Bariatric Surgery for Diabetes: Overview

Bariatric surgery (weight loss surgery) is most often associated with the treatment of obesity, but it is increasingly being recommended for managing diabetes. Many people are able to achieve remission from their diabetes after a gastric bypass or a sleeve gastrectomy. This surgery may be recommended for people with diabetes even when not also diagnosed with obesity.

This article will address the use of bariatric surgery as a treatment for diabetes.

What Is Bariatric Surgery for Diabetes?

Bariatric surgery is a type of surgery that is done on the stomach. It can be used to treat obesity and help with weight loss. The most common forms of weight loss surgery are gastric bypass and sleeve gastrectomy.

Gastric Bypass

In a gastric bypass, the stomach is separated into two parts. The upper part of the stomach is then connected to the small intestine.

Food then bypasses the larger, lower part of the stomach and the first and second parts of the small intestine (the duodenum and the beginning of the jejunum). The procedure reroutes the small intestine and creates a stomach that’s smaller and more like a pouch. 

After this surgery, people lose weight and experience better control over their blood glucose (sugar) levels. A gastric bypass may be performed in one of two ways: In laparoscopic surgery, a few small incisions are made in the abdomen, through which special tools are inserted to complete the surgery. Open surgery, which is now less common, requires one large incision to be made.

Sleeve Gastrectomy

A sleeve gastrectomy is a surgery that makes the stomach smaller. About 80% of the stomach is removed, and the remaining part is shaped like a tube. But unlike with gastric bypass, the small intestine is not altered. 

A smaller stomach means that after surgery, the person feels full quicker after eating. The surgery also spurs hormonal changes that can help with weight loss. A sleeve gastrectomy is most often done through laparoscopy.

Contraindications

Not everyone who lives with diabetes or obesity is a good candidate for weight loss surgery.

Some of the reasons that bariatric surgery might not be a good option include:

• An uncontrolled mental health diagnosis or intellectual disability that could make following the postsurgical instructions difficult to follow
• Advanced cancer
• Conditions such as end-stage kidney disease, liver disease, or cardiopulmonary disease (conditions affecting the heart and lungs)
• Cirrhosis with portal hypertension (liver disease complicated with high pressure in the vein leading from the liver to the intestines)
• Current smoker
• Inflammatory bowel disease (a group of conditions that affect the digestive system) that is not well-managed
• Pregnancy or planning to become pregnant in the next one to two years
• Substance use disorder

Potential Risks

In most cases, the benefits of bariatric surgery, including the management of diabetes, outweigh the risks. However, as with any type of surgery, there are some potential risks.

Some of the complications that may occur in the first month after gastric bypass surgery are:

• Bleeding in the abdomen or the gastrointestinal tract
• Bowel obstruction (blockage) 
• Infection 
• Internal hernia (intestine pushing through gaps where the surgery was performed and becoming stuck) 
• Leak at the surgical site
• Venous thromboembolism (a blood clot blocking a vein)
  

After a month, some of the more common potential complications include:

• Bowel obstruction (blockage)
• Cholelithiasis (gallstone disease)
• Dumping syndrome (food moving too quickly from the stomach to the small intestine) 
• Fistula (abnormal connection between two organs) 
• Hernia (a weak spot in the abdomen that causes a bulge) at the incision site or an internal hernia (intestine becoming stuck where the small intestine was altered during surgery)
• Malabsorption (not absorbing all the nutrients from food)
• Nutritional or vitamin deficiencies 
• Stricture at the surgery site (a narrowing of the connection between the stomach pouch and small intestine)
  

Some of the complications that might happen more often in the first month after sleeve gastrectomy include:

• Bleeding in the abdomen or the gastrointestinal tract
• Infection 
• Leak at the surgical site
• Venous thromboembolism (a blood clot blocking a vein)
  

After a month, some of the more common potential complications include:

• Cholelithiasis 
• Heartburn and regurgitation, gastroesophageal reflux disease (GERD)
• Incisional hernia (a weak spot that causes a bulge in the abdomen) 
• Nutritional or vitamin deficiencies 
• Sleeve stricture (a narrowing of the gastric sleeve)
  

Purpose of Bariatric Surgery for Diabetes

The inability of the body to control blood glucose levels can lead to a number of potential complications. For this reason, it’s important to manage diabetes properly.

However, some people are unable to achieve control even with diet, lifestyle changes, and medications. Bariatric surgery may be an option for some patients to manage the disease and promote weight loss.

How to Prepare

Preparing for bariatric surgery will include several steps, such as speaking with healthcare providers to decide which type of surgery will be done, what will be needed for preparation and recovery, and what to expect in the days and weeks after leaving the hospital.

There will be several appointments beforehand to learn about the surgery, the hospital stay, and what life will be like during recovery and beyond.

Some of the tests that might be done before the surgery include:

• Abdominal ultrasound: Uses sound waves for imaging
• Blood chemistry tests: Blood test panel to assess overall health
• Complete blood count (CBC): A blood test to evaluate blood cells
• Liver function tests: A blood test panel to assess the health of the liver
• Computerized tomography (CT): Uses X-rays and a computer to produce cross-sectional images
  
• Electrocardiogram (ECG or EKG): Electrodes are used to assess the heart's electrical activity
  

Directions about what medications to stop before surgery, what to bring to the hospital, and how to prepare in the days before it will be given. Some people may also be prescribed a specialized diet to follow in the period before surgery.

What to Expect on the Day of Surgery

Surgery day will include checking in at the hospital or surgical center to sign consent forms and get instructions. There may be more lab tests done and vitals will be taken (such as blood pressure, temperature, and oxygen levels). An intravenous (IV) line will be placed to provide fluids and anesthetic or other medications.

There will also be meetings with the surgeon, anesthesiologist, and other healthcare staff prior to the procedure. After being taken into the operating room, the person is prepped and put under anesthesia so they’re asleep during the surgery.

Recovery

Recovery from bariatric surgery will be in several stages. In the immediate days and hours after surgery, there will be a recovery period in the hospital. This will include pain and wound management and advancing the diet from clear liquid meals up to either thick liquids.

Walking and going to the bathroom to empty the bowels are also key parts of improving enough to be discharged to go home.

Long-Term Care 

A care plan will be put in place for long-term management after bariatric surgery. In the first few weeks and months, this will include appointments with the surgeon and/or other healthcare providers regarding the recovery from surgery and getting back to regular activities such as work and school.

Long-term care will also include changes to lifestyle, and especially to diet and exercise. This is because it will be important to manage your weight loss and watch for any vitamin or mineral deficiencies.

After surgery, you may work with a dietitian and a mental health specialist, in addition to the surgical team, to get the best outcome and optimize weight loss.

Summary

Diabetes is a common condition that is often treated with medication and lifestyle changes. However, for those who are unable to manage the disease with these methods, bariatric surgery may also be an effective treatment.

A Word From Verywell

Bariatric surgery may have benefits not only in treating obesity but also in managing diabetes. There are several types of bariatric surgery. Some are done laparoscopically and have quicker recovery times.

As bariatric surgery has become increasingly common, support in long-term care is more available. Support is necessary for learning how to live well and manage the condition for which the surgery was performed.