Everyone knows that diabetes damages the kidney makes us blind by damaging the retina of the eye causes damage and invades the blood vessels & nerves, thus resulting in silent heart attacks, diabetic foot resulting in amputation & septicemia and even deaths. Thus, Metabolic surgery coming up in a big way.
|| Monika Agarwal
Over 1/5th of the population in urban areas in India is diabetic & every 7th person with diabetes has diabetic eye disease in India as reported in the BMJ, opth journal in 2019.
Diabetes has become the 5th leading cause of blindness over the globe ( Indian opt. 2018).
According to the WHO Oct 2018 position statement, the Global prevalence of DM II was more than 8.5 % in 2014 in the adult population. Adults with diabetes have a 2-3 times increased risk of heart attack.
In 2016, 1.6 million deaths were directly caused by diabetes (kidney failure, heart attack, stroke, etc.)
India is known as the diabetes capital of the world with > 70 million diabetics, as reported by the international diabetes foundation. This number will cross 123 million by 2040.
More than 1,50,000 people in India are waiting for renal transplantation. One out of 30 people who need a kidney get one. 90% of the people on the waiting list die without getting an organ (MAMC Journal 2016).
In India, Every year > 100,000 new patients are diagnosed with kidney disease. Diabetes & hypertension are the major causes of renal failure (March 2019, India today).
How metabolic surgery control type 2 diabetes?
DR. KS KULAR, BARIATRIC SURGEON, MBBS, MS, F.M.A.S. says Metabolic surgery bypasses the first part of the intestine & makes the food reach a newer point on the intestine which is at least 5-8 feet away from the first part of the intestine (D1)
The old sensor( D1) gets used to the carbs & sugars which we were eating for the past 20-30 years & thus becomes numb and starts sending poor signals to the pancreas, causing raised blood sugar, although, as such, the pancreas is normal ( This is type 2 diabetes)
The new sensor now starts working:
The new part of the intestine starts getting direct food from the stomach after metabolic surgery. When we eat sugar/carbohydrates (like bread/chapati/biscuits etc), these directly touch the new part on intestine & thus releasing high amplitude signals to the pancreas, which in turn causes a sudden release of insulin, thus controlling the blood sugar.
The new sensor starts working afresh, sending high amplitude signals, thus controlling the blood sugar in type 2 diabetes.
What different types of surgeries are available?
DR. KS KULAR, BARIATRIC SURGEON, also says There can be more than a dozen types of procedures that can change the G-I system in such a way that the food releases into the distal intestine.
RNY Gastric Bypass, Mini Gastric Bypass, Omega loop/one anastomosis bypass, Ileal interposition, Duodeno-jejunal bypass (DJB), etc.
Can these surgeries be performed in all diabetic patients?
No, this metabolic surgery is reserved for those patients who have the following:
Body Mass Index of 30 kg/m2 but with poorly controlled diabetes. For Asians, the BMI is 27.5 kg/m2. These guidelines were published in ‘ diabetes cure’, USA, by the American Diabetes Association in the year 2016.
Since the publishing of these guidelines, there has been dramatic in the metabolic surgery number all around the world.
Precautions after surgery:
When we bypass the intestine, the absorption of vitamins, proteins, and iron, etc. also decreases. So, these patients need to focus on health, should take a high protein diet, regular vitamins, get their blood work done every 6 months to rule out any deficiencies. But the medical advantages outweigh the side effects & overall, metabolic surgery is a good option for uncontrolled diabetes.