How does weight loss surgery fix my diabetes?

Bariatric surgery and diabetes go hand in hand since many patients who are eligible to have weight loss surgery have type II diabetes. It became clear to surgeons decades ago, that these patients' diabetes went away quickly after the weight loss operation. This began the race to discover if or what surgery could cure diabetes. What was most interesting about their observations was that the diabetes began to get better or even go away before the patients would lose any significant amount of weight. This meant that their was some other explanation for the improvement in the diabetes after the bariatric surgery. So what was it?

It turns out that the intestines are prolific endocrine organs; that is to say, they make chemical that affect other organs in the body through the blood stream. What we have learned over the last several decades is that there are hundreds, if not thousands, of different pathways through which the intestines can control all sorts of things such as hunger, glucose levels in the blood, release of insulin, and how quickly our stomach empties food into the intestines, to name a few. This is nothing less than remarkable, and it is quick a shift in thinking in the medical word. Type 2 diabetes is a disease of the small intestines.

Diabetes type 2 surgery may not be the diabetes cure everyone is talking about with respect to bariatric surgery as the "new diabetes surgery" to cure diabetes. Weight loss surgery to cure diabetes, such as the gastric bypass surgery in diabetic patients, dose have a real "cure" rate, but the most common response is improvement, not remission. 100% of patients will see some improvement in the form a decreased intake of medications or insulin usage. Many patients, especially those who have had diabetes for less than 5 years and are not on large amounts of insulin already, may experience a true remission. That is, they will come of all their medications and have normal blood sugar levels.

As we learn more about the gut and all it's wonderful hormones, we will come up with better solutions to enteroinsular impairment and cures for type 2 diabetes. In the meanwhile, we have these operations to help.

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