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Gastric bypass lowers blood sugar, alleviates diabetes

In her battle with diabetes, Victoria Champagne was losing until she tried a drastic measure: bariatric surgery.

In the days following her surgery six months ago, her blood sugar levels returned to normal and have stayed there, even before she began dropping the 50 pounds she has lost so far.

Dr. Ryan Tyner, a bariatric surgeon with ABQ Health Partners, explains research shows 70 percent to 80 percent of those who have the surgery Champagne received, a Roux-en-Y gastric bypass, have remission from their diabetes. Some other weight-loss surgeries don’t seem to be as effective for diabetes control as the gastric bypass surgery. The surgery could offer hope to the millions of people who suffer from the twin epidemics of diabetes and obesity, he says.

Champagne, 44, a medical technologist, had dieted religiously to lose weight and had exhausted medical solutions to control her blood glucose.

“I was diagnosed with Type 2 diabetes seven years ago,” she says. “At first, like any other adult, I started work on my diet. I tried vegan; I tried Atkins; I tried everything.”

But it didn’t work. No matter how hard she tried with diet and exercise, the scale barely budged.

Soon she was prescribed multiple oral medications, but those also failed to reduce her blood glucose levels.

Finally she was injecting herself with insulin three to six times a day. Still, “It was poorly, horribly controlled. I was really in trouble.”

On an A1C test that measures average blood sugar levels over a two- or three-month period, she was double the normal score of seven, she says.

She found some hope when she listened to Tyner talk about research that showed bariatric surgery reversed diabetes: “It wasn’t solely the weight loss. It was something about the bypass itself.”

At first, she wasn’t comfortable with the idea, but soon became willing to try the surgery after her own careful investigation and with support from Tyner and his office: “I didn’t want to be injecting myself with insulin the rest of my life. I really wanted to see if it could work for me. If it meant I could just get back on oral medication, I would have been pretty happy.”

Although at 230 pounds with a body mass index of 35, she was at the low end for qualifying for the surgery, her diabetes made her a candidate, she says.

Tyner performs the gastric bypass laproscopically with several small incisions and a scope.

Nurse practitioner Marjorie Cypress, also with ABQ Health Partners, who is president-elect in healthcare and education for the American Diabetes Association, says about 26 million people in the country have diabetes. That translates to a cost of $1.5 million annually in New Mexico: “One out of every five of health-care dollars goes to taking care of people with diabetes.” Without intervention, by 2030, one in three people are expected to have diabetes, she says.

She cautions bariatric surgery should not be taken lightly, although it has resulted in remission of diabetes in a number of cases and clearly has benefits. She adds that the surgery is not a replacement for healthy living through physical activity and a nutritionally sound diet: “When my patients ask me about it, I tell them to get more information and to discuss the risks and benefits. It is not as simple as saying that they will lose weight and ‘cure’ diabetes. This surgery requires that you change the way you eat forever. People need to ask themselves if they think they can follow the nutritional recommendations.”

In the gastric bypass operation, a small part of the stomach is used to create a new stomach pouch, which will ultimately hold about 3 ounces, Tyner says. That small stomach pouch is connected directly to the mid portion of the small intestine, bypassing the rest of the stomach and the upper portion of the small intestine.

Tyner’s success with the surgery for people with diabetes bears out the statistics reported in an April 2012 New England Journal of Medicine and a June 2013 World Journal of Diabetes.

“Their diabetes isn’t cured. It’s a chronic medical condition,” he says. “The remission is the miraculous part. It’s overwhelmingly dramatic. It occurs in the first 24 to 48 hours after surgery. They have lost a pound or two, not enough for the weight loss to cause the remission. It’s a powerful thing.”

He says that the gastric bypass surgery appears to create metabolic changes driven by the changes to the stomach and the small intestine.

More and more the medical community is beginning to understand the value of gastric bypass surgery for diabetes control, Tyner says.

“The old-fashioned idea is to use this surgery to get them into their swimsuits. The ultimate goal is to treat all these conditions associated with obesity,” he says.

The major surgery, like any other, has risks. Although Tyner, who has been performing the surgeries since 2011, has not experienced any of these complications, some include leakage, a blood clot or bleeding from the surgery, he says.

“We don’t know exactly how it all works, but I’ve done this for years and it’s still miraculous,” he says of blood sugar levels dropping to normal the day following a gastric bypass.

Champagne says she was surprised at how rapidly her blood glucose returned to normal: “I was not prepared for how rapid and extreme the changes were. I was not expecting a switch to go off.”

Her recovery took some time. She was off work for four weeks and then returned to light duty.

She had to learn a new way of eating. She can eat about three or four bites at a time, so her food must provide optimum nutrition. She has to be careful of not eating the wrong things, because of a dumping syndrome, where food passes through too quickly: “You have to chew your food 30 times before you swallow it.”

Champagne also feared people would judge her harshly for having the surgery, as if it were an easier way out of her diabetes and weight issues than mustering through with willpower alone.

To prepare, she had to go on a liquid diet two weeks before her surgery: “That took quite a bit of willpower. If people think this is easy, they should try it themselves.”

Still she is happy with the outcome, because she understands the real dangers that diabetes poses: “Now I feel as if nothing happened to me. I feel completely normal. The cumulative effects of diabetes are aging your body from the inside out. With diabetes, your body is dying from the inside.”