Surgery for Diatebes
In patients without obesity
During the last 30 years, special attention has been directed to study the effect of bariatric surgery on blood glucose levels in patients with obesity. It is known that something besides weight loss is involved in the cure of diabetes following gastric bypass. Changes in carbohydrate digestion and hormonal changes are believed to be involved in the normalization of blood glucose levels.
This is how METABOLIC SURGERY, a new and exciting subdivision of bariatric surgery, was born. These types of operations intend to create changes in the metabolism of people, thereby normalizing blood glucose levels by producing more insulin and improving of the effect of this insulin on cells. Since its purpose is not to induce weight loss, it is performed in patients without obesity.
The duodenal bypass, a modification of the gastric bypass was first reported in the medical literature in the early part of this decade. This operation consists of redirecting the nutrients from the stomach directly into the mid portion of the small bowel. This changes the way carbohydrates are absorbed and digested in the intestine.
There are two hypotheses why this operation works, they are the following:
- Proximal hypothesis: carbohydrates are absorbed mainly in the duodenum (the first part of the small bowel). It is here were a hormone is produced that hiders the effect of insulin in the cells. By diverting food away from the duodenum less carbohydrates are absorbed and the body does not produce the hormone that blocks the effect of the insulin, therefore decreasing blood sugar levels to normal.
- Distal hypothesis. the last part of the small bowel produces some hormones that stimulate the pancreas to produce insulin and also improve the effect of insulin in cells. Since food arrives faster and less digested to the distal part of the small bowel after the surgery, these hormones are produced faster and in larger amounts, therefore decreasing blood sugar levels to normal.
One hypothesis does not exclude the effect of the other one. However, regardless of which hypothesis is correct, the fact is that the surgery works and blood sugar levels are improved, if not normalized. Diabetes is cured or improved even if obesity is not present and weight loss is not achieved.