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Obesity surgery Archives | GB Obesitas

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Can bariatric surgery cure type 2 diabetes?

By | Obesity surgery - health and diseases

How and why can bariatric surgery cure type 2 diabetes?

In this blog post we will talk about how obesity surgery can cure type 2 diabetes for most patients. But what exactly is type 2 diabetes?

What is type 2 diabetes, what is insulin and how does it relate?

Type 2 diabetes is a chronic disease in which the affected person has a blood sugar level that is not regulated well enough due to partial or complete insulin resistance and excretion. That the disease is chronic means that it is long-lasting[1]. But what is insulin and how does it work?

Insulin is a hormone that plays a crucial role in the absorption of glucose (sugar). Simply explained, when we eat, the carbohydrates in food are converted into glucose which is absorbed into the bloodstream. However, glucose does little good in the bloodstream, we want the glucose into the body’s cells where it functions as fuel. Insulin acts as a key in the cells’ “keyholes” that are found in the surrounding membrane. Insulin (key) opens the door for the glucose do it can enter the cell[2].

If you have type 2 diabetes, as mentioned, you are less sensitive to insulin or maybe you do not secrete enough or no insulin at all. This causes the glucose to stay in the bloodstream and not enter the cells, which results in a too high blood sugar level. This can be measured with a blood glucose meter.

Having an elevated blood sugar level over a longer period of time increases the risk of various other diseases, which is why it is important to lower the blood sugar levels to a normal level.

What is the likelihood of my diabetes being cured?

First of all, we need to define what is meant by cured. When we talk about the patient being cured of type 2 diabetes (sometimes also called diabetes remission), it means that the patient has a normal blood sugar level and no longer needs to take any antidiabetic medication.

It is not possible to predict what the likelihood of diabetes remission is on an individual level before obesity surgery. There are several factors that affect the outcome. Bodies react differently to treatment, just as it does with other medical treatments.

However, it is of course possible to say something about it in general and talk about the average likelihood. Most studies show that 70-89% of patients who have type 2 diabetes prior to surgery are cured after undergoing obesity surgery[3],[4],[5],[6],[7].

In addition, you are more likely to experience complete remission of your diabetes if you have had the disease for a shorter period of time (under 5 years), have a milder degree of diabetes and have a large weight loss after surgery. For example, if you have had diabetes for less than 5 years there is a 95% probability of diabetes remission. Whereas if you have had the disease for 6-10 years, the probability is 75% and if you have had diabetes for more than 10 years, the probability of being cured is 54% [8].

Why can obesity surgery cure type 2 diabetes?

There are several factors that contribute to the fact that an obesity operation can cure type 2 diabetes, but there is not complete agreement on these mechanisms. One of the simple factors is weight loss itself, which increases insulin sensitivity. However, for example, gastric bypass surgery improves diabetes already within days after surgery and thus there are mechanisms other than weight loss that come into play[8].

For example, one hypothesized (the “Hindgut hypothesis”) explains that since food more quickly affects the distal (later) part of the intestines after surgery, there is an increased excretion of the hormones GLP-1 and peptide YY, which causes both increased insulin excretion and sensitivity[9].

Another hypothesis (“Foregut”) related to bypass is that the exclusion of the proximal (first) part of the small intestine on the food’s path through the intestinal system avoids the excretion of a suspected (and not yet clarified) signal that otherwise promotes insulin resistance[10].

In general, calorie restrictions (less than 1100 kcal/day) will result in increased liver insulin sensitivity within 2 days, as there is less insulin in the bloodstream and insulin-producing (beta) cells can rest because they therefore do not have to produce as much insulin [11],[12].

A very small Swedish study with 9 patients has shown that 90% of what affects the insulin mechanisms related to the hormorers GLP-1 and GIP are created by the dietary changes. They believe the same effect is experienced as if the patient had surgery, if the patient is on a powder diet and consumes less than 1000 kcal/day . However, the researchers behind the study find that weight loss is stronger and more permanent in surgery rather than on diet alone [13]. The results are very new and further research on the new findings must be conducted to support the theory.

Summary

In short, obesity surgery fixes the problems you have with insulin that cause elevated blood sugar when you are affected by type 2 diabetes through various mechanisms. These mechanisms are related to weight loss, increased insulin excretion and sensitivity and avoidance of insulin resistance.

Type 1 diabetes cannot be cured as this disease is caused by the destruction of the insulin-producing cells in the pancreas.

 

If you want to know more about overweight surgery, you can read about it here and here. Contact usif you consider that surgery could be beneficial for you!

But. till exempel.

[1] https://www.sundhed.dk/sundhedsfaglig/laegehaandbogen/endokrinologi/tilstande-og-sygdomme/diabetes-mellitus/type-2-diabetes/ But. till exempel.

[2] https://endocrinology.dk/nbv/diabetes-melitus/behandling-og-kontrol-af-type-2-diabetes/

[3] https://diabetes.dk/aktuelt/nyheder/nyhedsarkiv/2019/fedmekirurgi-faar-type-2-diabetes-til-at-forsvinde-hos-3-af-4.aspx But. till exempel.

[4] https://pubmed.ncbi.nlm.nih.gov/19272486/

[5] https://pubmed.ncbi.nlm.nih.gov/15479938/ But. till exempel.

[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1234815/

[7] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1360104/

[8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3102524/

[9] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2936261/

[10] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1856597/ But. till exempel.

[11] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4202361/

[12] https://www.gastrojournal.org/article/S0016-5085(09)00150-4/pdf

[13] https://www.medicin.lu.se/article/strang-diet-forklarar-fetmakirurgins-magi-0

How does the anaesthesia work during an obesity operation?

By | News, Operating methods

Our anaesthesiologist Magnus explains

The purpose of the anaesthesia in bariatric surgery – in addition to making it possible to operate – is to help you feel as good as possible after surgery taking into account pain, nausea, mobilization and temperature control.

When you enter the operating room, you have probably already received a peripheral venous catheter in one arm, at the ward. We will carry out an additional verification of your identity and confirm the type of operation that is planned. In the room there are some people who all have a specific role during the operation: we are 2-3 surgical nurses, 2 surgeons, 1-2 anesthesiology nurses and one anesthesiologist.

You lie down on the operating table and some of the operations team work around you, connect you to surveillance equipment and start preparing the operation. There will be no stings or other painful things that are done in the operating room while you are awake. We also connect our drug pumps to the venous catheter and soon start giving you a small dose of medicine to help you relax before you go to sleep.

Anaesthesia with intravenous drugs in gastric bypass and sleeve gastrectomy

In the pumps there are 2 different medications, propofol (sedative agent) and remifentanil which is a strong analgesic medicine akin to morphine. In some patients, a burning sensation is experienced during the infusion into the vein that goes away with local anesthesia. It is not dangerous and does not indicate that the venous catheter is in the wrong place. Before you fall asleep completely, you breathe pure oxygen through a mask. This is a safety measure. If you experience the mask very unpleasant, we can in most cases lighten some on the mask so it does not close too tightly.

While you’re asleep, we’ll tilt the whole table in the way that we elevate the head end. To ensure that you do not slip during the operation, there is a footplate that you should lie close to with your sole and we also put a seat belt around your legs.

FREQUENTLY ASKED QUESTIONS:

Will I be in pain after surgery?
Most of our patients feel pretty good when they wake up after surgery and some even ask if we should not start operating soon! We will transfer you in a bed to the recovery area and you will be monitored for 1-2 hours before you can get to your room. Approximately 15-20 minutes after the end of surgery, most of the anesthesia has lost its effect and you can expect discomfort similar to post exercise muscle aches in the abdominal wall, as if you had done too many situps the day before. Many also experience pain in their shoulders. This is explained by irritation of the diaphragm and abdominal cavity after the laparoscopic surgery and that these organs share sensorics with the shoulders – so we have done nothing with the shoulders. Some patients have an experience of suction high up in the middle of the abdominal cavity. Often it is effective pain relief to change position and rise up to reduce these discomforts.

You don’t have to worry about suffering from severe pain. You should be so well pain-relieved that you can draw deep breaths, cough, be able to move in bed and relax. Please also see our information video about general anesthesia.
You will get extra pain relief if necessary – but the goal of pain relief is to make your discomfort manageable, not to make you painless! If we were to be too generous with pain-relieving drugs (morphine-like agents), it would greatly contribute to increased nausea, lower your ability to breathe and make you very lethargic. The goal is to help you move as soon as possible and stand up on your feet. This is to reduce the risk of blood clots and lung complications and to get the small intestine up and running again.

What pain killers will I receive?
Pain relief consists of different parts. By default, paracetamol and anti-inflammatory medicine (eterocoxib) are given in tablet form at the ward. During the operation we also give you oxycodone, clonidine and local anesthesia in the abdominal wall where the peepholes will be.

Am I going to feel sick after the surgery?
It’s individual how likely you are to feel sick after surgery. Patients who suffer from motion sickness and have felt ill during previous anaesthisia have an increased risk of nausea. Sleeve gastrectomy patients feel to some extent more ill the first hours after surgery than other types of surgery. In any case, this will pass, usually the first hours or before evening. To reduce the risk of nausea, we provide preventive medicines as a standard, in addition to that we avoid all anesthetic gases and instead sedate using propofol.

Am I completely sedated during the operation?
Yes, it’s the only way to perform laparoscopic operations safely.

Can I wake up during the operation?
No. We constantly monitor you during the operation and would notice if something did not look right a long time before you would be conscious. The medicines we use have been used for a long time and we have performed thousands of these operations without it ever happening. Among other things, we monitor heart rate, blood pressure, oxygenation, body movements, breath size, pressure in the airways and your eye movements.

When do I wake up?
You wake up from the sedation to the degree that you can breathe yourself and we can communicate with you in simple sentences immediately after completing the operation when you are still on the operating table. In most cases, patients do not remember these first few minutes afterwards. However, you will be tired in the first few hours after surgery when you are in the recovery unit and most fall asleep for shorter periods there.

Do I get a tube in my throat?
Yes, but only while you’re asleep. You won’t be awake with a tube in your throat.
We use a tube to help you breathe and it is called an endotracheal tube. It goes down the trachea. A second tube goes down the esophagus. In some cases, patients may subsequently experience discomfort in the throat, similar to the onset of tonsillitis. It usually goes over in 1-2 days.

When can I see my relatives?
After you leave the recovery department. Since there are other patients who are waking up in the room, we are not able to receive relatives there. Most often you can call your relatives from the recovery department.

GB Obesitas -now also working on behalf of Region Skåne!

By | News | No Comments

Our personnel and surgical team at GB Obesitas Skåne -under the leadership of Dr. Gislason and Dr. Broden -worked for many years at Aleris Obesitas in Malmö and Kristianstad. This included private and public funded surgery. Last spring, our team and Aleris went separate ways when Aleris ended its public obesity surgery business (post operative check-ups at Aleris will take place another six months, but no new publicly funded operations are performed).

During the summer, Region Skåne issued a new tender for publicly funded obesity surgery, for which we submitted an ambitious and serious offer on 12 September. The analysis and decision-making process is now completed and GB Obesitas Skåne won the contract. Earlier this week we could formally sign the agreement with Region Skåne -so now we can release the news:

GB Obesitas Skåne works on behalf of Region Skåne from 1 January 2020!

This agreement applies to public obesity surgery and runs until 31 December 2025, with the possibility of extension after that for another two years.

The following is clear: GB Obesitas becomes a direct referral body, a doctor’s referral letter or patient’s own referral letter must no longer go through the surgery clinic in Landskrona. We will follow Region Skåne’s guidelines for obesity surgery, that document you can find on the Region Skåne official website. In short, the indications for a publicly funded operation are the following;

  • 18 – 65 years of age> with BMI 40
  • 18 – 65 years of age> with BMI 35 and a co-morbidity linked to the obesity disease; such as Type 2 diabetes, sleep apnea, severe osteoarthritis of weight-bearing joint, and more.

The procurement includes on-call preparedness for possible complications after the procedure and one year of medical follow-up. All of our patients have access to the digital support tool Baribuddy, and are continuously reported to the Swedish Obesity Surgery registry SOReg.

 

The procurement also has a “secondary care chain”

This means that a referral can be made to the assessment of long-term problems after previous obesity surgery. We will set up a structured care package for this. The procurement allows for everything from out patient visits to diagnostic laparoscopy and renewed surgical procedures. We will return with more details.

Operations at the Centralsjukhuset in Kristianstad, CSK

As with previous procurements (which were previously won by Aleris), GB Obesitas Skåne will have access to the ward and operating room at CSK in Kristianstad. This allows for safe surgery even in more complex patient cases, with the backing of the hospital’s other resources when required. We will start by calling those to preoperative checklist that are already in the existing public queue to obesity surgery. You who belong to this group will be contacted by us in due time. Many details remain to be solved. Keep an eye on our digital platforms and we will provide more information on an ongoing basis!

Our private obesity surgery and obesity care continues as before

-with procedures includinggastric bypass, sleeve gastrektomy, SASI, revisional surgery, distal gastric bypass and medical packages. Read more in the section packages and prices. Our information meetings can be found here.

We are now taking the next step towards our high set goals for GB Obesitas Skåne -to become a complete center for advanced Obesity Care: with educational initiatives for the public including lectures on Best Weight, lectures for health care professionals, primary obesity surgery including complication management and follow-up, secondary care chains with care for those with long-term problems after previous surgery, as well as active clinical research.

Many details remain, and it is still too early to send your referral letters directly to us. But follow us on our platforms and we’ll keep you updated -we’re also on Facebook and Instagram.

Yours,

Dr Hjörtur Gislason, Dr. Carl-Magnus Broden and the entire GB Obesitas team