How a gastric bypass can reverse diabetes Here are thee reasons
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, (650-800 calories per day), for 1 to 2 weeks before surgery primarily so they have an opportunity to use up the stored calories in there liver, (glycogen), which results in loss of water stored in the liver and the reduction of the size of the liver. This allows me to work more easily under the left side of the liver where the upper part of the stomach lives. This makes the operation easier for me and safer for my patients. What I have observed is that frequently many of my patients 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). Second, 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 which was caused by their obesity in the first place. Therefore the amount of insulin they are able to make is frequently 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.
3). Finally, of these three most common operations, (gastric bypass, gastric sleeve, adjustable gastric band), the gastric bypass has an additional component that helps the diabetic. It 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 after consuming carbohydrates.
Instead of giving yourself an injection of Byetta or Symulin, which is the injectable form of GLP-1, after a gastric bypass operation your body produces more GLP-1 on its own in response to ingesting carbohydrates resulting in better production of insulin and improved use of insulin where the insulin does it’s work.
This begins immediately after the operation and is part of the reason that many diabetics that still needed some diabetic medicines before surgery even while they were on a very low carbohydrate diet will leave the hospital after their gastric bypass operation on no diabetic medicines at all and have normal blood glucose.
If a person of size has had diabetes for 10 or 20 years, sometimes the insulin producing cells of the pancreas have been so severely damaged that they are no longer able to produce enough insulin to meet their needs even if they lose their excess weight and therefore lose the insulin resistance that comes along with obesity. Nevertheless I have observed amazing results even when I did not expect them. Even if all the patient who has had diabetes for many years are not able to stop all of their diabetic medicines, generally they are on alot less medicines and their diabetes is much easier to manage. They still should be able to maintain a HbA1c
of 6 or less.
The gastric bypass operation is a wonderful tool for persons of size who want to improve or reverse their Type II diabetes.
