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| Photo by M Clock |
So, I spent the weekend on Cape Cod recently, and saw this hurricane evacuation sign and I thought about an "Evacuation" of sorts from Diabetes after Bariatric Surgery. Kind of cheesy, I agree, but I'm going with it anyway. Diabetes and the 'storm' of Glucotoxicity (see 'Tale of 2 Fish'...above) might just seal the assimilation...
The big question I get asked from both patients and Providers alike is, "So how does it work that the surgery is so good for Diabetes, and works so fast?
This is a 2 part answer; here's part 1.
The initial weight loss advantage of the surgery parallels the amount of weight loss directly. As you have likely seen in your practices, even a 10% loss in weight via lifestyle alteration by a patient can significantly alter their Diabetes meds and insulin sensitivity. We require a near 10% weight loss prior to going to the OR not solely for that reason, but for the benefit of liver shrinkage, the diuretic effect on the internal structures, and to help improve co-morbidities (HTN, Respiratory function, DM, etc.).
Studied averages of percentage of excess weight lost (Excess weight is true body weight over Ideal body weight, reported as % lost):
And now, the physiology of how weight loss itself effects Diabetes:
1. Dramatic increase in insulin sensitivity which unburdens the pancreas
2. Reduction in glucotoxicity, as well as lipotoxicity (FFA, Adipokines) which restore beta cell function and increase insulin sensitivity
3. Increased level of Adiponectin, which increases muscle sensitivity to insulin
Our next post will go over the NON weight loss associated benefits of the surgeries, focusing on the Sleeve and the Bypass. That is where we even further deliver our Metabolic Mojo.
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