Sleeve Gastrectomy and Illeal Transposition (SGIT) ~ DM cure !!

Avimet; Conformin; dibimet; formet ; Glumet ; Glyciphage ; Glycomet ; Insumet ;Medformin ; Metlife ; Obimet ; Omet ; Walaphage and more……… most likely that you can identify what this is easily as many Indians are buying this daily……..

Insulin is a hormone, produced by the pancreas, which is central to regulating carbohydrate and fat metabolism in the body. Insulin causes cells in the liver, muscle, and fat tissue to take up glucose from the blood, storing it as glycogen inside these tissues.  Insulin stops the use of fat as an energy source by inhibiting the release of glucagon. When blood glucose levels fall below a certain level, the body begins to use stored sugar as an energy source through glycogenolysis, which breaks down the glycogen stored in the liver and muscles into glucose, which can then be utilized as an energy source. When control of insulin levels fails, diabetes mellitus will result. As a consequence, insulin is used medically to treat some forms of diabetes mellitus. Patients with type 1 diabetes depend on external insulin for their survival because the hormone is no longer produced internally. Patients with type 2 diabetes are often insulin resistant and, because of such resistance, may suffer from a "relative" insulin deficiency. Metformin is an oral antidiabetic drug. It reportedly is the first-line drug of choice for the treatment of type 2 diabetes.

Since its earliest description several thousand years ago, diabetes has remained a chronic progressive disease.  There are millions of people now afflicted globally. Diabetes is now ranked as the sixth leading cause of death by disease in the U.S ; and in many places, it ranks far higher. Diet modification and oral hypoglycemic medications have proven inadequate, whereas insulin therapy only solves the problem temporarily.

Diabetes mellitus, or simply diabetes, is a group of metabolic diseases in which a person has high blood sugar, either because the pancreas does not produce enough insulin, or because cells do not respond to the insulin that is produced. This high blood sugar produces the classical symptoms of polyuria (frequent urination), polydipsia (increased thirst) and polyphagia (increased hunger). Besides 1 & 2, there is the third variant – the  gestational diabetes occurring in pregnant women without a previous diagnosis of diabetes develop a high blood glucose level. It may precede development of type 2 DM. Untreated, diabetes can cause many complications. Acute complications include diabetic ketoacidosis and nonketotic hyperosmolar coma. Serious long-term complications include cardiovascular disease, chronic renal failure, and diabetic retinopathy (retinal damage).

Adequate treatment of diabetes is thus important, as well as blood pressure control and lifestyle factors such as stopping smoking and maintaining a healthy body weight. Combination of laparoscopic ileal interposition (II) with sleeve gastrectomy (SG) is an upcoming procedure, which offers good metabolic improvement and weight reduction without causing significant malabsorption.

Bariatric surgery has evolved as a double-edged tool to manage obesity and related comorbidities like diabetes, hypertension, and hyperlipidemia. Following bariatric surgery, glycemic improvement starts earlier and is disproportionately more than weight reduction.  Here is an interesting report that appeared in Times of India Chennai edition recently, that offers hope for those afflicted.

Obese diabetics have a lot of surgical options that help them lose weight and have a better control over diabetes, but slim diabetics are condemned to regular insulin shots and medication. Now, a simple nip and tuck in the intestine can help slim diabetics live normal lives. Doctors at Rigid Lifeline Hospital performed a Sleeve Gastrectomy and Illeal Transposition (SGIT) procedure on a diabetic weighing just 70kg.

In the SGIT procedure, a Brazil-based method, doctors shorten the intestine so that it is closer to the stomach. “When a 6-foot section of the intestine is removed, food reaches the lower portion faster. This way , the intestine gets tricked into thinking that the patient has diarrhoea and releases a hormone called GLP-1 which acts as a brake and secretes insulin to regularise sugar levels,“ said Dr JS Raj Kumar who performed the surgery.  In the 36-year-old patient who had been battling diabetes for more than four years, doctors made three cuts in the intestine and joined it in three sections again. “We also ensure that ghrelin, the hormone that triggers hunger, is decreased. The significant factor that should be kept in mind while doing the surgery is to ensure there are no leaks after re-attaching the intestines,” he said.

Merely three weeks after the surgery,  the diabetes levels were dramatically regularised, said diabetologist Dr Dinakar. “His sugar levels had hit 400 before the surgery and he was forced to take 30 units of insulin every day . Now after the surgery, all he needs is three units.” Dr Dinakar said effects of the surgery would be felt only after six months and 50% of patients had a chance of having complete diabetes remission post surgery !!

With regards – S. Sampathkumar

25^th May 2015.