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Does Diabetes Cure With Surgery?

Does Diabetes Cure With Surgery?

• Diabetes is the leading cause of death in Mexico

• 415 million people worldwide have diabetes. In Mexico there are 6.4 million who have been diagnosed.

• 193 million people with diabetes in the world do NOT know that they have it.

• China, India, USA And Russia are the countries with the most diabetes in the world.

• Every 6 seconds a person with diabetes in the world dies.

• Only 1 in 4 people have good metabolic control.

• 16% of patients with diabetes have no health protection.

• 47% have also been diagnosed with hypertension.

What is it?

• It is a chronic disease that is triggered when the pancreas does not produce enough insulin (a hormone that regulates blood sugar, or glucose, in the blood), or when the body can not effectively use the insulin it produces.

• This deterioration causes potentially life-threatening health complications.

• A person with diabetes does not absorb glucose properly, and it is circulating in the blood (hyperglycemia) and damages tissues over time.

symptom

• Blurry vision

Thirst

• Fatigue

• Urinate a lot

• Hungry

• Thick and dark skin on the neck, armpit. It happens by the insulin resistance this cause pigmentation and growth of the skin.



How can we avoid this disease?

• Ideal weight

• Eat healthy and high in fiber

• Avoid foods high in carbohydrates such as soda and sugary drinks

• Eliminate industrialized foods

• Doing physical activity

• Preventive measures (bariatric surgery)

• And of course if you have obesity or family history go to medical evaluation.

How is this disease treated?

• The first thing to do is to have an accurate diagnosis, then modify the diet and increase physical activity.

• Following this comes a cascade of medications that can be used gradually for the control of blood glucose.

• This is a complex issue and we will focus on providing the basis for patients to know that with 1 surgery they can have complete remission of their diabetes without using medication or diet.

So does diabetes cure with metabolic surgeries?

What are they?

Metabolic surgery is what helps us to have control not only of the patient's weight, but also of diabetes, dyslipidemia, hypertension and sleep apnea.

How did this start?

• An international consensus was reached in July 2016, "The 2nd Diabetes Surgery Summit (DSS-II)" with the idea of ​​developing global guidelines for the benefits of surgery for diabetes treatment.

• A group of 48 specialists, 75% of whom were not surgeons, studied a lot of research where they found that metabolic surgery (gastric bypass, gastric sleeve) causes excellent control of glucose, decreases cardiovascular risk, Hypertension, sleep apnea, cancer, etc.

• The American Diabetes Association (ADA) recommends bariatric surgery for the treatment of patients with a BMI greater than 35 kg / m2sc.

• The STAMPEDE study published in February 2017 in the New England Journal of Medicine compared the results obtained in patients with type II diabetes mellitus with intensive medical treatment (diet, exercise and oral hypoglycemic agents) against Patients with surgical treatment (gastric sleeve and gastric bypass).

• 45% of patients receiving surgical treatment had a total remission of disease compared to less than 2% of patients receiving intensive medical treatment.

What is the mechanism of glucose control?

It is not magic how the surgery allows to have control of the glucose, there are 4 basic concepts:

• Decreases body fat, fat blocks the function of insulin, when losing weight insulin works better.

• It decreases the presence of a hormone called ghrelin, this hormone has two functions to give appetite and block insulin. When doing the procedure the levels of ghrelin go down consequently the patient is not hungry and the insulin works better.

• When food reaches a distant segment of the small intestine, hormones such as GLP1, GIP, and PYY are elevated that promote the proliferation of insulin-producing cells and increase insulin secretion.

• The food no longer passes through the area of ​​greater glucose absorption, the duodenum.

• The gastrointestinal tract is conceived as the largest endocrine organ in the body, expresses more than 30 genes of intestinal hormones, more than 100 bioactive peptides are distributed in it.



The advantages of bariatric surgery over medical treatment are:

• Normalization of glycosylated hemoglobin. (Average glucose in 3 months).

• 45 to 65% chance of remission of diabetes in 48 months. (Or more depending on the reference study).

• Decreased insulin or medication in those patients in whom no remission occurred.

• Avoid complications related to Diabetes.

Who should operate?

• Obese with a BMI greater than 30

• Have less than 10 years of being diabetic

• It does not matter if they use pills or insulin

• Have poor glucose control even with medical treatment and hygiene measures

• Another indication is to Prevent Diabetes, it can be done in those patients with obesity and insulin resistance or obesity and family history of diabetes.

What are metabolic surgeries?

GASTRIC MANGO (Tubular gastrectomy)

WHAT TO DO: Restriction procedure

• It is done laparoscopically and consists of removing most of the stomach.

• The left portion of the stomach is removed, which includes the gastric fundus, where most of the appetite-stimulating hormone called Ghrelin is produced.

• It decreases the capacity of the stomach when performing a vertical gastroplasty and the levels of ghrelin are reduced significantly.

• Recovery is fast, but requires approx. 2 days of hospitalization.

RESULTS: In one year, the loss of excess weight goes from 35-90%

• There will be a drop in weight because having a smaller stomach, will be filled with less food and also have a noticeable decrease in appetite

FOR WHOM IT IS:

• Patients who have a Body Mass Index ≥ 40 (Morbid Obesity) or a Body Mass Index ≥ 33 and who have a disease associated with obesity such as diabetes, high blood pressure, high cholesterol, etc.

• Patients who present with Super Obesity Morbid (BMI ≥ 60), since for them the risk of intra and postoperative complications is very high.



GASTRIC BYPASS

WHAT THEY DO TO YOU


• It is the most widely performed bariatric surgery in the world and is considered by the American Society of Bariatric and Metabolic Surgery (ASMBS) as the gold standard of surgeries for weight loss.

• Mixed surgical procedure; Combines a restrictive element (decreases the amount of food that can be ingested), with a component that does not allow most of the food ingested to be absorbed by the body.

• When performed laparoscopically, it offers all the benefits of minimally invasive surgery: less pain and faster recovery.

• It is the most assiduous operation: it has been done since 1966, it has passed the test of time, being the only operation that has been going on for more than 30 years

RESULTS

• There is a low rate of reoperation due to long-term failure, loss of 65-75% overweight at 5 years and that help more than 75% of patients

FOR WHOM IT IS

• Patients with high rates of obesity, Morbid Obesity (BMI ≥ 40), or Super Obesity Morbid (BMI ≥ 50) with some associated metabolic diseases such as Type II Diabetes Mellitus or Metabolic Syndrome (glucose intolerance, hyperinsulinism, hypertension, high triglycerides).

bypass
Myths

• Myth 1. Any overweight person can undergo metabolic surgery

• Myth 2. There will be no changes in my life after surgery.

• Myth 3. If I am very anxious about food, that anxiety will disappear as soon as it is operated on.

• Myth 4. Regardless of what I eat, I will not regrow.

• Myth 5. After surgery I will only be able to eat ground foods.

• Myth 6. After the operation, the discomforts will prevent me from doing my normal life.

• Myth 7. Operate in simple, you just have to want it.

• Myth 8. Hair falls and nails weaken after surgery.

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