Bariatric Surgery for Weight Loss
Chronic obesity that is not responsive to conservative medical treatment, diet and exercise has been shown to respond well to weight loss surgery, also known as bariatric surgery. After the procedure patients have been observed to lose around fifty percent of their weight in the first two years and are able to maintain an improved health thereafter. Bariatric surgery may be done in different techniques like gastric bypass, lap band and gastric balloon.
Recently, many patients who are obese and suffering from diabetes type 2 have also found an effective way to control both their weight and blood sugar levels; many of these patients are even able to live the rest of their lives without medications after the surgery. Is there a role for type 1 diabetes bariatric surgery for the obese?
Type 1 Diabetes and Obesity
Obesity has always been associated with type 2 diabetics who have increased blood sugar levels due to insulin resistance. In these patients, control of diet, exercise and oral medications are recommended to reduce blood sugar levels, excess body weight and to control other related conditions like atherosclerosis and heart disease. In those who do not respond to conservative treatment and are chronically obese, bariatric surgery offers an effective solution.
People who are suffering from type I diabetes on the other hand, are hardly known to be obese and their disease is not related to obesity or a diet high in sugar alone. Instead, their high blood sugar levels are due to an autoimmune disorder where there is a complete lack of insulin production by the pancreas. Therapy consists of a lifetime periodic injection of insulin and blood sugar monitoring to prevent sudden decreases in blood sugar.
Although type 1 diabetics are historically known to be underweight, it has been found that a certain subset of diabetes type 1 patients suffer from central obesity characterized by increasing abdominal girth and accompanied by a disorder in lipid (fat) metabolism. Their requirement for insulin injections are increasing constantly and this has aided in unmasking an underlying metabolic disorder that coexists with their condition.
Bariatric Surgery for Obese Type 1 Diabetics
A group of doctors from Poland (Czupryniak, MD, PhD et al) reported two cases of type I diabetes patients who were treated with gastric bypass for severe and chronic obesity increasing insulin requirements and lipid disorder. After the surgery-induced weight loss (around 50 percent) the patients were observed to have a better response to insulin therapy, requiring smaller daily doses per unit of body weight. They no longer needed medications for hypertension and blood lipid disorder. Their observations have led them to believe that bariatric surgery may have a significant role in treating obese patients who are suffering from diabetes type 1.
Since this report was probably the first according to the authors (in 2004) and that type I diabetics are traditionally known to be underweight rather than overweight, more studies have to be done to make sound conclusions over these observations. Bariatric surgery is currently an accepted treatment for certain obese individuals, including type II diabetics, but much has yet to be reported on its significance in the autoimmune type or juvenile type diabetes. Nevertheless, it is reasonable to hope that since bariatric surgery aims to reduce weight and maintain health thereafter, conditions like insulin resistance, hypertension and metabolic disorders may also be expected to improve.
Diabetes Care, "Gastric Bypass Surgery in Severely Obese Type 1 Diabetic Patients" https://care.diabetesjournals.org/content/27/10/2561.full.pdf+html
JCEM, "Visceral Obesity, Hepatic Lipase Activity, and Dyslipidemia in Type 1 Diabetes", https://jcem.endojournals.org/cgi/content/abstract/88/7/3379?ijkey=b689af99c0f5592da88a79e2c66ab643b9acbae5&keytype2=tf_ipsecsha