ŞEKER HASTALIĞI (TİP 2 DİYABET) NEDİR?

What is Diabetes Type II/ What causes it?

Type II diabetes, known as the ‘sugar disease’, a chronic disease that is caused by inefficient use of pancreas-produced hormone insulin, which consequently leads to several other comorbidities.

Insulin, allows glucose (the major energy source for the human body) to turn into energy so that organs can function. Problems associated with pancreas may lead to insulin production issues, which leads to diabetes and other associated comorbidities.

Hormones have vital roles in being overweight, eating habits, sedentary life, nervous and environment factors.

Tip 2 Diyabet İle Tip 1 Diyabetin Farkı Nedir?

Type I diabetes is the inability to produce insulin. Type II diabetes on the other hand is known as the lack of utilization of insulin. Diabetes Surgeries, also known as metabolic surgeries can help patients with type II diabetes to better utilize their insulin. There is currently not a surgery that proved to be effective for Type I diabetes.

The classical treatment options for diabetes type II, which involve high dose of insulin use may not lead to the desired control of the condition. According to the scientific research, the incompatibility is highly prevalent throughout the classical treatment options. Furthermore, for drug treatment to be effective, life-long diet and exercise is necessary, which may be difficult to achieve.

What Are Symptoms of Type II Diabetes?

Type II diabetes has many symptoms.  The most frequent symptoms are listed under.  Diabetes has an insidious progression. Symptoms to be prevalent just like many other metabolic diseases may take time.

  • Frequent urination
  • Permanent thirst
  • Permanent dry mouth
  • Constant feeling of hunger
  • Later recovery of scar tissues
  • Sexual performance problems
  • Dry skin and itch
  • Frequent infections
  • Sensation problems in hands and feet or tingling

What Happens if Type II Diabetes Progresses?

The most important point in Type II diabetes treatment is to prevent the organ damage.  The classical treatment options often fail to regulate the blood sugar levels, which increases the extent of organ damage with time. Diabetes attacks the organs by damaging the vascular wall. The damaged vasculatures varies in each patient; however, in general, heart, nervous system, kidneys, sexual problems (erectile dysfunction and early ejeculation), eye and peripheral nervous system problems are common. If not treated, diabetes may negatively impact the functioning of other organs.

How Does Diabetes Type II Progress?

The vascular damage begins before the diagnosis of type II diabetes. It would not be wrong to state that, most type II diabetes patients have vascular damage as the diagnosis comes a few years after the start of the disease. However, because it is a slowly-progressing disease, it takes years for any tissue damage to occur. During this time, the patients often get the classical treatment options; however, most of the patients cannot comply with the treatment (including diet and exercise support), which leads to improper regulation of the blood sugar levels. Patients get accustomed to the high blood sugar levels and do not experience momentary problems. This leads patients to not take the blood sugar levels seriously that leads to organ damage progressively. Furthermore, some patients do not even comply with any of the treatment options since the day one, which leads to uncontrolled blood sugar levels and consequently, early organ loss(es). Also, because the insulin reserves of the body decrease during this period, the chance of getting the surgery might decrease. Therefore, patients can be too late to get the Type II diabetes surgery.

Ameliyatla Tip 2 Diyabet Tedavi Edilebilir mi?

While it’s not new, I like to talk about a concept that gets everyone’s attention. Even the new generation doctors could not predict how the metabolic surgery changed our perspectives on chronic diseases.

Type II Diabetes Mellitus, also known as the ‘sugar disease’; due to its serious consequences (organ loss), is a globally important chronic disorders. As it is a chronic disease, all the efforts so far were focused on adjusting the blood sugar level to a normal state. However, we now talk about treating patients with type II diabetes via surgeries, which does not require the patients to use any medication or insulin. Furthermore, besides type II diabetes, we produce a level of success with other related metabolic disease at a level that has never been done before. It is very enjoyable to be able to help patients with chronic diseases and see the positive impacts it has on them.

Imagine;

You are a Type II diabetes patient who uses insulin: you need to eat everyday at certain times, adjust your insulin levels according to each meal, bring insulin and other medications to everywhere you go and in some situations, inject yourself 3-4 times in order to assess the results and then must poke your finger to measure your blood sugar levels. Every physician you visit tells you to lose weight, and because they might be insisting, you do not even want to go see them anymore. In the meanwhile, you may not even know that a side effect of insulin use is tendency to gain weight. You are exposed to Type II diabetes and its comorbidities, therefore you are far away to protect your cardiovascular system. Your efforts to diet are not successful due to your insulin-resistance related to high-low blood sugar levels. Nevertheless, you are determined to fight Type II diabetes. In order to live with diabetes and to use insulin properly, you are getting various lessons but in the era of consumerism, the moment you get out of the way even a little bit, you are being punished with bad blood sugar regulation. On the other hand, your physician started to observe organ damage in several of your organs. You realized that a lot of the information you used to hear is true such as most of the patients with kidney failure are in fact Type II diabetes patients.

What would you do?

Back in the day, we would just recommend diet and constant exercise. Fortunately, our journey doesn’t end here anymore. Obesity surgery-based experiences and studies revealed the importance of intestinal insulin use, expanded our horizons and opened the doors of a new world.

Can you treat Type II diabetes with one surgery?

Why not? Now we can. Type II diabetes disease that progresses through insulin resistance, can simply be described as the poor insulin utilization (leads to issues with blood regulation) in the human body. Now our capabilities for this disease are very advanced. Via the standard approach, we would have prescribed more insulin to patients with Type II diabetes who cannot utilize their insulin efficiently. However; now we are moving away from this strategy. Ever since we scientifically accepted the regulatory functions of the intestines, we really like a group of hormones that allow body to utilize its insulin more efficiently. The drug industry also learned from this and added GLP-1 hormone into their plans. The new generation diabetes medications, instead of increasing the insulin levels [strengthens the futile cycle], involve GLP-1 hormones that produces a similar impact as our surgeries and compared to the traditional treatments, are much more successful. The surgery alters the stomach and small intestine, which increases the impacts of this hormone group that increases the effect of insulin (hence better glucose utilization/treating Type II diabetes) without needing to take these hormones as medication.

Therefore, our answer is YES.

Is that all?

No; these surgeries can also have large positive effects on hypertension, cholesterol, sexual problems (for men), gout and even lung problems.

Therefore, with this operation that is done laparoscopically (closed) allows you to go back to your normal life after a few days. You can be cured from Type II diabetes and many other chronic diseases. This is not a JOKE…

At which stage of the disease do the Type II Diabetes Surgeries are performed?

Not every diabetic patient can undergo surgery. For surgery to be done, the disease should not have be controlled via the classical treatment options or there needs to be evidence for organ damage. In order to assess the patient’s fitness for the surgery and to better understand the level of benefit through the operation that will have on the patient, we need to test for insulin reserves and activity as well as do an extensive medical assessment of the organ damage potential of the disease.

Doing the diabetes surgery before the organ damage will make it easier to protect the organs!

Metabolic Surgery (Diabetes Surgery)

What is Metabolic Surgery (Diabetes Surgery)

Metabolic Surgery refers to the surgical interventions for Type II Diabetes patients who cannot control their disease via classical treatment options. These operations are done on the stomach and the intestines laparoscopically [closed surgery].

Due to Type II Diabetes’ ability to slowly damage organs, the habit(s) that led to the development of diabetes in the first place may turn into a way of living. Therefore, many people may not succeed via the classical diabetic treatment options. It is not easy to change one’s life style either. There are many patients who depends on medication to live with Type II Diabetes. Furthermore, due to the poor control of diabetes, organ damage is often inevitable.

After your discussion with Dr. Recep Aktimur, your fitness for the operations will be finalized, which is co-decided with the potential applicability of the metabolic surgery. This is going to be the first step towards your new life. After that, all you have to do is to “dream” what you want to do with it.

What are the Risks and Benefits of the Metabolic Surgery?

What are benefits of the Diabetes Surgery for the patients?

Diabetes Surgeries are known to control Diabetes Type II in the past 10 year period in 90% of the patients without having the need to use any medication and insulin. Furthermore, it is known to prevent diabetes-induced organ damage.

Diabetes Surgery is effective on hypertension, high cholesterol and sleep apnea!

Diabetes Surgery (Metabolic Surgery) also allows patients to reach their ideal body weights and have positive impacts on co-morbidities that negatively impact patients’ comfort such as hypertension, high cholesterol and sleep apnea.

Are these surgeries dangerous?

These operations have less than 10% chance of developing any problems. While in the short term after the surgery: bleeding, leaking, infection and problems associated with anesthesia may develop, in the long run, rarely small intestine hernia, diarrhea and gall bladder stone development may be experienced.

In our practice, the percentage of the chance of experiencing a problem in the upper digestive systems are significantly lower than these values.

Which stage of the disease are appropriate for metabolic surgeries?

For us to give the surgical intervention decision, your diabetes must be uncontrollable via the classical treatment options or there has to be an evidence for diabetes-induced organ damage. In order to assess the patient’s fitness for the surgery and the level of benefit they will receive from the surgery, we need to test for adequate insulin reserves and activity as well as an extensive medical assessment in order to better understand which organs were or are being damaged.

How are the operations done? What is the purpose?

These stomach and intestine-related surgeries are done closed (laparoscopic) via 4-5 small incisions around the stomach with a diameter of 1 cm. All the operations involve moving the back side of the small intestine higher up, in order for it to meet with food earlier. This allows the activation of the hormones that are secreted from the back of the small intestine, which allow body’s insulin to be used more efficiently.

Can I be cured from Diabetes Type II forever via metabolic surgery?

Based on 3-month blood sugar levels, it is known that 90% of the patients can control their diabetes without medication or insulin in the 10 year process after the surgery. Therefore, our main goal is to delay the organ damage as long as possible. On the other hand, due to aging, the impact of the surgery metabolically may decrease. The surgeries allow the insulin reserves to be used more efficiently. Therefore, when the insulin reserve is depleted, no effect can be seen.

The main goal of diabetes surgery is to delay organ damage as long as possible

You do not need to diet after the operation

Normal MideKüçültülen Mide

MİDE KÜÇÜLTME OPERASYONU

What are the pre-surgery criteria?

The blood glucose (sugar) standard should be under 100 mg/dl. The fasting blood glucose range between 100-125 mg/dl are considered problematic. Individuals in this range are considered pre-diabetic, which means  that they are not yet diabetic. However, these patients are a step behind Diabetes Type II and have a high chance of developing the disease.

For someone to be diagnosed with Type II Diabetes, their fasting glucose levels must be 126 mg/dl or higher. When these patients undergo the 2-hour oral glucose tolerance test (OGTT), their blood sugar levels will go over 200 mg/dl after the second hour.

            In this situation, there only needs to be one of two criteria for one to be diagnosed with Type II Diabetes:

  • Fasting Blood Glucose (FBG) ≥ 126 mg/dl
  • OGTT (Oral Glucose Tolerance Test) Second hour value ≥ 200 mg/dl

What is HbA1c?

Hemoglobin (Hb) is the oxygen carrying protein in the blood. Based on the blood sugar levels, some levels of hemoglobin gets covered by glucose. These Hb are called glucosed-Hb, also known as HbA1c. People who do not have diabetes also have HbA1c molecules; however, this value is under 6.5%. HbA1c levels indicate the progression of blood levels of the past several months. We monitor the mid-term blood levels and the efficacy of the treatments of diabetic patients by monitoring HbA1c levels.  If someone has HbA1c ≥ 6.5%, they are diabetic. If they are in the range of 5.7-6.5%, they are under high risk of developing Type II Diabetes.

Should I be afraid of the surgery?

When someone mentions surgery, many people think about the operations that are done with scalpel. Metabolic surgeries are done in a closed way, which leads to a lot of our patients who are normally afraid of surgeries to give their decisions without any difficulty. Prof. Dr. Recep Aktimur’s special technique in metabolic surgery allows our patients to be discharged in a day.

Is it possible to be equally successful with every patient?

Patients with high insulin reserves and activities experience more benefits from the surgery. Because patients with lower insulin reserve would experience less benefits from the surgery, the operation may not be recommended. The surgery’s success occurs through a hormonal control. Therefore, the emotions (i.e. anger, sadness) observed in Type II Diabetes can be experienced.

What’s going to happen after the surgery?

The closed (laparoscopic) surgeries maximize the patient comfort. Additionally, these benefits are enhanced by “accelerated recovery protocols”, which is only applied by our clinic in our country that allow achieving the next level with patient comfort and shortens the period required to go back to normal life. These protocols suggest not using nasal catheter, drain and urinary catheter as well as start water consumption 4 hour after the surgery, which collectively allow us to discharge our patients on the first day. We do not require any period of soft food (i.e. pure) and after a week of liquid nourishment, we move to normal eating habits. Our patients can eat without any restrictions after the surgery, which is one of the main goals of the operation; however, as we all know there are a lot of benefits of having healthy eating habits. In the meanwhile, the body is being cured from Diabetes and our patients are continuously feeling better and more refreshed.

Some changes in the blood glucose levels will be observed right after the surgery; however, we closely monitor our patients until we see the desired effects.

After our diabetes surgeries, our patients need to use multivitamin for 1 year.

Metabolic Surgery Day & After

We start the surgery after our patients go under the required tests and preparations on the day of the surgery. Operations take approximately 45 minutes. After that, we take our patients to their room to rest.

The closed (laparoscopic) surgeries highlight the patient comfort. Additionally, these benefits are enhanced by “accelerated recovery protocols”, which is only applied by our clinic in our country that allow us to achieve the next level in terms of the patient comfort and it shortens the period required to go back to normal life. These protocols suggests not using nasal catheter, drain and urinary catheter as well as start water consumption 4 hour after the surgery, which collectively allow us to discharge our patients on the first day

We do not require any period of soft food (i.e. pure) and after a week of liquid nourishment, we move to normal eating habits. Our patients can eat without any restrictions after the surgery, which is one of the main goals of the operation; however, as we all know there are a lot of benefits in having healthy eating habits. In the meanwhile, the body is being cured from Diabetes and our patients are continuously feeling better and more refreshed.

Some changes in the blood glucose levels will be observed right after the surgery; however, we closely monitor our patients until we see the desired effects. We remain in constant communications with our patients in order to support them to adapt to their new lives.

After our Type II diabetes surgeries, our patients need to use multivitamin for 1 year. This is vital for our patients’ adaptation to their new body.

After the metabolic surgery, our patients change their life styles and can start doing a lot of activities that they couldn’t do previously. The changes in their quality of life occur rapidly. In order for our patients to have a high quality life, our patients should participate in healthy habits such as; eating health, sleeping well, doing physical activities. These activities are not only good for the patients who have gone through metabolic surgery but for everyone who wants to be healthy.

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