Diabetes and bariatric surgery procedures

Diabetes often accompanies excessive body weight and is a reason for bariatric surgery. However, patients often fear such surgery because they think that the recovery period after the operation will be prolonged and the diabetes itself will negatively affect the weight loss process. Nothing could be further from the truth.

What is the relationship between diabetes and obesity?

Obesity is a disease manifested by a BMI starting at 30-35kg/m2. With the development of obesity, insulin resistance increases. Insulin is a hormone that is responsible for glucose metabolism. Moreover, insulin acts to stimulate the need for appetite. When there is an extra energy balance, insulin concentration rises, while the metabolism switches to storage rather than burning. Abdominal obesity raises the risk of developing diabetes and cardiovascular disease, while also making it more difficult to treat them and control blood sugar levels. It is worth considering that almost 80% of people struggling with diabetes suffer from obesity.

Can people with diabetes undertake bariatric surgery?

Diabetics can undergo bariatric surgery because it has very good effects not only on weight reduction, but also on decreasing blood sugar levels. Diabetes is an additional indication for bariatric surgery. More than half of those struggling with diabetes have seen significant improvements in their health after undergoing surgery. Studies have shown that undergoing bariatric surgery significantly reduces patients’ need for diabetes treatment. Depending on the severity of the disease, this could be a reduction in the administration of medication or the complete withdrawal of diabetes medications. Nevertheless, the progress of treatment is determined by the stage of diabetes at the time of the decision to undergo surgery. The less developed the diabetes, the better, as the likelihood of successful surgery is higher.

Is bariatric surgery dangerous for diabetics?

Any surgery is dangerous for people struggling with diabetes, as the formation of wounds risks problems with the healing process. However,  there is a dedicated type of bariatric surgery for diabetics, which makes the likelihood of complications negligible. Diabetics usually undergo Gastric Sleeve surgery – a sleeve gastrectomy or mini Gastric Bypass – these are done entirely laparoscopically. In the case of sleeve gastrectomy, the surgeon, through four small incisions, reduces the current stomach by about 75-80% in volume and takes away the part of the stomach responsible for the secretion of the hunger hormone – the so-called ghrelin. In the case of the mini Gastric Bypass in four to five places, the Surgeon makes small incisions on the abdomen and divides the stomach into two parts. The upper one, which is the size of a chicken egg, is connected to the intestine. This allows food to reach the small intestine faster, which has a huge impact on metabolism.

What does remission look like in this situation?

According to a Danish study, about 75% of people who underwent bariatric surgery experienced diabetes remission within 12 months of surgery. Within six months of surgery, 65% of patients went into remission. The percentage rose to 74% in the following six months. Diabetics taking insulin before surgery had 43% lower remission rates than those diabetics who did not use insulin. The rates relative to those not undergoing surgery are also promising. Patients who underwent the surgery were less likely to experience diseases associated with advanced diabetes (e.g., microvascular complications, eye problems, kidney problems) by more than 40%.

Bariatric surgery performed laparoscopically can significantly improve a diabetic’s health. If the patient undergoes surgery in the early stages of diabetes, there is the possibility of long-term remission and living virtually as well as a healthy, thin person. However, for this to happen, the patient must adhere to medical restrictions.