Type 2 diabetes is a long term metabolic disorder in which afflicted patients have elevated sugar (or glucose) in their blood.  It is the most common form of diabetes, accounting for approximately 95% of all cases according to the American Society for Metabolic and Bariatric Surgery.

Type 2 diabetes occurs because of a condition called Insulin resistance.  Insulin is a hormone released by the pancreas in response to a meal containing sugar or carbohydrates.  Insulin’s job is to lower the amount of sugar circulating in the blood by making it enter the cells.  When people are Insulin resistant, their bodies need to produce extra amounts of Insulin to effectively lower the amount of sugar in their blood.  The cells are not “listening” to the Insulin, so more and more of the hormone is produced in order to get the same effect.

 

The association between obesity and Insulin Resistance, or Type 2 diabetes, is undergoing much research.  There are several explanations of why people who suffer from obesity are more likely to develop diabetes.  One thought is that increased visceral fat (or fat that is found around abdominal organs) leads to “fatty liver” which in turn impairs effective signaling by Insulin.  Another explanation is that visceral fat causes inflammation and disrupts the Insulin signaling pathways.

For patient who are obese, some medical treatments for diabetes, such as insulin, actually cause patients to gain more weight, leading to a vicious cycle of weight gain, worsening blood sugars, higher doses of insulin, etc.

Given its prevalence and effect on our health, patients and physicians alike are consistently searching for ways to improve the symptoms or resolve the condition completely.

Bariatric surgery – gastric sleeve and gastric bypass –  is the most effective treatments for Type 2 diabetes.  These surgeries can break the cycle lowering a patient’s blood sugar and improving any health problems related to her diabetes.  In fact, post bariatric surgery, Type 2 diabetes is resolved in more than 82% of patients*

While many people know that Type 2 diabetes and obesity are related, most do not realize that it is the hormonal effects of weight loss surgery, in addition to weight loss, that help improve a patient’s blood sugar. This is evident in patients who have gastric bypass or sleeve gastrectomy, who may not need to take their diabetes medication after surgery, even before they start losing significant amounts of weight.  The improved blood sugar levels result from changes in certain signals from the gut to the brain, liver, and muscles after a person’s anatomy has been changed with surgery.  To date, there is no pill or injectable form of medication that can mimic these metabolic effects of surgery.

 

 

Diabetes Sources:

*Schauer PR, Ikramuddin S, Gourash W, et al.  Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity.  Ann Surg 2000; 232(4): 515-29

*Wittgrove AC, Clark GW.  Laparoscopic gastric bypass, Roux-en-Y – 500 patients; technique and results, with 3-60 month follow-up.  Obes Surg 2000; 10(3): 233-9.

* Schauer PR, Brugera B, Ikramuddin S, et al.  Effect of laparoscopic Roux-en-Y gastric bypass on type 2 diabetes mellitus.  Ann Surg 2003; 238(4): 467-84; discussion 84-5.