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Surgical Vs Non- Surgical Management of Diabetes

Management of diabetes is very important particular considering its effects. The type of the management method depends on various factors. Both surgical and medical methods can be used. However, medical therapy and lifestyle modifications continue to be the standard procedures for management. Weight loss surgeries are also performed to manage diabetes.

Adequate changes in lifestyle and medications fall under the category of non-surgical treatment methods.

Lifestyle modifications: The main theme behind this management strategy is control of blood sugar. The following tips can help in diabetes management:

Diet changes: The amount & time spent in food consumption plays a pivotal role in diabetes management. The list below mentions some useful tips:

  • Maintaining a balanced diet: A balanced diet shall contain the right proportion of every nutrients & minerals. Every meal should contain the same amount of carbohydrates. In order to prevent the drop in glucose levels, healthy snacks can be taken at fixed intervals. Consultation with a dietitian is very much necessary.
  • Maintenance of a schedule: The level of sugar in the blood increases sharply 1-2 hours after the food intake. After that, it decreases over a period of time. The degree of change in the blood glucose level can be kept steady if the food is consumed at the same time every day. One is required to avoid binge eating.
  • Coordinate medications & meals: Certain food items require adequate quantity of food. The prominent example is that of insulin. Insulin needs certain food to be consumed. Otherwise, steep decrease in the blood sugar, known as hypoglycemia can occur. Care should also be taken to ensure that glucose levels don't increase, leading to hyperglycemia.

Exercises: Performing regular exercises is a vital component in the management strategy. When the muscles strain during physical activity, glucose is utilized for energy. A certain idea about the required levels of glucose needs to be understood by the patient. Body response to insulin can also be improved by doing regular exercises. The following guidelines need to be understood before making a proper exercise plan:

  • Maintain an exercise schedule.
  • Drinking plenty of water during exercises is necessary.
  • Monitor blood sugar levels before & after the exercise.

Medications: Although all the anti-diabetic drugs aim at managing diabetes, the method by which they attain it uniquely different. The most commonly prescribed medication for diabetes cure is insulin.

Insulin: In type 1 form of diabetes, insufficient amount of insulin is secreted by pancreas. In type 2 diabetes, the pancreas secretes insulin but the cells do not consider this insulin. In either of the cases, insulin intake is necessary. Insulin is commonly injected into the body subcutaneously. Subcutaneous injection into the abdomen is generally preferred due to the fact that insulin absorption is more consistent from the abdominal area. The rate of absorption is observed to be the quickest from abdomen than from other parts of the body. It is absorbed at a moderately slower when injected through the arms. Injection through the legs and buttocks is even slower. It is always advised to rotate the parts where the insulin is injected.

Insulin has many forms and each of the forms differ in some way or the other.

Regular insulin (Humulin R Novolin R): The effect of this insulin type can be observed after 30 min. The effect reaches its peak after 1-3hours and can last to about 8 hours maximum.

NPH Insulin: The effect of this type of insulin last for about 18-26 hours. After injection, the effect can be felt after 2 hours of injection. Peak effect is experienced after 4 hours.

Novolog: This insulin category has a much quicker onset of action of 20min. Compared to human insulin, this type of insulin has a relatively shorter duration of action.

Lantus: This insulin type has longer action duration than the human insulin. The action is found to remain for the entire 24 hours. However, its effect is uniform throughout and does not peak at any stage.

NPH human insulin: This kind of insulin similar to the human counterpart can be injected through syringes, cartridges and vials.

Nowadays various appliances like insulin pens, insulin pumps etc are also available. Such alternative devices offer a pain-free and easy to use way for injecting the insulin.

In addition to insulin, there are other medicines also for diabetes control. Some of the classes are alpha Glucosidase inhibitors, biguanides, amylin analogues, DPP-4 inhibitors, Incretin Mimetics, prandial glucose regulators etc.

Surgical treatment: Weight loss surgeries or bariatric surgeries are the conventionally used surgical methods used for managing diabetes. Bariatric procedures are classified into 2 main categories: restrictive procedures & mal-absorptive procedures. Procedures that reduce the calories and nutrients absorbed by the body are called mal-absorptive procedures. Restrictive methods are those surgical methods that reduce the capacity of the stomach. Gastric bypass, gastric sleeve and gastric band are the major types of bariatric surgeries done. Among them, gastric sleeve and gastric band are of restrictive type whereas gastric bypass is a mal-absorptive procedure.

Gastric bypass: The procedure is also termed as Roux-en-Y. Te procedure helps to manage diabetes in 2 ways:

  1. By this procedure, portion of stomach is closed so that the food intake is limited. The amount hunger hormone secreted is also reduced by the reduction in the size of the stomach.
  2. The pathway of the small intestine is re-routed to an extent. This ensures that only a small amount of food and nutrients are absorbed by the body. The effect is known as mal-absorption effect. After gastric bypass, it becomes essential to take vitamins and other supplements.

Gastric bypass procedure is said to result in more weight loss than other types of surgeries.

Gastric sleeve: the method is also known as sleeve gastrectomy. In this procedure, a considerable portion of the stomach is removed so that the remaining portion resembles a sleeve. The lesser reduction of hunger hormone shall result in loss of appetite.

The surgery involves greater risk for obese persons. In these cases, a 2step procedure is advocated. The mal-aborptive procedure is performed a year after the 1st surgery.

Gastric band or laparoscopic adjustable gastric band (LAGB): This procedure involves placing a band on the top of the stomach. In order to adjust the size of the gastric band, a small port is affixed inside the body. Laparoscopic surgery refers to keyhole surgery.

Ileal transposition surgery: This happens to be one of the latest procedures used for the treatment of diabetes in the terminal stages. The surgery achieves the objective by connecting ileum (distal portion of small intestine) to the first part of the intestine i.e. duodenum. The middle part i.e. jejunum is bypassed. This technique is the modification of the earlier surgery which connected jejunum to ileum. The transposition aided in the production of Glucagon-like Peptide (GLP). Increase in GLP caused increased in the production of insulin, inevitable to process glucose. Stimulation of the pancreas was done by this hormone.

The method was first performed by a Brazilian surgeon Aureo De Paula. In India, the procedure was 1st done by Dr.Surendra Ugale of Kirloskar Hospital's Laparoscopic Surgery Center in 2008. The rate of success of this procedure was very high compared to the other conventional procedures.

The surgical measures used for diabetic treatments have surpassed the non-surgical treatment. This can be attributed to the immediate effect after the surgery in contrast to the other treatment mode that requires relatively more time. In case of medications, significant decrease in diabetes resulted only after obtaining maximal weight loss. This may result in changes to body like gut hormone alterations.

Patients who undergo surgical methods were free from diabetes even after 2 years.