Diabetes Improvement after Bariatric Surgery

Question: Describe the mechanisms of type 2 Diabetes improvement after bariatric surger? Answer: Link between obecity and diabetes- Type 2 diabetes is one of most common physico-metabolic disorder which is characterized by high glucose level in blood which caused by insulin resistant by internal metabolic system or lack of insulin. Almost 85%-90% cases are type 2 diabetes among diabetes. So here bariatric surgery which is mainly associated with weight loss can be a significant solution for the people suffering from type 2 diabetes. There are some physico-chemical mechanism of body system are responsible for normalization of blood sugar level .Such as caloric restriction hypothesis, gastrointestinal hormonal changes hypothesis etc. (Mingrone , Castagneto-Gissey,2009) 80%-90% of diabetes affected peoples are diagnosed with obese. It provides enough support to the fact that there is an significant co-relation between diabetes obesity. Overweight give extra stress on the human body in a various way. Infact abnormal weight can be a significant factor to insulin resistance of body system. Overweight is common symptom which is generally seen in the people who are take insulin to maintain body glucose level. (Allen et al. 2013).The mechanism is more the insulin is taken more the glucose is absorbed in the cell, which is later transformed into fat. Thus a chance of gaining abnormal body weight is enhances. To get rid of this complications bariatric surgery are often prescribed by the physicians. There are several mechanism to normalize the blood glucose level after bariatric surgery. (Madsbad , Dirksen , Holst 2014). Various mechanism of reducing Type 2 diabetes after bariatric surgery- Research shows type 2 diabetes is markedly improve after a successful weight loss surgery such as bariatric surgery. One long-term study tracked 400 people diagnosed with type 2 diabetes. After 6 year of performing bariatric surgery on them,62% among them have no sign of diabetes. In this blood glucose normalization process various mechanism are associated. These are as follows- 1)Caloric restriction hypothesis- Patient diagnosed with Type 2 diabetes has shown outstanding improvement in insulin sensitivity as well as in bte-cell function also with minimum optimum calorie diet which is maintained consistently as follow up of bariatric surgery where both subcutaneous and central fat decreases.(Bradley , Magkos , Klein ,2012). A small study shows Insulin secretion low down 13.7 mclU/mL to 6.7 mclU/mL(p0.001) in the optimally controlled diet group compared with a fell from 23.2mclU/mL to 12.8 mclU/mL(p0.001) in the bariatric surgery group, performed by Judith Korner, MD, PhD, of Columbia University. 2) Gastrointestinal hormonal changes hypothesis- The concise blood sugar controlling effect of bariatric procedures has been very effective since recent years. In a concise metabolic analysis by Buchwald et al.,shows that controlling rate of blood sugar in type 2 diabetes followed by bariatric procedure, Roux-en-Y gastric bypass (RYGB) were recorded to be 80%. The various gastrointestinal hormones produced from endocrine cells scattered along the whole GI tract. The latest characterization of intestinal metabolism after the bariatric surgery which is associated with entailing systematical alteration of food pathway nutrients through the GI tract composed with the fast frequent controlling of blood glucose level in type 2 diabetes after this operation. (Navarro-Diaz , Serra , Romero , Bonet , Bayes et al. 2006) Figure-1 Img-a Img-b [In the image-a normal gastrointestinal physiology and anatomical structure is shown. In image-b the physiology after RYGB is displayed.] As secretion of L-cell which is located in small intestine plays a significant physic-chemical operative role in management of blood glucose ,and in order to minimizes the L-cell secretion various follow-up chemical function occurred. Such as reduced secretion of the other hormone, glucose-dependent insulinotropic polypeptide from enteroendocrine K cells,which is mainly located in the proximal portion of the small intestine and suppression of ghreline secretion . These all physico-chemical procedures plays a significant role in maintain the blood glucose. In various hormone of stomach Ghrelin glucagon like peptide-1 has an distinct role in post bariatric surgical procedure for normalization of blood sugar level. ( Lieske , Mehta , Milliner , Rule , Bergstralh , Sarr . 2014). a- Decrease Ghrelin hormone Secretion It is known as Hunger hormone, is neuropeptide produced from ghrelin cell. It mainly regulates hunger as well as responsible in distribution and rate of use of energy. Circulation of ghrelin is predominantly occurred in the stomach. Mainly in the alpha beta-cells islet of langerhans ghrelin found to be produced within the pancreas. Here in order to significant concern, with regards to production of insulin ,GHS-R1 a partly co localizes in the pancreatic islet of human body system with the help of insulin positive beta cell. Acknowledging that ghrelin stimulation is one of the significant responsibility of human beta-cell. In this context it is also concern that decrease in ghrelin secretion directly decreases the blood glucose level. (Rodieux , Giusti , D'Alessio , Suter , Tappy 2008) b- Increase glucagon-like peptide-1 release This hormone basically categorized within the incretins group of hormone, the hormone is named like that, as it enhance the secretion of Insulin. L-cells of small intestine are the major source of this hormone. It enhance the secretion of insulin from the pancreas, followed by the enlargement in the volume of cells in the pancreas. After this pancreas produce insulin and stuck glucagon release. Food is the maise are n stimulus of this particular hormone release. In modern days in the formulation of anti hyperglycemic drug designing to mimic this peptide 1 in the human body system to control the blood sugar level in type 2 diabetes. (Sun , Asnicar , Saha , Chan , Smith . 2006) 3) The hindgut hypothesis- After bariatric surgery weight loss is occurring rapidly. Although these are the significant concern of recent research but till these are not clarified prominently. Two hypotheses are available concerning this. The hindgut hypothesis suggests that the rapid transformation of food to the distal bowel improve glucose transformation followed by minimizing glucose level. 4) The foregut hypothesis- Bariatric surgery significantly responsible for weight loss and metabolic changes which is occur after the surgery is associated with alteration in gut hormone which are associated in the glucose maintaining mechanism. In this particular concern the foregut hypothesis suggest that concerning the promoting of insulin resisting factors are till not prominently identified. (Kashyap, Gatmaitan , Brethauer , Schauer 2010) Conclusion- Two significant conclusions are obtained from above discussion and it is also understood that clarification of multiple field is to be needed. First, Insulin response is increased by the alteration of pathway of nutrients with the help of bariatric surgery. Second Maintaining of optimum calorie balance normalize plasma glucose level. References- 1. 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