Can Weight Loss Surgery Reverse Diabetes?

Excess weight and obesity often go hand-in-hand with Type 2 diabetes, a chronic condition in which the pancreas does not produce enough of the hormone insulin and/or the body’s cells cannot use insulin efficiently.

Insulin’s job is to regulate and transport blood glucose (sugar) to your muscles for energy. Any extra, is stored in the liver until it is needed. If the body’s cells are insulin resistant, they don’t allow the sugar to enter and it remains in the bloodstream or is sent back to the liver for storage. Eventually, however, the liver can run out of storage space and the sugars have nowhere to go. The pancreas then creates even more insulin in an attempt to move glucose out of the blood. Over time, if nothing changes, the pancreas essentially gives up, starts producing less insulin and blood sugar levels continue to rise. This is what leads up to a diagnosis of diabetes. Untreated, diabetes can cause serious complications including disorders of the circulatory, nervous and immune systems.

Why is it So Hard to Lose Weight?

Losing weight can be a challenge because there are so many psychological, physical and metabolic factors involved, including diet, exercise, sleep patterns and types of foods consumed. Everyone has different triggers for their weight loss/gain which may explain why there are so many diets out there – some good and clinically sound, while others fall into the “fad” category and are unlikely to result in sustained, permanent weight loss.

And because significant weight loss is often a key part of the disease management plan for people with Type 2 diabetes, consulting with a clinical dietitian to develop a personalized weight loss strategy is always a good idea. And, although certainly not appropriate for everybody, for some people, weight loss surgery might be something to consider.

The Type of Bariatric Surgery Matters

Weight loss surgery is also called bariatric surgery. There are many different bariatric procedures that can be performed to help you lose weight, but there are only a handful that actually alter your body’s metabolism and trick the brain into accepting a new, lower body fat level. These procedures not only limit how much food you can eat, they alter the anatomy of the stomach and/or intestines and initiate hormonal signals that decrease appetite and increase metabolism. For many patients, these procedures lead to a reduced need for diabetes medications and, for others, their diabetes may essentially be cured or reversed.

Bariatric procedures that have been shown to effectively alter metabolism and either improve or reverse Type 2 diabetes, include:

• Gastric bypass. For this procedure, the surgeon divides the stomach into two chambers - one of which is the size of a golf ball. The small chamber is connected directly to the small intestine and the larger chamber is bypassed and not able to receive food. The rerouting of the intestines changes the way insulin is metabolized and therefore has a significant effect on diabetes that is not related to weight loss.
• Sleeve gastrectomy. A laparoscopic procedure in which the surgeon removes 80-90 percent of the stomach and forms the remainder into a sleeve shape but does not reroute the digestive tract. This limits how much one eats and reduces hunger.

“Gastric bypass is really an extremely effective procedure for Type 2 diabetes management and is even effective in controlling diabetes in the non-obese,” says UH bariatric surgeon, Leena Khaitan, MD. “The effect of this procedure on diabetes is almost magical. There is great data showing sustained remission of diabetes with both the sleeve and bypass, but the bypass is more effective and sustainable,” she notes.

A third surgical option is Biliopancreatic diversion with a duodenal switch (bbdds). For this procedure, the doctor removes a large part of the stomach and also changes the way the food moves to the intestines. It is the most effective surgery for people with diabetes, however it also has the highest risk of nutritional complications and is therefore only used for select patients.

After the Surgery

Bariatric surgery results in significant weight loss and remission of diabetes in most patients. After surgery, blood sugar balance is restored by a combination of enforced caloric restriction, enhanced insulin sensitivity, and increased insulin production. After the procedure, patients will need to pay close attention to their diet and take supplements to ensure their nutritional needs are being met.

Significant weight loss in obese patients not only offers a chance of diabetes remission – it allows them to live a more active and healthy lifestyle and reduces the risk of digestive disorders, heart disease, sleep apnea, infertility, joint pain, urinary incontinence and other cancers.

Who is Eligible?

A bariatric procedure is major surgery and never the first treatment option – patients must have tried to lose weight by other means before being considered for surgery. They are also required to undergo a psychological evaluation, attend nutrition education classes and meet certain body mass index (BMI) criteria.

University Hospitals Digestive Health Institute’s Nutritional Health & Bariatric Surgery Center is the only program in Northeast Ohio with three accredited bariatric centers. Our experts can help patients lose weight by conventional means such as dietary and lifestyle changes or through surgical interventions.