Type 2 Diabetes

The existence or threat of Type 2 Diabetes is the BEST reason to consider metabolic surgery…

Imagine literally being nondiabetic.  Imagine a complete remission.  It is difficult to understand why anyone with a BMI > 35 and a diagnosis of T2 DM would not want to seriously consider metabolic surgery, especially if their DM is difficult to control.

Type 2 Diabetes Mellitus (DM)

What is diabetes?

Diabetes is a disease in which the body’s ability to produce or respond to the hormone insulin is impaired, resulting in abnormal metabolism of carbohydrates and elevated levels of glucose in the blood and urine.   The pancreas produces a critical hormone called insulin that’s responsible for regulating your blood sugar levels. Insulin is a hormone needed to allow sugar (glucose) to enter cells to produce energy.

Diabetes Mellitus.  The meaning of the word diabetes means to pass through, that is urinating a lot.  The word Mellitus means “sweet” or “honey”.

There are two main types of “sugar” diabetes.

Type 1

Once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin. It is thought to be from autoimmune destruction of the cells that produce insulin.  It is most often diagnoses as a child.  Despite active research, type 1 diabetes has no cure.

Type 2

Sometimes called adult-onset diabetes, as previously it was diagnosed most of the time in adults, but more and more children are being diagnosed with type 2 due to childhood obesity.

Type 2 diabetes is a metabolic disorder that is characterized by high blood sugar caused by insulin resistance at the cellular level (primarily in skeletal muscles and fat cells).  In the long term, as the disease progresses, the pancreas has difficulty making enough insulin.  The pancreas gets “burned out” and cannot produce enough natural insulin.  Type 2 diabetics have to take insulin as the disease progresses.  The drugs (oral medications) to treat type 2 diabetes most often try to make the insulin work better at the cellular level, encourage more natural insulin to be produced at the cellular level, or cause sugar to be excreted in the urine.  When this is not enough, the patient has to inject insulin to control blood sugar.  Type 2 diabetes used to be called non-insulin-dependent diabetes (NIDDM), but when it advances, patients do need to inject insulin. The term NIDDM is generally not used anymore.

Consequences of Type 2 Diabetes

Too much sugar circulating in your bloodstream can lead to heart disease, vascular disease, kidney problems (kidney failure), nerve damage (neuropathy or gastroparesis), poor circulation, wound healing problems (amputations), and blindness.

Type 2 diabetes is often associated with cholesterol and fat metabolism diseases (hypertriglyceridemia, hypercholesterolemia), fatty liver (steatohepatitis), central obesity, and generalized systemic inflammation.  This is called “metabolic syndrome”.  These problems over time lead to cardiovascular disease and the diseases above.

How can you tell if you have diabetes type 2?

That is the problem.  Until the sugar causes organ damage or disease, it is essentially asymptomatic for the most part.  What are the acute symptoms of diabetes?  The high blood sugar makes one pass a lot of sugar in the urine and with it a lot of water.  Therefore, copious urination, increased hunger, and thirst, or dry mouth can lead to a diagnosis.  Occasionally people with DM type 2 can have a crisis, like diabetic ketoacidosis.   Long term signs of end-organ damage like blurry vision, cardiovascular disease like heart attacks, poor circulation, kidney disease, poor wound healing, numbness in the extremities, etc can happen.

How is Type 2 DM diagnosed? 

By testing fasting blood sugar and a blood test called Hemoglobin A1c.  A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If it’s 126 mg/dL (7 mmol/L) or higher on two separate tests, you have diabetes. An oral glucose tolerance test is sometimes used to confirm the diagnosis.  Hemoglobin A1c is a measure of long term elevations of blood sugar.  It is the chronically elevated blood sugar that causes all the damage.

Who is at risk for Type 2 DM?

Anyone that is obese, anyone who has a BMI (Body Mass Index) >30.  9% of the population has T2 DM.  80-90% of those people have a BMI > 30.  Many people (as many as 30%) do not know they are diabetic.  It is quite common for surgeons to diagnose T2 DM when people are looking into weight loss surgery.

If your BMI >40 there is a 28% chance that you have T2 DM.  If your BMI >40 and you don’t have T2 DM yet, you have a 28% chance of becoming diabetic over 10 years.  If your BMI is >50 the chances keep going up and up.

Is there a cure type 2 diabetes?

There is no “cure” for type 2 DM.  But we can put Type 2 DM in complete remission if we perform weight loss surgery, also known as bariatric surgery or metabolic surgery. 

• Remission means that you are no longer on diabetes medication and your Hemoglobin A1c is less than 6.0. 
• Metabolic surgery provides a 77% chance patients go into remission and remain in remission.
• Profound improvement for severe diabetic (need high levels of insulin preoperatively).  If the type 2 DM is not put in complete remission after metabolic surgery, it is radically better.  Finally, the patient will have an A1c of less than 6.0.  It is very typical for T2DM patients to be on 100 u of insulin or so and then only need 10 to 20 units of insulin per day after surgery, yet have a low A1c.
• Surgeons cannot call it a “cure” for diabetes type 2 because we cannot really cure obesity with weight loss surgery.  But we can put both Type 2 DM and obesity into remission.  We can make lifelong changes in gastrointestinal hormones that counter the genetics of obesity.

Yes, remission means that most patients after metabolic surgery no longer have to check their blood sugars or take pills or insulin for their diabetes.

How does weight loss (bariatric surgery, metabolic surgery cause remission of T2 DM?

Several ways.  Number one, Both the gastric sleeve and the gastric bypass significantly change the way gastrointestinal hormones work.  We know this because we put T2DM in remission the day of surgery, even before any weight loss.  We know this because we can measure these gastrointestinal hormone changes after surgery to significantly change. Number two, ultimately, the weight loss decreases the peripheral fat mass, and the insulin resistance of those cells decreases.  If weight is regained after surgery, the diabetes may return.  That is why we need to work together to have a long term weight loss result.

To learn how bariatric surgery can halt the progression of type 2 diabetes, call our office today!