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Diabetes Mellitus -

Definition:
Diabetes mellitus is a chronic disease resulting from abnormally elevated blood glucose. Obesity is associated with type 2 diabetes, the characteristics of which are resistance of the tissues to insulin as well as a relative deficiency of insulin in the β-cells of the pancreas. Insulin resistance, decreased insulin secretion, and increased hepatic glucose output are the hallmarks of type 2 diabetes.

Long-term Implications:
Intra-abdominal fat results in the increased inflammatory molecules, toxins and free fatty acids that cause insulin resistance, pancreatic β-cell damage, abnormal cholesterol and triglycerides, hypertension and other deleterious effects. In people who have the genetic predisposition to develop diabetes, the β-cells of the pancreas cannot keep up with the increased demand for insulin caused by the insulin resistance in the liver, muscle and fat cells, so that diabetes results. By the time diabetes is diagnosed, more than 50% of the β-cells of the pancreas have already been damaged. This damage is chronic and progressive and although diet, exercise and pills may control it initially, many patients will ultimately need to take insulin injections to control their blood glucose levels. Metformin, which decreases hepatic (liver) glucose output and sensitizes peripheral tissues to insulin, is considered the first-line agent. Other medications include sulfonylureas and non-sulfonylurea secretagogues, α-glucosidase inhibitors, and thiazolidinediones. Insulin can be used to manage an acute case of blood glucose imbalance in patients newly diagnosed with type 2 diabetes or it can be added to a regimen of oral medication to improve glycaemic control.


The symptoms of diabetes mellitus are increased thirst, passage of increased volumes of urine, hunger, weight changes (variable), blurred vision, tiredness and bacterial and fungal infections like Candida (thrush). However, very often the disease remains silent and may only be diagnosed after developing one of the complications of diabetes – impaired vision, painful or numb feet, angina or heart attack, stroke, or arterial insufficiency in the legs. This is because preceding the diagnosis of overt diabetes there is a silent period of up to 10 years of metabolic upset (metabolic syndrome and pre-diabetes) when high blood pressure, elevated cholesterol levels, elevated insulin levels and insulin resistance cause unrecognised damage to arteries.

Complications of diabetes include:

Inflammation of small arteries and arterioles that cause:
• Damage to the retina of the eye – resulting in visual impairment or blindness
• Damage to the kidneys
• Damage to nerves
• Erectile dysfunction

Damage to and narrowing of larger arteries, resulting in:
• Heart attacks
• Strokes
• Arterial insufficiency in the legs that can result in gangrene, requiring amputations

How Is It Affected By Weight?
Because obesity and type 2 diabetes co-exist in more than 90% of type 2 diabetics and because there is a world-wide epidemic of obesity, there is also an epidemic of type 2 diabetes. The economic and health implications of this epidemic cannot be over-emphasized.

Will Having Bariatric Surgery Help?
By treating obesity, insulin resistance is reduced and diabetes ameliorated or even cured in some cases. When insulin resistance is decreased the pancreas has to produce less insulin to control blood glucose levels.

After Roux-en-Y gastric bypass and biliopancreatic diversion (BPD) surgery, insulin levels often rise. It is thought that this is the result of increased secretion of gut hormones called incretins the one thought to be most important in this respect is GLP-1. These operations, therefore, have important endocrine effects, in addition to and independent of the beneficial effects of significant weight loss.