What Is The Diabetes Surgery? To Whom and How Is It Performed?

Diabetes is a chronic disease that develops when a hormone that arranges the blood sugar can not produce enough insulin, or increase in blood glucose level due to the defect in produced blood sugar.

There are particular surgical interventions applied for this disease. Nutritients digest in our bowels to turn glucose which is the major fuel of our body. Then this glucose pass from the bowels to blood and the level of blood glucose begins to increase.

If there is an insulin hormone deficiency or use disorder since the sugar can not be transported into the cells, glucose increases in the blood and rise in the blood sugar, thy name is diabetes, develops.

The process between normal individuals and diabetes called “prediabetes”. Prediabetes indicates that the risk of diabetes development is high and the development of diabetes can be prevented by 45-48% through lifestyle changes.

The patients undergoing surgery should be informed clearly about the necessity of biochemical follow-ups and lifetime nutrition counselling and the risks and long terms results of the surgery.

With this method, while the volume of the stomach is reduced by 90%, malabsorption is provided through bypass the duodenum. The ROUX leg can pull up from the front of the stomach and colon, front of the colon and behind the stomach or behind the colon and stomach for gastrojejunostomy. After the stomach is cut vertically to small curvature from the 3-5 cm distal of the esophagogastric junction with linear STAPLER (60 mm height and 3,8 mm thickness), o pouch is created by completing the cutting operation according to the angular incisure. Adequate liquid supplement and urinate is very important after the surgery.

A laparoscopic gastric band (stomach stapling, adjustable gastric band: LAGB): is only a restrictive effective surgery method. An adjustable BAND is placed to the proximal of the stomach, under the lower part of the cardia. This method which is developed firstly in 1984i is applied frequently in Europe and Australia. The usage of it becomes widespread in the USA after getting FDA approval in 2011.

One of the most sensitive issues is to whom it is applied in diabetes surgery. Diabetes surgery can be applied to type 2 diabetes patients.

Type 1 Diabetes: Generally, it occurs as a result of the autoimmune demolish in the pancreas beta işlet-cells which causes absolute insulin deficiency. It becomes in early ages generally. The symptoms belong to hyperglycemia emerge suddenly. Diabetic ketoacidosis may progress. Insulin is used in its treatment.

Type 2 Diabetes: It depends on insulin secretion as a result of insufficiency of beta cells and insulin response caused by insulin resistance. Generally, there is genetic susceptibility and insidious beginning. Most of the patients (85-95%) are type 2 diabetes patients. Usually, it emerges after age 30. Hyperglycemia in diabetes causes long term harm to vital organs, dysfunction and failure over time. The diabetes surgery can be applied if the BMI is above 35 and one of the situations that affect daily life such as the obesity hypoventilation syndrome which develops due to overweight and is defined as can not breathe sufficiently or arthritis.

The classical treatment is related to decreasing blood sugar in diabetes surgery patients. 50 % part of the stomach is removed, and the places of the small bowels are changed. Within this change, an insulin secretion signal comes and the efficiency increases. The 250 cm part of the small bowels (this 250 cm part of the small bowels called as ileum and the L cells which provides insulin secretion in human located in this part of the bowel) is combined side by side to the lower end of the stomach by measuring. The intraabdominal part inflated with carbon dioxide gas. The blood sugar level of the patients kept under control and the patients can get rid of the sugar pills and insulin shots.

In surgical operations, separate assessment şs done according to the organ deformations.

• The test is done for the capacity of insulin production.
• It is laparoscopic, closed, surgery.
• The injuries do not heal late because the surgery is performed by cutting holes pen-wide, so it does not require a suture.
• The duration of the operation is between 2-3 hours.
• After the surgery, the patient can stand up in 4 or 6 hours at the latest.
• In 48 hours, a pharmaceutical leak test is done.
• The hunger hormone on the stomach is intervened.
• At the last stage, the pancreas activated by making changes in the bowels.

The number of patients increases when the risk groups can not be identified in terms of diabetes, and the development of the disease can not be prevented. Also, when enough resources are not allocated for patient education, initially heart attacks, kidney failure, eye disorders, foot injuries and amputations impose a serious burden.

Although the evidence-based studies intended to prevent Type 1 Diabetes, there are numerous studies about facilitating or preventing the occurrence of Type 2 Diabetes and the success of the lifestyle changes is indicated in these studies.

In the Diabetes Prevention Program, it is indicated that that especially for the ethnic groups prone to diabetes, type 2 diabetes can be prevented at a rate of 58 % through nutrition, exercise and body weight control. The risk factors of diabetes can be classified as unchangeable and changeable/controllable risk factors. The unchangeable risk factors are genetic factors, age and gender.

The diabetes risk increases with the age but the development of type 2 diabetes rises in adolescent and children. These risk groups need to be researched more frequently from an early age. There are studies about that the “FINDRISK Type 2 Diabetes Evaluation Form” which is widely used in our country too and reference by the Turkey Endocrinology and Metabolism Society, is beneficial to determine the Type 2 Diabetes Risk in the early period.

Diabetes surgery is done to type 2 diabetes patients who have a body mass index above 30 and whose insulin stores are not depleted. However, the surgery is not performed on all type 2 diabetes patients. The important thing is the pancreas needs to protect insulin production.

Treating diabetes with surgery provides recovery of many obesity-related metabolic problems such as hypertensive cardiac diseases. However, there are significant criteria for successful and efficient surgery. The first of these is to choose patients carefully. We observe the increase in the number of diabetes surgeries with each passing day. Moreover, in the current publishings, it is stated that this group makes up 10 % of all diabetes surgeries.

There are risks of diabetes surgery for cirrhosis patients. If surgery is required for any reason, there is a danger of liver and accompanying kidney failure and bleeding depending on the impaired blood clothing. This can cause death. In this case, having diabetes surgery is not possible. Individuals aged under 18 or above 65 and who have an unhealed endocrine disease that causes diabetes can not have diabetes surgery.

ROUX-en-Y .gastric Bypass (RYGB): This surgery method which is done in the 1960s at first, has restrictive and malabsorptive impacts.

A laparoscopic adjustable gastric band (gastric band, stomach staple: LAGB): It is only a restrictive effective surgery method. An adjustable band is placed to the proximal of the stomach under the lower cardia. This method which is generated in 1984 at first, is applied more frequently in Europe and Australia.

Sleeve gastrectomy (sg): It is a kind of partial gastrectomy in which the big part of the curvature part of the stomach is removed and the stomach takes shape as the tube.

Biliopancreatic diversion (BPD): The main aim of the surgery is that providing to get rid of the taken foods without absorption by decreasing contact with gall and pancreas secretions.

Duodenal switch (ds): This surgery includes PYLORUS preserving vertical subtotal gastrectomy bypass and duodenal switch operations.

Biliopancreatic Diversion + Duodenal Switch (BPD/ds): It is primer malabsorption and a variant of biliopancreatic diversion.

Vertical Banded Gastroplasty (VBG): It is a full restrictive surgery. A vertical stapler is applied to the upper part of the stomach. The lower end is wound by mec or a band.

Jejunuileyal bypass surgery (JIB): It is a historically important surgery that is first performed in 1969. The JEJUNUM is cut out near the Treitz ligament, and an anastomosis with the ileum is made around the ileocecal valve.

After the diabetes surgery, evaluating the nutrition situation of the patient and follow-ups regularly should be compulsory. Determining weight management is pretty important for weight loss after surgery.

• To prefer calorie-free or low-calorie drinks
• Paying attention to choosing the foods proper for nutrition program in all conditions
• Eating slowly by chewing well as much as possible
• Not eating anything after the dinner

It is important to eat dinner between 18:00-20:00 as much as possible, thereafter avoiding high-energy foods (tea without sugar, linden tea may be drunk), avoiding alcohol, rich sauces and ornaments.

Late breakfast should not be done, should not be hungry for more than 4 hours, protein-rich foods should be preferred for main meals and snacks. Fibrous foods like vegetable and fruits should be included certainly. At least 6-8 glass of water should be consumed in a day.

A multi-disciplinary team experienced in surgery, consisting of a surgeon, dietitian and a psychiatrist that is an expert in her/his area is quite important in the treatment of diabetes and to continue the process.