Bariatric Surgery and Diabetes

What are the Risks of Bariatric Surgery for Diabetes?

According to a 2021 report from the CDC (Centers for Disease Control and Prevention), up to 13% of people in the United States have diabetes. Moreover, nearly 50% of people with diabetes are also obese.

Being overweight or obese increases your risk of developing diabetes or worsening its symptoms, and weight loss is one of the key elements of managing diabetes. Bariatric surgery can result in weight loss and prevention or remission of type 2 diabetes in more than 75% of patients. After the procedure, glycemic control improves as a result of calorie restriction, increased insulin sensitivity, and enhanced insulin sensitivity.

Doctors often recommend bariatric surgery as a long-term weight loss solution for type 2 diabetes patients with a BMI (body mass index) of 35 or higher. The procedure improves type 2 diabetes by lowering blood sugar levels, which could also result in a change in diabetes medications. In some cases, bariatric surgery may even result in permanent or long-term remission from type 2 diabetes.

However, it is important to note that bariatric surgery is a major surgery, and it may have some short-term or long-term risks.

Bariatric surgery encompasses several surgical procedures that change the digestive system in a bid to help patients lose weight. These procedures usually reduce the size of the stomach, helping you feel fuller sooner. In addition to helping you eat less food, these procedures also limit the absorption of calories by the small intestines and improve how your body uses insulin and metabolizes fat.

Some studies indicate that besides helping type 2 diabetes patients lose weight, bariatric surgery also improves kidney function, cholesterol levels, blood pressure, and overall blood sugar control.

Types of bariatric surgery

1. Gastric bypass

Gastric bypass surgery is typically recommended for people with a body mass index (BMI) above 40 or a BMI above 35 with obesity-related health conditions such as type 2 diabetes, high blood pressure, or sleep apnea.

Also known as Roux-en-Y, gastric surgery is a permanent surgical procedure that involves stapling off the upper section of the stomach in order to reduce the organ’s size. As a result, you’ll eat less and the food will spend less time in the small intestine. Therefore, the small intestine will absorb fewer calories, leading to weight loss.

It’s important to note that gastric bypass surgery is not a quick fix for weight loss and requires a long-term commitment to lifestyle changes, including a healthy diet and regular exercise, to achieve and maintain successful results.

2. Vertical sleeve gastrectomy

This procedure is also known as stomach stapling. Vertical sleeve gastrectomy works by removing up to 80% of your stomach, leaving behind a smaller, tube-shaped “sleeve” or “banana-shaped” stomach.

This new stomach is about the size of a banana and can hold significantly less food compared to the original stomach. By reducing the stomach’s capacity, the procedure helps in restricting the amount of food a person can consume, resulting in reduced calorie intake.

Vertical sleeve gastrectomy has become a popular weight-loss procedure because it offers several benefits. In addition to limiting food intake, it also causes hormonal changes that can help reduce appetite and improve blood sugar control – however, the intestines are not rerouted and so the procedure is permanent.

3. Laparoscopic adjustable gastric banding.

This surgical procedure involves inserting a band on the top side of the stomach to reduce the amount of food your stomach can hold as well as the amount you can eat.

Find out more on gastric banding HERE

Risks and side effects of bariatric surgery

Some of the most common risks associated with bariatric surgery include:

Short-term risks

Anesthesia-related risks
Infection
Acid reflux
Dilation of the esophagus
Nausea and vomiting
Inability to eat specific foods
Failure to lose weight
Weight gain
Obstruction of the stomach

Long-term risks

Dumping syndrome (commonly associated with symptoms such as dizziness, nausea and vomiting after surgery)
Ulcers
Hernias
Low blood sugar
Vomiting
Malnutrition
Bowel obstruction

Bariatric surgery risks by procedure:

Risks and complications may vary depending on the type of bariatric surgery procedure. Your surgeon will help you understand the potential risks and side effects of the specific procedure you want to undergo

1. Gastric bypass risks and side effects

Gallstones (risk may increase with substantial or rapid weight loss)
Leakage
Hernia
Dumping syndrome
Leakage
Internal bleeding
Bleeding of the wound
Perforation of intestines or stomach
Bowel or pouch obstruction
Skin separation
Spleen injury
Calorie or protein malnutrition
Cardiac problems
Pulmonary problems
Stricture
Intestine or stomach ulceration
Iron or vitamin deficiency

2. Potential risks and complications of gastric sleeve surgery

Gall stones
Internal bleeding
stricture
Blood clots
Hernia
Skin separation
Leakage
Perforation of intestines or stomach
Iron or vitamin deficiency

How can you reduce your bariatric surgery risks?

You can reduce some of the risk and side effects of surgery by taking measures such as:

Stopping smoking
Decreasing your BMI (body mass index)
Exercising regularly (as recommended by your doctor)

The bottom line

Bariatric surgery is highly effective against type 2 diabetes and obesity. It is often recommended for people with diabetes who are unable to achieve and maintain a healthy weight with medications or lifestyle changes.

Although bariatric surgery offers many potential health benefits, it is just one tool for managing diabetes and obesity.

Long-term success still demands regular exercise and a healthy diet. If you want to undergo bariatric surgery, you should also commit to regular healthcare visits as well as lifelong maintenance of exercise and diet.

Bariatric surgery, also known as weight loss surgery, can be used to control diabetes and can be done in several minimally invasive procedures. The surgery helps treat diabetes by regulating the amount of glucose in the blood. For some people with obesity and type 2 diabetes, blood glucose levels can get back to normal after weight loss surgery. This typically means you may need less diabetes medication or even none at all.

Studies show significant improvement in diabetes and type 2 diabetes after bariatric surgery. One study tracked 400 diabetic individuals. Six years after weight loss surgery, 62% of the participants showed no signs of type 2 diabetes. Moreover, these people had better triglyceride, blood pressure, and triglyceride levels.

On the other hand, only 7% of people under diabetes medication, but hadn’t undergone weight loss surgery, experienced similar improvements.

Is bariatric surgery right for you?

Several factors must be taken into consideration when it comes to determining whether you are a good candidate for bariatric surgery.

Do you have metabolic syndrome or type 2 diabetes?
Is your body mass index (BMI) 30 or higher?
Have you been trying to lose weight without success?

If your answer to these questions is yes, your doctor will ask you some questions and give you a check-up to see if you are emotionally and physically ready for the procedure and the changes you’ll have to make. Some of these changes include adhering to a healthy diet, eating a lot less, and exercising regularly for the rest of your life.

It is essential to understand that every situation is different and other doctors may get involved in some cases. For example, if you’ve been diagnosed with any cardiovascular disease, your cardiologist and other specialists may need to approve you for weight loss surgery.

What are the Different Types of Bariatric Surgery?

There are various different types of weight loss surgery. Some procedures change the way the body absorbs nutrients, vitamins, and minerals. Others help patients lose weight by simply shrinking their stomachs to make them feel full for longer, even after smaller meals.

So, what does each of these procedures involve?

1. Roux-en-Y gastric bypass surgery

Simply known as gastric bypass surgery, this procedure involves creating a small pouch at the top of the stomach by separating it from the rest of the stomach. When the patient eats, food goes to the pouch and is made to bypass the top part of the small intestine. As a result, the patient gets full faster and absorbs fewer nutrients and calories.

Pros

Patients lose between 60 and 80% of their unwanted weight.
Research shows that 80% of patients show no signs of type 2 diabetes after surgery.

Cons

The body does not absorb as many nutrients and vitamins as before and this can lead to health complications such as dumping syndrome.
Gastric bypass surgery is irreversible.

2. Gastric sleeve surgery (sleeve gastrectomy surgery)

This procedure involves removing a big part of the stomach. This makes the patient feel full faster because there is less room for food. Gastric sleeve surgery also helps lower a hormone known as ghrelin, which is responsible for making you feel hungry.

Pros

At least 60% of patients show no signs of type 2 diabetes after the procedure.
Patients lose up to 50% of their unwanted weight.
The surgery can be done laparoscopically.

Cons

The surgery is irreversible.
The body does not absorb as many nutrients and vitamins as it used to, which could cause health problems.

3. Adjustable gastric band

An inflatable band is placed around the top of your stomach to create a small pouch where everything you consume goes. You’ll feel full faster because this small pouch fills up faster as well.

Pros

The surgeon doesn’t have to move the intestines or cut the stomach, like in other procedures.
Less invasive resulting in fewer complications
The band can be taken out or adjusted later
Up to 60% of people who undergo this surgery show no signs of diabetes after the procedure.

Cons

The band may become worn or it may slip and you may have to undergo another surgery to fix such problems.

4. Biliopancreatic diversion (with duodenal switch)

This procedure is not common, largely because it is one of the most complicated weight-loss surgeries. The doctor removes part of your stomach and changes how food moves in the intestines.

Pros

It is one of the most effective surgeries for diabetes patients.
You’ll lose up to 70% of your extra weight.

Cons

The risk of complications with this procedure is higher compared to other surgeries.
It has a longer recovery period
The procedure may lead to problems digesting and absorbing food.

What are the Risks of Bariatric Surgery for Diabetes?

As with other major operations, all bariatric and metabolic surgeries (also called weight-loss surgeries) have potential risks for complications. These include infection, bleeding, and leaks in your digestive system.

5. Electric implant device

This procedure involves implanting an electric device beneath the skin of the abdomen. This electric implant device controls signals in the nerve connecting the brain to the stomach, reducing the feelings of hunger.

Pros

The procedure is considered minor surgery and the device can be easily removed once you achieve your desired weight.
The implant can be controlled remotely

Cons

The implant is associated with side effects such as pain, problems swallowing, heartburn, nausea, chest pain, and belching.

6. Gastric balloon

An intragastric or gastric balloon is a temporary device that is placed in the stomach through the mouth. These devices can last for up to 6 months. You end up eating less because the balloon takes up space in your stomach.

Pros

The procedure is easy, temporary, and reversible.
Less expensive than other weight-loss surgeries.
The device is inserted by a procedure known as endoscopy, which does not involve cutting.
It is commonly recommended for people who are not eligible for other weight-loss surgical procedures.

Cons

Gastric balloons may cause complications such as stomach perforations or blue-green urine as a result of balloon deflation.

The bottom-line

The best way to lose weight and keep it off is to adhere to the diet and exercise plan recommended by your doctors. You may have to eat considerably smaller meals and it’s recommended that you choose at least half a cup of protein-rich foods and vegetables per serving. Choose low-fat yogurt and cheese, lean cuts of meat, beans, and fish.

Be sure to work with a professional nutritionist as you change your eating habits, primarily because your body does not absorb vitamins and nutrients as well as it used to before the weight loss surgery.

Your nutritionist will make sure you’re getting enough of all the nutrients and vitamins you need.