Patient's Query
Hello Doctor,
I am a 38-year-old female, 5 feet 6 inches tall, weighing 322 pounds, with a body mass index (BMI) of 52. I have struggled with obesity my entire life, but my health has significantly deteriorated over the past five years. I was diagnosed with type 2 diabetes mellitus three years ago, and despite being on the maximum doses of metformin, glipizide, and 50 units of insulin daily, my hemoglobin A1C remains at 9.3 percent. My blood pressure is consistently around 165/95 mmHg, even while taking three antihypertensive medications. I was recently diagnosed with moderate obstructive sleep apnea with an apnea-hypopnea index (AHI) of 22, but I am unable to tolerate continuous positive airway pressure (CPAP) therapy due to a feeling of suffocation. I experience constant joint pain in my knees, hips, and back, which makes exercise nearly impossible. Four years ago, I lost 70 pounds through a medically supervised weight loss program, but I regained 95 pounds after complications during pregnancy forced me to stop. My obstetrician-gynecologist (OB-GYN) has advised me to lose weight before trying to conceive again, as my last pregnancy was complicated by gestational diabetes mellitus, preeclampsia, and an emergency cesarean section at 34 weeks. My liver enzymes are elevated (alanine aminotransferase [ALT] 92 U/L and aspartate aminotransferase [AST] 78 U/L), and an abdominal ultrasound confirmed severe hepatic steatosis. Most concerning, my cardiologist noted signs of left ventricular hypertrophy on my latest echocardiogram. My health insurance covers both Roux-en-Y gastric bypass and sleeve gastrectomy, but I am fearful of complications. My mother had a gastric bypass 15 years ago and suffered from severe vitamin deficiencies and osteoporosis. I want to know if metabolic surgery is truly effective for diabetes reversal, whether gastric bypass or sleeve gastrectomy is more suitable given my conditions, and how risky surgery would be considering my current health issues.
Kindly help.
Hello,
Welcome to icliniq.com.
I understand your concern.
Metabolic surgery, also known as bariatric surgery, can be a viable option for improving glycemic control, even in individuals who are not classified as morbidly obese. With a body mass index (BMI) of 32 and poorly controlled type 2 diabetes mellitus, you may still be a candidate for surgery, particularly if conventional treatments have proven ineffective. It is essential to consult with a board-certified bariatric surgeon to assess your individual medical history and suitability for the procedure.
Blood glucose levels often begin to improve rapidly following surgery, sometimes within days to weeks. Many patients experience significant reductions in their insulin requirements, and some may be able to discontinue insulin therapy entirely. However, outcomes can vary, and ongoing monitoring by a multidisciplinary healthcare team is crucial for ensuring safety and long-term success.
I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.
Thank you.
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Answered byDr. Srinivasa Murthy
Medically reviewed byiCliniq medical review team
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