Tuesday, 7 February 2017

Diabetes: Does Surgery have any role in treatment of Diabetes? What is Metabolic Surgery?

Diabetes currently affects more than 150 million people worldwide and that number is expected to quickly increase. Over 90% of people with the disease have the Type 2 form, which is associated with obesity and overweight, lack of physical activity, family history and older age. Unlike Type 1 diabetes in which the pancreas fails to produce sufficient insulin, the pancreas in patients with Type 2 diabetes produces enough insulin, but for unknown reasons, the body is unable to use the insulin. Diabetes can lead to blindness, heart and blood vessel disease, strokes, kidney failure, amputations, and nerve damage. Current therapies, which include diet, exercise, oral antidiabetic drugs and insulin, do not always cure the disease.

The goal of treatment is to improve the symptoms of diabetes through normalizing blood glucose levels. The ongoing goals are to prevent long-term complications like eye and kidney disease, damage of nerves and blood vessels. Strict control of blood glucose reduces risk of death, stroke, heart failure, and other complications. Glycosylated hemoglobin (HbA1C) is a test that determines risk for long-term complications. It measures how much glucose has been sticking to red blood cells and other cells. The first-line treatment for type 2 diabetes is weight lost, diet and exercise. Appropriate meal planning includes choosing healthy foods and eating the right amount of food. Exercise is important for effective treatment of diabetes. Regular exercising helps burning excess calories, managing weight thus improves control of the glucose amount in the blood. 2 When diet and exercise are not sufficient to maintain normal blood glucose levels, medications may be needed. They work through triggering the pancreas to make more insulin, helping insulin work better, decreasing the absorption of carbohydrates from the gut or decreasing glucose production in the liver. Poor blood glucose control despite lifestyle changes and taking medications means insulin should be injected.

Despite continuing advances in diabetes pharmacotherapy, fewer than half of adults with type 2 diabetes mellitus (T2D) attain therapeutic goals designed to reduce long-term risks of complications, especially for glycemic control, and lifestyle interventions are disappointing in the long term. Metabolic surgery, on the other hand, has been shown to improve glucose homeostasis more effectively than any known pharmaceutical or behavioral approach.
For the patients having diabetes for les than 5 years there is a high lifelihood of  achieving normal blood sugar levels wihout any medications. If the person is obese and not yet requiring Insulin his chances of compelte stopage of medication and still acheiving normal sugar levels are very high. If they are having very poorly controlled diabetes , are on high dose of insulin and are having diabetes for a very long time, surgery helps in acheiving normal sugar levels with decresed requirements of Insulin and medications. Such patients may still need medications but they can achieve good glycemic control leading to prevention of diabetes related complications
While Metabolic surgery( Surgery for Diabetes) certainly has some risk, the long-term risk of continued diabetes (which is often inadequately treated with medication) typically outweighs the risk of a surgical procedure for most patients. Each patient’s individual risks for surgery, though, should be evaluated in the context of the duration and severity of their diabetes as well as their other obesity-related health problems.

A key finding of many studies is that the shorter the history of diabetes, the greater the likelihood of complete remission. Glucose toxicity, particularly in poorly controlled diabetes, accelerates B-cell failure. B-cells are located in the pancreas and produce and secrete insulin. Weight loss can improve B-cell responsiveness to glucose. If the bariatric surgical procedure is performed before irreversible B-cell failure has occurred, durable weight loss will be accompanied by a high likelihood of long-term remission.

Tuesday, 20 September 2016

Do not Ignore your Obesity- There is a solution to all your problems

Do not Ignore your Obesity- There is a solution  to all your problems

There has been a significant rise in obesity in the last decade, but obesity has been a part of our society since long. It was not considered seriously  due to lack of surgery for it and a degree of hopelessness in finding its solution. Excuses, denials and turning their face from the truth was a normal thing for all obese persons. It was also quite common for the society to consider obese persons less active and helpful and to a certain extent, a burden to the society. The attitude of society was one which made more problems for them than helping them. Their lack of control for eating and  inability to do physical activity was considered very negatively by society making their condition worse. This increased their psychological  problems as well as  their non acceptance of obesity and decreased their efforts to reduce weight.
There is still an argument by normal nonobese persons regarding bariatric surgery- that why a surgery for a condition like obesity which can be cured by diet and exercise? They all feel that it is a lack of effort and commitment from the obese person if they are not able to loose weight. It is certainly not true. Only an obese person can understand that with significant obesity loosing adequate amount of weight and maintaining it is almost impossible even with all effort and commitment.
Obesity related health hazard is also not new with India being one of the leading countries in no of diabetes, knee osteoarthritis and heart problem patients.
But now things have changed to a great extent. With the availability and a great amount of experience with bariatric surgery there is a ray of hope for obese persons. Those who are on a higher side of their weight,  have failed in multiple attempts of weight loss with diet and excercise, have diabetes, breathing problems, have knee problems limiting their mobility severly have still hope in bariatric surgery that can lead them back to a normal life led by all other people surrounding them.
This has lead to greater confidence in accepting that they are obese, that they have a problem and they want to solve it. A positive attitude is seen in their attempt to loose weight with diet modification and exercise. A confidence in demanding surgery to regain back their health is seen. Obese people have started becoming proactive in loosing weight and leading a normal healthy and active life. And miracles happen after bariatric surgery and weight loss. All our patients feel they are living a totally different life. Their relatives and friends see a different person in them. With freedom from lot many medical problems like diabetes, breathing problems, knee problems and with a increase in their mobility in general, they feel a new enthusiasm, a new zest for life. Patients themselves and all surrounding them see a very active and enthusiastic person in them. Its like a rebirth of that person.