Dr AvinashTank, is a super-specialist (MCh) Laparoscopic Gastro-intestinal Surgeon,

Metabolic Surgery

Amazing Facts about Diabetes

  • Global Prevalence: Diabetes is a global health concern, with an estimated 463 million adults worldwide living with diabetes in 2019. This number is expected to rise to 700 million by 2045. (Source)
  • Insulin Discovery: Insulin, a hormone responsible for regulating blood sugar levels, was discovered in 1921 by Sir Frederick Banting and Charles Best. This breakthrough revolutionized the treatment of type 1 diabetes and saved countless lives. (Source)
  • Types of Diabetes: There are different types of diabetes, including type 1 diabetes, type 2 diabetes, and gestational diabetes. Each type has its own causes, risk factors, and management strategies. (Source)
  • Diabetes and Mental Health: Diabetes can have an impact on mental health, and individuals with diabetes may experience increased stress, anxiety, and depression. It is important to address the emotional well-being of individuals with diabetes and provide them with the necessary support and resources. (Source)

4 Reasons for Early Treatment of  Diabetes

  1. Blood Sugar Control: Early treatment of diabetes helps in achieving and maintaining optimal blood sugar control. This reduces the risk of long-term complications associated with high blood sugar levels, such as cardiovascular disease, kidney damage, nerve damage, and vision problems.
  2. Prevention of Complications: Diabetes can lead to various complications, including heart disease, stroke, kidney failure, eye damage, and nerve damage.
  3. Lifestyle Modifications: Early treatment provides an opportunity for individuals to make necessary lifestyle modifications, such as adopting a healthy diet, engaging in regular physical activity, and maintaining a healthy weight. These lifestyle changes are crucial for blood sugar control, weight management, and overall health.
  4. Education and Support: Early treatment allows individuals to receive education and support from healthcare professionals, diabetes educators, and support groups. This helps in understanding the condition, learning self-management skills, and addressing any concerns or questions related to diabetes management.

Complications of Untreated Diabetes

  1. Cardiovascular Complications: Untreated diabetes can lead to various cardiovascular complications, including heart disease, stroke, and peripheral artery disease. Elevated blood sugar levels can damage blood vessels and increase the risk of these conditions.
  2. Kidney Disease: Diabetes is a leading cause of kidney disease, also known as diabetic nephropathy. Untreated diabetes can damage the kidneys over time, leading to reduced kidney function and potentially kidney failure.
  3. Nerve Damage: High blood sugar levels can cause nerve damage, known as diabetic neuropathy. This can result in numbness, tingling, or pain in the extremities, as well as problems with digestion, sexual function, and coordination.
  4. Eye Complications: Untreated diabetes can damage the blood vessels in the eyes, leading to diabetic retinopathy, cataracts, and glaucoma. These conditions can cause vision loss and even blindness if left untreated.

Celebrities who have Diabetes

Tom Hanks

The Oscar-winning actor announced he has type 2 diabetes when late-night host David Letterman commented on his newly slim figure in October 2013. “I went to the doctor and he said, ‘You know those high blood sugar numbers you’ve been dealing with since you were 36? Well, you’ve graduated. You’ve got type 2 diabetes, young man.'” Hanks added that the condition is controllable, but he joked that he couldn’t get back down to his high-school weight of 96 pounds. “I was a very skinny boy!” (Source) 

Salma Hayek

The Oscar-nominee had gestational diabetes, which happens during pregnancy, while expecting her daughter, Valentina. Hayek has a family history of diabetes. Experts say all women should get checked for gestational diabetes when they are 24-28 weeks pregnant. Those at risk for type 2 diabetes are checked at their first prenatal visit. Gestational diabetes usually goes away after delivery, but  it could return with a later pregnancy. It can also make you more likely to get type 2 diabetes later on. (Source) 

Billie Jean King

Tennis champion Billie Jean King was diagnosed with type 2 diabetes at age 63. According to King, she had previously had an eating disorder. (Source) 

Samantha Ruth Prabhu

Popular South Indian Actress was diagnosed with diabetes in 2013. She overcame it with healthy eating and exercising. (Source) 

Nick Jonas

Nick Jonas was diagnosed with type 1 diabetes at the young age of 13. But this never slowed him down. He learned to manage his diabetes with healthy eating and exercising. (Source) 

What is Metabolic Surgery

Understanding Metabolic Surgery

Bariatric surgery that aims to treat the comorbid conditions, such as diabetes mellitus associated with obesity, is generally called metabolic surgery. It has emerged as an effective treatment option for type 2 diabetes, particularly in individuals with obesity or severe insulin resistance. Metabolic surgery works by modifying the gastrointestinal tract to enhance metabolic function and improve blood sugar control.

Types of Metabolic Surgery for Diabetes

  1. Roux-en-Y Gastric Bypass (RYGB): This procedure involves creating a small pouch at the top of the stomach and rerouting a portion of the small intestine. RYGB not only restricts food intake but also alters the gut hormones responsible for regulating blood sugar levels, resulting in improved glycemic control.
  2. Sleeve Gastrectomy: In this procedure, a large portion of the stomach is surgically removed, leaving behind a smaller, banana-shaped sleeve. Sleeve gastrectomy helps control portion sizes and reduces the production of ghrelin, a hormone that stimulates hunger. It has shown promising results in improving blood sugar levels and promoting weight loss.
Additional Types of Metabolic Surgeries for Diabetes-
  1. Biliopancreatic Diversion with Duodenal Switch (BPD-DS): This procedure involves the creation of a small stomach pouch and rerouting the small intestine to bypass a significant portion of the digestive tract. BPD-DS combines a restrictive and malabsorptive component, leading to significant weight loss and improved glycemic control. It has shown favorable outcomes in achieving diabetes remission and reducing cardiovascular risk factors.
  2. Adjustable Gastric Banding: In this procedure, a silicone band is placed around the upper part of the stomach, creating a small pouch. The band can be adjusted to control food intake. While adjustable gastric banding primarily focuses on weight loss, it has demonstrated beneficial effects on blood sugar control in some patients with type 2 diabetes.
  3. Mini Gastric Bypass: This technique involves creating a small stomach pouch and connecting it to a lower part of the small intestine. Mini gastric bypass combines restriction and intestinal bypass, leading to weight loss and metabolic improvements. Although this procedure is less common than traditional gastric bypass, it has shown promising results in diabetes management.
Each type of metabolic surgery offers unique benefits and considerations, and the choice of procedure depends on individual factors such as body mass index, medical history, and surgeon’s recommendation. It is important to consult with a gastroenterologist or bariatric surgeon who specializes in metabolic surgery to determine the most suitable option based on your specific needs.

Who needs Metabolic Surgery

Metabolic surgery, also known as bariatric surgery, may be considered for individuals with obesity and type 2 diabetes who have not achieved adequate blood sugar control through lifestyle modifications and medical management alone. While not everyone with type 2 diabetes is a candidate for metabolic surgery, it may be recommended for those who meet specific criteria. The following are some factors that may indicate the need for metabolic surgery for diabetes reversal:
  1. Obesity: Metabolic surgery is primarily recommended for individuals with a body mass index (BMI) of 40 or higher (severe obesity) or a BMI of 35-39.9 (obesity) with significant obesity-related health complications. Obesity is a significant risk factor for developing type 2 diabetes, and weight loss through surgery can have a positive impact on blood sugar control.
  2. Inadequate diabetes control: Despite attempts to manage type 2 diabetes through lifestyle changes, such as diet and exercise, and medication management, if blood sugar levels remain poorly controlled over an extended period, metabolic surgery may be considered. The goal is to achieve better glycemic control and reduce the reliance on diabetes medications.
  3. Presence of obesity-related comorbidities: Metabolic surgery may be recommended for individuals with type 2 diabetes who also have other obesity-related health conditions, such as high blood pressure, sleep apnea, heart disease, or fatty liver disease. Addressing obesity through surgery can lead to improvements in these conditions, including better management of diabetes.
  4. Patient preference and commitment: The decision to undergo metabolic surgery should involve a comprehensive evaluation by a healthcare team, including a bariatric surgeon, endocrinologist, and other specialists. The patient’s readiness, commitment to long-term lifestyle changes, and understanding of the potential benefits and risks of surgery are important factors in determining the suitability for metabolic surgery.
It is essential to consult with a healthcare professional experienced in metabolic surgery and diabetes management to assess individual eligibility for the procedure. Each case is unique, and a comprehensive evaluation of medical history, current health status, and personal goals will help determine whether metabolic surgery is a suitable option for diabetes reversal.

How to prepare for Metabolic Surgery

Preparing for metabolic surgery for diabetes reversal involves several steps to ensure the best possible outcome and reduce the risk of complications. Here are some general guidelines for preparing for metabolic surgery:
  1. Consultation with a healthcare team: Schedule an appointment with a bariatric surgeon who specializes in metabolic surgery for diabetes reversal. They will assess your medical history, current health status, and suitability for the procedure. You may also consult with an endocrinologist and a registered dietitian to evaluate your diabetes management and nutritional needs.
  2. Medical evaluation: Your healthcare team will perform a thorough medical evaluation to assess your overall health and identify any underlying medical conditions that may affect the surgery. This may include blood tests, imaging studies, and other diagnostic procedures.
  3. Weight loss and lifestyle modifications: Prior to metabolic surgery, your healthcare team may recommend weight loss and lifestyle modifications to improve overall health and facilitate surgical success. This may involve following a specific diet plan, increasing physical activity, and stopping smoking if applicable.
  4. Diabetes management optimization: It is important to optimize your diabetes management before surgery. This may involve working closely with your endocrinologist to adjust your diabetes medications, ensure stable blood sugar levels, and manage any associated complications.
  5. Nutritional counseling: A registered dietitian will provide guidance on preoperative nutrition and dietary modifications. They will help you understand the necessary changes to your eating habits and provide recommendations for a balanced diet to support your overall health and diabetes management.
  6. Psychological evaluation: Metabolic surgery is a significant procedure that can have both physical and emotional impacts. A psychological evaluation may be conducted to assess your mental health, emotional readiness, and support systems. This evaluation helps ensure that you are mentally prepared for the lifestyle changes that come with metabolic surgery.
  7. Education and support: Attend educational sessions or support groups offered by your healthcare team. These sessions provide valuable information about the surgery, recovery process, and long-term lifestyle changes. They also provide an opportunity to connect with others who have undergone similar procedures.
It is crucial to closely follow the guidance of your healthcare team and adhere to their recommendations for preparation. Each individual’s preparation may vary based on specific health needs and the type of metabolic surgery planned. Your healthcare team will provide personalized instructions to ensure you are well-prepared for the procedure and have a successful outcome.

Benefits of Metabolic Surgery

  1. Improved Blood Sugar Control: Metabolic surgery has been found to induce remission or significant improvement in type 2 diabetes. Many patients experience a substantial reduction in blood sugar levels, decreased insulin resistance, and reduced dependency on diabetes medications.
  2. Weight Loss and Metabolic Benefits: Metabolic surgery promotes significant and sustained weight loss, leading to improved overall metabolic health. It helps reduce obesity-related inflammation, improves lipid profile, and lowers blood pressure, contributing to a reduced risk of cardiovascular complications.
  3. Potential Remission of Diabetes: In some cases, metabolic surgery can result in long-term diabetes remission, where blood sugar levels remain within the normal range without the need for diabetes medications. Remission rates vary among individuals, and regular follow-up care is essential for monitoring and maintaining glycemic control.
  4. Additional Health Benefits: Metabolic surgery can have a positive impact on other obesity-related comorbidities, including hypertension, sleep apnea, and non-alcoholic fatty liver disease. It can also lead to improvements in quality of life, increased mobility, and enhanced psychological well-being.

Risks of Metabolic Surgery

Metabolic surgery, like any surgical procedure, carries certain risks. These can include infection, bleeding, gastrointestinal complications, and vitamin/mineral deficiencies. It is crucial for individuals considering metabolic surgery to have a comprehensive evaluation by a gastroenterologist or bariatric surgeon, who can assess their eligibility, discuss the potential risks, and provide necessary pre- and post-operative care.

What to do after Metabolic Surgery

After metabolic surgery, it is essential to follow a comprehensive post-operative plan to maximize the benefits of the procedure and ensure a successful outcome. Here are some important steps to take after metabolic surgery:
  1. Follow post-operative instructions: Adhere to the specific instructions provided by your healthcare team regarding wound care, medication management, and dietary guidelines. These instructions may include recommendations for pain management, incision care, and the use of prescribed medications.
  2. Gradually introduce oral intake: After metabolic surgery, your healthcare team will provide a phased approach to reintroducing oral intake. This typically involves starting with clear liquids and gradually progressing to pureed and then solid foods. Follow the recommended dietary plan and consume small, frequent meals to avoid overeating and promote proper digestion.
  3. Nutritional guidance and counseling: Work closely with a registered dietitian who specializes in metabolic surgery to develop a personalized nutrition plan. They will provide guidance on portion control, macronutrient balance, and vitamin and mineral supplementation. Adhere to the recommended dietary guidelines to support weight loss, manage diabetes, and prevent nutritional deficiencies.
  4. Regular physical activity: Engage in regular physical activity as advised by your healthcare team. Start with low-impact exercises and gradually increase intensity and duration over time. Regular physical activity aids in weight loss, improves cardiovascular health, and enhances overall well-being.
  5. Attend follow-up appointments: Regularly attend follow-up appointments with your healthcare team to monitor your progress, assess your nutritional status, and address any concerns or complications that may arise. These appointments allow for ongoing evaluation of your health and provide an opportunity to make any necessary adjustments to your post-operative plan.
  6. Psychological support: Metabolic surgery can bring about emotional and psychological changes. Seek support from a mental health professional or participate in support groups to address any emotional challenges and learn coping strategies for managing the post-operative journey.
  7. Maintain a healthy lifestyle: Metabolic surgery is a tool to support long-term weight loss and diabetes management. To maintain the benefits of the procedure, adopt and maintain a healthy lifestyle that includes a balanced diet, regular physical activity, stress management, and adequate sleep.
Remember, the post-operative period is crucial for achieving successful outcomes. Stay in close communication with your healthcare team, follow their guidance, and actively participate in your recovery and long-term health journey.

80 years old, heart patient. Nevertheless, a ruptured gall bladder was successfully treated with binoculars.

Celebrities who have Diabetes

Tom Hanks

The Oscar-winning actor announced he has type 2 diabetes when late-night host David Letterman commented on his newly slim figure in October 2013. “I went to the doctor and he said, ‘You know those high blood sugar numbers you’ve been dealing with since you were 36? Well, you’ve graduated. You’ve got type 2 diabetes, young man.'” Hanks added that the condition is controllable, but he joked that he couldn’t get back down to his high-school weight of 96 pounds. “I was a very skinny boy!”

Salma Hayek

The Oscar-nominee had gestational diabetes, which happens during pregnancy, while expecting her daughter, Valentina. Hayek has a family history of diabetes. Experts say all women should get checked for gestational diabetes when they are 24-28 weeks pregnant. Those at risk for type 2 diabetes are checked at their first prenatal visit. Gestational diabetes usually goes away after delivery, but it could return with a later pregnancy. It can also make you more likely to get type 2 diabetes later on.

Billie Jean King

Tennis champion Billie Jean King was diagnosed with type 2 diabetes at age 63. According to King, she had previously had an eating disorder.

Samantha Ruth Prabhu

Popular South Indian Actress was diagnosed with diabetes in 2013. She overcame it with healthy eating and exercising.

Nick Jonas

Nick Jonas was diagnosed with type 1 diabetes at the young age of 13. But this never slowed him down. He learned to manage his diabetes with healthy eating and exercising

Amazing Facts about Diabetes

Diabetes is a global health concern, with an estimated 463 million adults worldwide living with diabetes in 2019. This number is expected to rise to 700 million by 2045. (Source)

Insulin, a hormone responsible for regulating blood sugar levels, was discovered in 1921 by Sir Frederick Banting and Charles Best. This breakthrough revolutionized the treatment of type 1 diabetes and saved countless lives. (Source)

There are different types of diabetes, including type 1 diabetes, type 2 diabetes, and gestational diabetes. Each type has its own causes, risk factors, and management strategies. (Source)

Diabetes can have an impact on mental health, and individuals with diabetes may experience increased stress, anxiety, and depression. It is important to address the emotional well-being of individuals with diabetes and provide them with the necessary support and resources. (Source)

4 Reasons for Early Treatment of Diabetes

Complications of Untreated Diabetes

What is Metabolic Surgery

Understanding Metabolic Surgery

Bariatric surgery that aims to treat the comorbid conditions, such as diabetes mellitus associated with obesity, is generally called metabolic surgery. It has emerged as an effective treatment option for type 2 diabetes, particularly in individuals with obesity or severe insulin resistance. Metabolic surgery works by modifying the gastrointestinal tract to enhance metabolic function and improve blood sugar control.

An umbilical hernia occurs when a portion of the intestine or fatty tissue protrudes through a weak spot in the abdominal muscles near the navel (belly button). This type of hernia is commonly seen in infants but can also occur in adults, particularly those who are overweight or have undergone abdominal surgery.

Types of Metabolic Surgery for Diabetes

  1. Roux-en-Y Gastric Bypass (RYGB): This procedure involves creating a small pouch at the top of the stomach and rerouting a portion of the small intestine. RYGB not only restricts food intake but also alters the gut hormones responsible for regulating blood sugar levels, resulting in improved glycemic control.
  2. Sleeve Gastrectomy: In this procedure, a large portion of the stomach is surgically removed, leaving behind a smaller, banana-shaped sleeve. Sleeve gastrectomy helps control portion sizes and reduces the production of ghrelin, a hormone that stimulates hunger. It has shown promising results in improving blood sugar levels and promoting weight loss.

Additional Types of Metabolic Surgeries for Diabetes-

  1. Biliopancreatic Diversion with Duodenal Switch (BPD-DS): This procedure involves the creation of a small stomach pouch and rerouting the small intestine to bypass a significant portion of the digestive tract. BPD-DS combines a restrictive and malabsorptive component, leading to significant weight loss and improved glycemic control. It has shown favorable outcomes in achieving diabetes remission and reducing cardiovascular risk factors.
  2. Adjustable Gastric Banding: In this procedure, a silicone band is placed around the upper part of the stomach, creating a small pouch. The band can be adjusted to control food intake. While adjustable gastric banding primarily focuses on weight loss, it has demonstrated beneficial effects on blood sugar control in some patients with type 2 diabetes.
  3. Mini Gastric Bypass: This technique involves creating a small stomach pouch and connecting it to a lower part of the small intestine. Mini gastric bypass combines restriction and intestinal bypass, leading to weight loss and metabolic improvements. Although this procedure is less common than traditional gastric bypass, it has shown promising results in diabetes management.

Each type of metabolic surgery offers unique benefits and considerations, and the choice of procedure depends on individual factors such as body mass index, medical history, and surgeon’s recommendation. It is important to consult with a gastroenterologist or bariatric surgeon who specializes in metabolic surgery to determine the most suitable option based on your specific needs.

Who needs Metabolic Surgery

Metabolic surgery, also known as bariatric surgery, may be considered for individuals with obesity and type 2 diabetes who have not achieved adequate blood sugar control through lifestyle modifications and medical management alone. While not everyone with type 2 diabetes is a candidate for metabolic surgery, it may be recommended for those who meet specific criteria. The following are some factors that may indicate the need for metabolic surgery for diabetes reversal:

  1. Obesity: Metabolic surgery is primarily recommended for individuals with a body mass index (BMI) of 40 or higher (severe obesity) or a BMI of 35-39.9 (obesity) with significant obesity-related health complications. Obesity is a significant risk factor for developing type 2 diabetes, and weight loss through surgery can have a positive impact on blood sugar control.
  2. Inadequate diabetes control: Despite attempts to manage type 2 diabetes through lifestyle changes, such as diet and exercise, and medication management, if blood sugar levels remain poorly controlled over an extended period, metabolic surgery may be considered. The goal is to achieve better glycemic control and reduce the reliance on diabetes medications.
  3. Presence of obesity-related comorbidities: Metabolic surgery may be recommended for individuals with type 2 diabetes who also have other obesity-related health conditions, such as high blood pressure, sleep apnea, heart disease, or fatty liver disease. Addressing obesity through surgery can lead to improvements in these conditions, including better management of diabetes.
  4. Patient preference and commitment: The decision to undergo metabolic surgery should involve a comprehensive evaluation by a healthcare team, including a bariatric surgeon, endocrinologist, and other specialists. The patient’s readiness, commitment to long-term lifestyle changes, and understanding of the potential benefits and risks of surgery are important factors in determining the suitability for metabolic surgery.

It is essential to consult with a healthcare professional experienced in metabolic surgery and diabetes management to assess individual eligibility for the procedure. Each case is unique, and a comprehensive evaluation of medical history, current health status, and personal goals will help determine whether metabolic surgery is a suitable option for diabetes reversal.

How to prepare for Metabolic Surgery

Preparing for metabolic surgery for diabetes reversal involves several steps to ensure the best possible outcome and reduce the risk of complications. Here are some general guidelines for preparing for metabolic surgery:

  1. Consultation with a healthcare team: Schedule an appointment with a bariatric surgeon who specializes in metabolic surgery for diabetes reversal. They will assess your medical history, current health status, and suitability for the procedure. You may also consult with an endocrinologist and a registered dietitian to evaluate your diabetes management and nutritional needs.
  2. Medical evaluation: Your healthcare team will perform a thorough medical evaluation to assess your overall health and identify any underlying medical conditions that may affect the surgery. This may include blood tests, imaging studies, and other diagnostic procedures.
  3. Weight loss and lifestyle modifications: Prior to metabolic surgery, your healthcare team may recommend weight loss and lifestyle modifications to improve overall health and facilitate surgical success. This may involve following a specific diet plan, increasing physical activity, and stopping smoking if applicable.
  4. Diabetes management optimization: It is important to optimize your diabetes management before surgery. This may involve working closely with your endocrinologist to adjust your diabetes medications, ensure stable blood sugar levels, and manage any associated complications.
  5. Nutritional counseling: A registered dietitian will provide guidance on preoperative nutrition and dietary modifications. They will help you understand the necessary changes to your eating habits and provide recommendations for a balanced diet to support your overall health and diabetes management.
  6. Psychological evaluation: Metabolic surgery is a significant procedure that can have both physical and emotional impacts. A psychological evaluation may be conducted to assess your mental health, emotional readiness, and support systems. This evaluation helps ensure that you are mentally prepared for the lifestyle changes that come with metabolic surgery.
  7. Education and support: Attend educational sessions or support groups offered by your healthcare team. These sessions provide valuable information about the surgery, recovery process, and long-term lifestyle changes. They also provide an opportunity to connect with others who have undergone similar procedures.

It is crucial to closely follow the guidance of your healthcare team and adhere to their recommendations for preparation. Each individual’s preparation may vary based on specific health needs and the type of metabolic surgery planned. Your healthcare team will provide personalized instructions to ensure you are well-prepared for the procedure and have a successful outcome.

Benefits of Metabolic Surgery

  1. Improved Blood Sugar Control: Metabolic surgery has been found to induce remission or significant improvement in type 2 diabetes. Many patients experience a substantial reduction in blood sugar levels, decreased insulin resistance, and reduced dependency on diabetes medications.
  2. Weight Loss and Metabolic Benefits: Metabolic surgery promotes significant and sustained weight loss, leading to improved overall metabolic health. It helps reduce obesity-related inflammation, improves lipid profile, and lowers blood pressure, contributing to a reduced risk of cardiovascular complications.
  3. Potential Remission of Diabetes: In some cases, metabolic surgery can result in long-term diabetes remission, where blood sugar levels remain within the normal range without the need for diabetes medications. Remission rates vary among individuals, and regular follow-up care is essential for monitoring and maintaining glycemic control.
  4. Additional Health Benefits: Metabolic surgery can have a positive impact on other obesity-related comorbidities, including hypertension, sleep apnea, and non-alcoholic fatty liver disease. It can also lead to improvements in quality of life, increased mobility, and enhanced psychological well-being.

Risks of Metabolic Surgery

Metabolic surgery, like any surgical procedure, carries certain risks. These can include infection, bleeding, gastrointestinal complications, and vitamin/mineral deficiencies. It is crucial for individuals considering metabolic surgery to have a comprehensive evaluation by a gastroenterologist or bariatric surgeon, who can assess their eligibility, discuss the potential risks, and provide necessary pre- and post-operative care.

What to do after Metabolic Surgery

After metabolic surgery, it is essential to follow a comprehensive post-operative plan to maximize the benefits of the procedure and ensure a successful outcome. Here are some important steps to take after metabolic surgery:

Remember, the post-operative period is crucial for achieving successful outcomes. Stay in close communication with your healthcare team, follow their guidance, and actively participate in your recovery and long-term health journey.

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