In addition to helping to lose weight, this surgery can have a great effect on blood sugar control in diabetic patients. Sleeve Gastrectomy: In this surgery, a part of the stomach is removed to reduce the volume of the stomach. This surgery reduces appetite and food absorption and is especially useful for patients with type 2 diabetes who are obese. Gastric sleeve can have a significant effect on improving blood sugar control. Pancreas Transplantation: This surgery is usually performed for patients with type 1 diabetes and in severe cases of the disease. In this surgery, a new pancreas from a donor is transplanted to the patient to restore insulin production in the patient's body. The surgery is considered an advanced treatment for type 1 diabetes, but it has its limitations, including the need for immunosuppressive drugs to prevent graft rejection. Surgery as a treatment option for diabetes started from ancient times and over time with scientific and medical advances, especially in the field of metabolic surgeries and gastric bypass, it has gained a special place. These surgeries not only help patients lose weight, but can also have positive effects in controlling blood sugar and improving insulin sensitivity. Further research and developments in this field promise a bright future for the use of surgery in the treatment of diabetes, especially in patients with type 2 diabetes. How surgeries affect insulin function and glucose metabolism One of the most important parts of therapeutic surgeries for diabetes is their effect on insulin action and glucose metabolism. In diabetes, especially type 2 diabetes, the main problems are related to decreased insulin sensitivity and increased glucose production in the liver. Various surgeries can help improve these disorders through changes in the structure of the digestive system, hormones and metabolic systems. ### 1-Effect on insulin sensitivity: Surgeries such as gastric bypass and gastric sleeve can have a great effect on increasing the body's sensitivity to insulin by changing the path of the intestine and reducing the volume of the stomach. In type 2 diabetes, one of the main problems is insulin resistance, meaning that the body's cells are unable to properly use insulin to absorb glucose. Metabolic surgeries help improve insulin sensitivity through weight loss, changes in gut microbiome composition, and hormonal changes. After surgery, changes occur in the levels of hormones such as glucagon-like peptide 1 (GLP-1) and pancreatic peptide (PPY), which help improve insulin action and reduce glucose release from the liver. These changes allow the body to use insulin more effectively and reduce the need for diabetes medications. ### 2-Reduction of glucose production in the liver: Another effect of diabetes surgery is to reduce glucose production in the liver. In patients with type 2 diabetes, the liver abnormally produces more glucose, which is especially problematic during times of fasting or when insulin levels are low. Surgeries such as gastric bypass and intestinal rerouting can inhibit glucose production in the liver by changing hormonal pathways and reducing glucose levels in the intestine. Changes in hormonal signals after surgery cause the brain and liver to notice the need to reduce glucose production. In other words, these surgeries change the body's metabolic signaling systems and make the body produce less glucose and use it better. ### 3-Hormonal effects and digestive systems: Metabolic surgeries, especially gastric bypass, cause significant changes in the production and release of gastrointestinal hormones. These hormones directly affect glucose metabolism. For example, after these surgeries, the level of GLP-1 and GIP (Gastric Inhibitory Peptide) increases, which help to increase insulin secretion and decrease glucose secretion from the liver. Also, the change in the intestinal structure and the activity of intestinal enzymes can help to better absorb glucose and reduce insulin resistance. Surgery is known as one of the effective treatment options for type 2 diabetes. Advantages and disadvantages of surgery as a treatment for diabetes Surgery as a treatment option for diabetes, especially type 2 diabetes, has received increasing attention in recent years. These treatments, especially metabolic surgery and gastric bypass, can have dramatic effects in some patients and improve blood sugar control. However, like any other treatment, surgeries have their own advantages and disadvantages that should be carefully considered. In this section, the advantages and disadvantages of surgery as a treatment for diabetes are discussed. ### Advantages: - **Reduction of drug dependence** One of the biggest advantages of diabetes treatment surgeries is reducing or even eliminating the need for diabetes medications. After surgeries such as gastric bypass or gastric sleeve, many patients will be able to control their blood sugar without needing to take diabetes medications. These surgeries help to better control blood sugar by improving insulin sensitivity and reducing glucose production in the liver. In some cases, patients with type 2 diabetes clearly see a reduction in the need for insulin and other antidiabetic drugs after surgery. These changes may greatly improve the patient's quality of life and prevent the side effects of long-term diabetes medications, such as hypoglycemia and digestive problems. - **Improving blood sugar control** Metabolic surgeries, especially gastric bypass and gastric sleeve, have a significant effect on improving blood sugar control. These surgeries are able to regulate the level of glucose in the body by reducing the absorption of food and changing the function of the hormonal and digestive system. Changes in the level of hormones such as GLP-1 and pancreatic peptide after surgery improve insulin secretion and reduce insulin resistance. For example, patients with type 2 diabetes who have not been able to control their blood sugar due to insulin resistance will see a decrease in blood sugar levels and improved insulin efficiency in the body after surgery. These changes can help patients gain better control of their disease and prevent complications from diabetes, such as heart, vascular, and kidney problems. - **Reducing the risks of side effects of diabetes** Uncontrolled diabetes can lead to serious and life-threatening complications. These complications include cardiovascular disease, stroke, kidney damage, blindness, and neurological problems. Metabolic surgeries and gastric bypass can have positive effects in reducing the side effects of the disease by improving blood sugar control and reducing the risks associated with diabetes. Patients who manage to keep their blood sugar at normal levels after surgery are at lower risk of developing serious diabetic complications. Also, some patients are able to lose significant weight after surgery, which helps to reduce the pressure on the cardiovascular system and prevent heart diseases. ### Disadvantages: - **Dangers of surgery**: Like any other surgery, surgeries for the treatment of diabetes are also associated with risks. These risks include infection, bleeding, problems with anesthesia, and damage to internal organs such as the intestines and stomach. Surgeries performed specifically for weight loss or to treat obesity may be more complex and require greater care on the part of the surgical team. Additionally, metabolic surgeries that require changes to the bowel or stomach can carry risks such as bowel obstruction, intestinal fissures, or gastrointestinal problems after surgery. These issues may require additional treatments or even corrective surgeries. - **need for long-term care after surgery** Another disadvantage of diabetes treatment surgeries is the need for long-term care after surgery. Patients should be under the continuous supervision of doctors to prevent problems caused by surgery and to monitor their condition after the operation. These cares include monitoring blood sugar levels, diet, and nutritional supplements. Many patients need regular follow-up after surgery to prevent digestive problems, hormonal problems, or nutritional deficiencies. For example, after gastric bypass surgery, the patient must carefully adjust his diet and may need vitamin and mineral supplements. Also, patients should be closely monitored by specialist doctors to avoid serious complications. **Long-term effects and treatment complications** Diabetes treatment surgeries may have long-term effects for some patients that may not be predictable at first. For example, a reduction in stomach volume or a change in the path of the intestines can lead to digestive problems such as indigestion, nausea, or problems absorbing nutrients. These problems can affect the patient's quality of life and require long-term care to manage them. Also, in some cases, surgery may lead to decreased nutrient absorption or vitamin and mineral deficiencies. Post-surgery patients should carefully monitor their nutrition and take supplements seriously to avoid problems caused by nutritional deficiencies. - **Limitations in specific patients** Diabetes treatment surgeries are not suitable for all patients. Patients with certain conditions such as heart problems, breathing problems or severe obesity that require complex surgeries may not be able to undergo surgeries such as gastric bypass or gastric sleeve. In addition, metabolic surgeries may not be appropriate, especially for older patients or those with other serious medical conditions. Also, some patients may not be able to fully follow the new diet and lifestyle after surgery due to psychological problems, which can reduce the effectiveness of surgery. Suitable candidates for diabetes surgery Surgery as a treatment option for diabetes, especially type 2 diabetes, can be very effective for some patients. However, not all diabetic patients respond positively to surgery, and choosing suitable candidates for this type of treatment requires careful evaluation of the patient's physical and medical conditions. In this section, we will examine diabetic patients who can respond to surgery, criteria for selecting suitable candidates for surgery, and necessary preoperative consultations. Diabetic patients who respond positively to surgery Metabolic surgeries, such as gastric bypass, gastric sleeve, and similar surgeries, are usually appropriate for patients who do not respond to other diabetes treatments. These treatments are often recommended when lifestyle changes and medications fail to control blood sugar. Patients who typically respond favorably to diabetes surgeries typically have the following characteristics: - **Treatment-resistant type 2 diabetes**: Patients who have type 2 diabetes and have not been able to control their blood sugar using medications, lifestyle changes, or diet, are usually good candidates for diabetes surgery. In these patients, insulin resistance and increased glucose production in the liver make the usual treatments ineffective. - **Obesity and overweight**: Metabolic surgeries are usually recommended for obese or severely overweight patients who have diabetes. Obesity is one of the main causes of type 2 diabetes and weight loss after surgery can have a great effect on improving insulin sensitivity and blood sugar control. - **Failure in other treatments**: Diabetic patients who have not responded to drug treatments and lifestyle changes and whose blood sugar is still high, may need surgery. Especially if the patient has serious diabetic complications such as heart disease, kidney problems or nerve damage, surgery can be an effective solution to improve his condition. - **Suitable age group**: usually younger and healthier patients who can tolerate surgery and avoid its side effects, respond more positively to surgery. Older patients who have heart problems or other chronic conditions may not be good candidates for surgery. Criteria for selecting suitable patients for surgery Choosing the right patients for diabetes surgery requires a comprehensive assessment of the patient's physical, medical and psychological conditions. These assessments help doctors make more accurate decisions about diabetes surgery. Patient selection criteria for surgery generally include the following: - **Body mass index (BMI)** One of the main criteria for selecting surgical candidates is body mass index (BMI). In most cases, patients with a BMI greater than 35 who have type 2 diabetes and have failed to lose weight with medications and lifestyle changes are good candidates for metabolic surgery. In some cases, if the BMI is between 30 and 35 and the patient has other medical problems related to diabetes, surgery may be recommended. - **Age of the patient** The age of the patient is also one of the important factors in the selection of surgical candidates. Metabolic surgeries are usually best suited for people under 65 years of age, as older patients may experience more risks, including problems with anesthesia, surgical complications, and prolonged rehabilitation. However, in some cases, older patients in good general condition may be good candidates for surgery. - **General health of the patient** Patients must have a good general physical condition to tolerate the surgery. This includes checking the condition of the heart, respiratory and other vital organs. Patients with heart, respiratory, or other chronic conditions such as kidney, liver, or severe infections should undergo a more careful evaluation. - **Improper Blood Sugar Control** Patients who are unable to control their blood sugar with conventional medications or lifestyle changes, and whose blood sugar remains at a high level, are usually good candidates for surgery. Also, patients who have complications of diabetes and the usual treatments have not worked effectively, should be carefully examined. **Absence of severe mental problems** Mental health is also important for selecting candidates for diabetes surgery. Patients should have the ability to follow basic changes in their diet and lifestyle and be ready to accept surgery and follow up post-operative care. In some patients, psychological problems such as depression or anxiety disorders can prevent successful follow-up of treatment after surgery. Choosing the right patients for diabetes surgery requires careful evaluation of the patient's medical, psychological and nutritional status. Diabetic patients who have not responded to drug treatments and lifestyle changes and have suitable conditions for surgery can benefit from this treatment. **To receive a visit (online or in person) with Dr. Yazdan Panah, fill out the form below**