How do you think a gastric bypass helps to resolve Type II Diabetes?

Over 80% of Type II Diabetics show no evidence of diabetes after a gastric bypass operation. If a person has had diabetes for less than 5 years 95% of these people have no evidence of diabetes after this operation. Although we are still working out the reasons why this occurs, I believe Diabetes is improved or resolved in a three staged sequence.

1). Early after the operation carbohydrate intake is minimal so the glucose level remains low. In fact in our practice I have patients on a very low carbohydrate diet for 1 to 2 weeks before surgery and frequently they no longer need their diabetic medicines even before surgery as long as they continue to consume very few carbohydrates. The reduction in the amount of carbohydrates consumed is clearly an important component in this process that continues even after their operation since it takes several weeks or a few months for the amount of carbohydrate a person consumes increases and stabilizes at a new lower amount.

2). A second component that helps the diabetic is the hormone change that occurs after a gastric bypass. Probably the most important of these changes is the increase in a hormone like substance from the last part of the small intestine and the first part of the large intestine called GPL-1 (Glucagon Like Polypeptide-1) which increases the amount of insulin a gastric bypass patient sends into the blood stream from their pancreas. This begins immediately after the operation and is part of the reason that most diabetics do not need further diabetic medicines by the time they leave the hospital after their operation.

3). Finally, since obesity is the most important reason most of our patients develop diabetes, losing weight and keeping it off decreases the obesity and the patients lose their resistance to insulin. Therefore the amount of insulin they are able to make is enough to keep their glucose in the right range. Unlike the previous two components that decrease the blood sugar right after surgery this component takes time to show the beneficial effect of weight loss but by the time the patient is able to consume a more normal amount of starch and sugar he or she has lost enough weight to no longer need their diabetic medicines because of the loss of insulin resistance from the resolution of their obesity. This is why with some patients we need to slowly decrease the amount of diabetic medicine they are on over several weeks or even a few months.

It is important to understand that not everyone will have resolution from their diabetes. About 15 to 20 percent will still need to be on some diabetic medicines after a gastric bypass operation. The longer a person has type II diabetes the less likely it is that they will resolve their disease. However I have seen some patients resolve their diabetes after a gastric bypass operation even after 10 or 15 years of diabetes. Nevertheless even if the diabetes is not completely resolved it is much easier to manage and usually a person needs to be only on a pill they can take by mouth and they will not need to take insulin shots.

Recently I have been hearing from our patients that their endocrinologist is encouraging them to investigate bariatric surgery early after a new diagnosis of type II diabetes so it is more likely that they will resolve the disease instead of waiting for years until they have sustained injury to other organs. This is an amazing change in the attitudes of endocrinologists and I believe it represents a great opportunity for people with diabetes.

And to think I have the privilege of helping people in this way! How cool is that?

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