Obesity, which is one of the most common diseases today, can cause different diseases in many people. Type II diabetes is one of these diseases. Type II diabetes, which occurs due to excess weight, causes patients to use insulin regularly. In the later stages of the disease, it is possible to develop many different diseases.
What is Diabetes?
Diabetes, also known as diabetes mellitus, is divided into Type I and Type II. Type II diabetes, in which insulin is produced in the body, but this insulin is ineffective, is usually associated with obesity. Insulin resistance is seen in Type II diabetes, which is seen in an average of 90% of people with diabetes worldwide. In healthy people, the person feels hunger and eats with a hormone secreted from the stomach. When the stomach wall is stretched with the food he/she eats, as a result of the stimulus to the brain, the stomach stops secreting hormones and the person begins to feel full. At this time, the food passes into the intestines and begins to be digested and absorbed. In healthy people, undigested foods can easily reach the last parts of the small intestine. Undigested foods cause the secretion of glp-1 hormone from here. This hormone provides more active insulin release from the pancreas and blood sugar is controlled. However, obese people have a larger stomach and more hunger hormone secretion. These people increase their portions or have to eat more often to feel full. In addition, the size of the intestine and the number of villi that provide food absorption in obese people increase further. Thus, undigested food cannot reach the last part of the small intestine and the glp-1 hormone cannot be activated, and as a result, blood sugar begins to rise because the insulin in the pancreas cannot be actively released. With the effect of insulin resistance, blood sugar rises excessively in patients, and as a result, diabetes begins.
What is Diabetes Surgery?
Metabolic surgery, also known as diabetes or diabetes surgery among people, includes surgeries that enables controlling both diabetes and obesity at the same time.
Medicines, diet, and appropriate exercises are generally used in the treatment of Type II Diabetes. However, in some cases, these treatments are not sufficient and the disease progresses and brings different diseases such as cardiovascular diseases, stroke, kidney and foot disorders, and vision loss. In some patients, the desired results cannot be achieved despite the intensive use of insulin. In type II diabetes, medications and other treatments are used to control the disease, not to cure it completely. However today, more precise results can be obtained in the treatment of Type II Diabetes by applying metabolic surgery procedures in suitable patients. Thanks to metabolic surgery, insulin produced in the body but does not show any effect is used. At the same time, with the improvement of other diseases caused by diabetes, the life expectancy of patients is prolonged, and their quality of life increases.
Diabetes surgery is generally performed with a series of operations under the name of metabolic surgery methods. This series of procedures is also known as Transit Bipartition surgery.
What is Transit Bipartition Surgery?
Transit Bipartition surgery is performed with a closed (laparoscopic) method. In the first stage of the operation, a sleeve gastrectomy is performed. In the second stage, the small intestines are marked by counting up to 80 cm from the bottom first, then the counting is continued and the 260th cm is marked. The small intestines are removed from the 260th cm. The removed lower part is brought and connected to the tubed stomach. The removed upper part is connected to the small intestine at the 80th cm that was previously marked. While 1/3 of the food continues to pass through the normal route, 2/3 passes through the small intestine that connects to the stomach.
The purpose of Transit Bipartition surgery is to provide diabetes control without medication (without insulin injection and/or pill treatment), especially in Type II Diabetes patients whose weight is close or normal (with a low body mass index). In Transit Bipartition surgeries, sugar control is ensured, while normal duodenum anatomy and structure are preserved.
For which patients is Diabetes Surgery suitable?
Metabolic surgery is not suitable for all types of diabetes. These surgeries do not affect patients with Type I Diabetes. To benefit from metabolic surgery, the body needs to produce insulin, albeit in a small amount. In this sense, different treatment methods are applied in Type I diabetes where there is no insulin production.
Type II Diabetes patients, who make up the majority of diabetics, are the most suitable candidates for metabolic surgery. However, even with Type II Diabetes, insulin production in the pancreas may be decreased in diabetic patients over 10 years of age, so it is necessary to measure the insulin level in the pancreas of these patients before metabolic surgery. For this, the level of C-peptide, which is the precursor of insulin in the pancreas, is checked with a blood test.
According to the World Health Organization data, approximately 90% of these patients are also overweight. Body mass index is also of great importance in patient selection. To benefit from metabolic surgery, patients must have a body mass index above 35. Patients who do not respond to medical Type II Diabetes treatment and whose mass index is above 30 may also have metabolic surgery.
Who cannot have metabolic surgery?
Some patient groups cannot benefit from metabolic surgical operations applied to type II diabetes patients. Metabolic surgery is not applied to people with a body mass index below 30, people who do not have enough insulin in the pancreas, those with severe psychiatric illness, and patients with organ function losses due to diabetes.
Is metabolic surgery the definitive solution for Type II Diabetes?
Type II diabetes patients need lifelong medication, insulin supplementation, diet, and exercise. However, for many years, most patients do not comply with these rules. Continuous and regular treatment also reduces the quality of life of patients. In this sense, metabolic surgery methods, which have been highly successful, reveal different results from patient to patient. Most patients abandon insulin supplementation completely after these methods. In this sense, metabolic surgery methods provide a definitive solution for these patients. In some patient groups, it is necessary to continue medical treatment by reducing the postoperative drug doses much more. Although treatment is continued with medication after surgical methods, weight loss is ensured, possible diseases are prevented and blood sugar is kept under control.
What are the points that patients should pay attention to after metabolic surgery operations?
Although these operations give effective results in most diabetes patients, patients also need to make changes in their lifestyles and eating habits to increase the success rate. In this process, which also has psychological effects, it is beneficial to get help from dietitians and general surgeons as well as psychiatric disorders.
I Decided to Have Diabetes Surgery What Should I Do?
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