Can women with uncontrolled diabetes have metabolic surgery?

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

As you mentioned, your BMI (body mass index) is over 45, with a weight of 315 lbs., which falls into class 3 obesity with uncontrolled diabetes and hypertension, so you are a strong candidate for bariatric or metabolic surgery. In such cases, the risk of not opting for surgery, continued progression of diabetes, cardiovascular disease, and kidney damage can outweigh the risks of surgery itself, especially if medications and lifestyle changes have not been effective. Metabolic surgery can help to improve both blood sugar and hypertension, depending on the type of surgical procedure. With around 60 to 70% inducing remission for diabetes and HTN (hypertension).

There are different types of bariatric surgeries.

1. Sleeve gastrectomy (up to 80% of the stomach is removed) is very effective for weight loss and diabetes improvement.

2. Roux-en-y- gastris bypass (RYGB) - It creates a small stomach pouch and reroutes the small intestine to bypass part of the stomach and duodenum, and it is most effective for type 2 diabetes remission.

3. Mini gastric bypass (one anastomosis bypass) - This is a shorter surgery with fewer complications. It is effective for weight loss and diabetes.

4. Adjustable gastric banding - This surgery has a high rate of long-term complications and reoperations.

5. Biliopancreatic diversion with duodenal switch (BPD-DS) - It has the highest weight loss and diabetes remission rates. This surgery creates a high risk of malnutrition. It requires lifelong strict vitamin and protein supplementation

The main difference between sleeve gastrectomy and Roux-en-Y gastric bypass is

1. Sleeve Gastrectomy - About 75 to 80 percent of the stomach is removed, leaving a narrow gastric "sleeve." There is no intestinal bypass, only restrictive. It reduces stomach volume and decreases ghrelin (hunger hormone). There is minimal malabsorption and a lower risk of deficiencies. Weight loss is around 60 to 70%.

2. Roux-en-Y Gastric Bypass (RYGB) - A small stomach pouch is created and connected directly to the jejunum. This bypasses the duodenum and part of the jejunum. It is both restrictive and malabsorptive. It reduces intake and nutrient absorption and also alters gut hormones. There is significant malabsorption. There is a higher risk of deficiencies in iron, B12, and calcium. Weight loss is around 65 to 80%, slightly more than sleeve gastrectomy. The complications faced were bleeding, infections, and anastomosis leakage.

Recovery period - It involves a hospital stay of one to three days. A person can do full activity within four to six weeks. You will follow a structured plan starting with liquids, then soft foods, and then regular meals over a few weeks. Most patients lose 60 to 80% of excess weight and maintain long-term improvements in blood sugar and pressure. You will need to commit to regular follow-up, nutritional counseling, and possibly vitamin supplements for life.

For more information, you can consult a bariatric surgeon, who will guide you to know the best option for you.

I hope this answers your query.

Let me know if I need to assist you further.

Thank you.