Introduction

Long-term Complications of Diabetes Mellitus

Type 2 diabetes can be a life long condition. Type 2 diabetes is an increasingly widespread health issue in India and has serious long-term consequences. You may want to compare bariatric surgery's high resolution rates for type 2 diabetes to the long-term effects of the condition.

People with type 2 diabetes are at risk for developing:

• Heart disease or suffer strokes.

• Kidney disease and eventually kidney failure, which may require either a kidney transplant or dialysis.

• Nerve damage which can lead to digestive problems, bladder problems, sexual dysfunction, and numbness and tingling in the legs.

• Foot problems including ulcers, and poor circulation, which can lead to amputation.

• Eye complications such as glaucoma, cataracts, and nerve damage, which can lead to blindness.

This procedure can be done for persons who have Type 2 Diabetes, who are on oral drugs & or insulin. This procedure will be useful if the C-Peptide blood test is more than one. The HBA1c test gives a person an indication of poor control if level is more than eight. Complications of diabetes will be arrested unless the organ damage has already progressed to a point of no return.

So, this surgery can cure diabetes, arrest the metabolic syndrome of body organ deterioration, thus avoiding future diabetic complications. High blood pressure and high cholesterol /triglycerides are also cured and body loses excess weight which is good for overall longevity with good health.

This switch operation causes a surge in the body's  insulin soon after taking food thus controlling post-prandial sugar. It also increases the insulin sensitivity of target cells so that fasting sugar levels dependent on liver are better controlled. Thus this operation controls sugar in the most physiological way by enhancing the effect of body insulin. The progressive destruction of insulin-secreting B-cells in pancreas is arrested.

This is a surgery done on the intestinal tract, and not on the pancreas. The procedure is done by key-hole surgery; is practically blood-less; using modern state-of-the-art Stapling Devices and blood vessel self-sealing devices; needs about  five days of stay in the hospital for observation, especially of the dropping blood sugar levels. The higher cost of this surgery is because of all the advanced equipment and skills required.

Diabetes being a medical disease, it was traditionally treated by diet and exercise with mild oral medicines. When this progressed, more drugs were added to control blood sugars; when this went on increasing, insulin injections were added.

Diabetes is the cause of  cardiac problems and kidney failure in many patients; it is a killer disease with epidemic proportions, in Asia, especially  in India. The disease keeps on progressing in most people with on-going complications on many organs in the body. It is associated with high cholesterol levels, high blood pressure, fatty liver disease, obesity and polycystic ovary disease causing the Metabolic Syndrome.

Thus, the greatest interest in the Laparoscopic Surgical field right now is Metabolic Surgery, especially for control of Diabetes, and India being the 'Diabetic Capital of World' as many physicians put it,  this procedure should be able to do a lot of good for Indian diabetics.

Standard Ileal Interposition with SG

What to expect" Before & After

Metabolic Surgery:  Patient  Information about operation

Before Operation

For 2 days before operation  you will be on liquid diet ( water, coconut water, juices, clear soups, butter milk).1 day before operation you can take only water, lime juice, coconut water & clear soups.

You have to bring your blood sugar measuring instrument(Glucometer) so that you can do blood sugar check yourself & for correct readings even after your discharge

You will be admitted one/two days before the operation for starting blood thinning medicine, steam inhalation, laxative tablets to clean your bowels & breathing exercises (spirometry). Your weight & abdominal girth will be measured; high glucose will be controlled with insulin.

After 10 pm on night before surgery only sips of water will be allowed till before the operation( This keeps your intestine clean & empty without giving enema & makes  operation cleaner & without infection)

At operation

A Blood Pressure measuring arm cuff will be applied, to measure your BP automatically by inflation of the cuff during operation

A body oxygen measuring probe will be attached to your finger to continuously monitor oxygen saturation during operation

In the operation theatre an intravenous line will be introduced through a needle in your arm, for fluids & medicines & anesthesia medicines

Another line may be put in your back (Epidural) to give pain relief medicines after operation. It will be removed in 2-3 days after the surgery

Under anesthesia one line may be put in the neck for diabetic operation. These will be removed in 3-5 days as your oral liquid intake becomes adequate after operation
 
There will be an intra-arterial line in left hand to measure your B.P. (in obese only) which will be removed 1 day after surgery

Tight stockings upto mid thighs will be placed with leg sleeves to rhythmically  massage  your legs. This will continuously keep your leg blood circulation going, till you start walking after the operation

A urinary catheter will be put to remove urine at operation & will be removed after operation as soon as you can walk to the toilet on your own.
 

After the operation

You will be shifted to Surgical ICU to keep you under observation & pain free for 1-3 days. You will be in your senses at the time of shifting to ICU. You can move your hands & legs & turn any side in the bed into a comfortable position soon  after shifting

A B.P. measuring arm cuff will be applied, to measure your BP automatically by inflation of the cuff every 15-30 min

A body oxygen measuring probe will be attached to your finger to continuously monitor oxygen saturation after surgery.

Oxygen will be given to you for 2-4 hrs using a face mask . Just breathe normally in it.

You will only be allowed sips of water for 2 days following operation, & coconut water & clear soups from day 3-4. Intravenous fluids & proteins (diabetic surgery) will be supplemented through IV line till your oral intake is adequate by 3-5 days

To keep your lungs strong you should start spirometric exercises using your own spirometer a day after surgery

You will be helped to stand & made to sit in a chair 1 day after surgery, when you may feel dizzy for few seconds on standing

By day 6-7 you will be put on semi-solids by which time you would have passed flatus; small meals every 3hrs & water in-between separately, would be ideal.

At Discharge

You will be discharged from 4-5 days after operation. A liquid & semi solid diet has to be taken as prescribed at 2-3 hrly intervals. To know that you are taking enough liquids you have to measure your 24hr urine output & keep it above 1.5 lits

You will have to take an antibiotic for 3-5 days, an anta-acid for 2 months, a vitamin & a calcium tablet supplement along with a protein supplement till your oral intake improves

After diabetic surgery depending upon blood sugar levels, a mild antidiabetic Metformin 500mg  2-3 tablets may have to be taken till blood sugar levels are under control. Monitor your blood sugar daily using your glucometer at home for 1month to fine tune metformin requirement

Your blood pressure tablet requirement will also reduce. Thus you have to measure your blood pressure every day for 15 days

Follow-Up

You will have to come for check-up & with fresh blood reports after 1 month, 3 months ,6 months, 1 year, 11/2 years, & 2 years. You have to undergo Upper GI endoscopy at1 month & 1 year to see healing of stomach.