Frequently Asked Questions

The treatment of Type 2 diabetes typically involves a combination of lifestyle modifications, medication, in some cases, insulin therapy and lastly surgery. The specific treatment plan varies for each individual and is tailored to their unique needs. Here are the key components of treatment for Type 2 diabetes:

• Lifestyle Modifications:
  • Healthy Diet: Adopting a balanced and nutritious diet, focusing on whole foods, fibre-rich foods, lean proteins, and healthy fats. Limiting the intake of processed foods, sugary beverages, and refined carbohydrates.
  • Regular Physical Activity: Engaging in regular exercise, such as brisk walking, jogging, cycling, or any other form of aerobic activity, for at least 150 minutes per week. Resistance training can also be beneficial.
  • Weight Management: Achieving and maintaining a healthy weight through a combination of diet and exercise.

• Pills (Oral Hypoglycemic Agents (OHA):
  • Metformin: Usually the first-line medication for Type 2 diabetes. It helps reduce glucose production by the liver and improves insulin sensitivity.
  • Sulfonylureas: Stimulate the pancreas to produce more insulin.
  • Dipeptidyl Peptidase-4 (DPP-4) Inhibitors: Enhance insulin secretion and reduce glucose production.
  • Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitors: Lower blood glucose levels by promoting the excretion of glucose through urine.

• Injectable Medications:
  • Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists: Stimulate insulin release, reduce glucagon production, slow digestion, and promote weight loss.
  • Insulin: If blood glucose levels remain uncontrolled with oral medications, insulin therapy may be initiated to improve glycemic control.

• Metabolic or Bariatric Surgery (in some cases):
  • For individuals with severe obesity and uncontrolled Type 2 diabetes, bariatric surgery, such as gastric bypass or sleeve gastrectomy, may be considered to promote weight loss and improve metabolic health.

Regular monitoring of blood glucose levels, HbA1c (average blood glucose over several months), blood pressure, and cholesterol levels is essential to assess the effectiveness of treatment and make any necessary adjustments.

Many people think that it will be alright to take extra pills and higher doses to get diabetes under control.

But, this thought process is proved wrong by one of the best medical study. It says that on the short term & long term, surgery gives better control of diabetes and its complications than giving extra pills or higher dose including insulin.

Diabetes Type 2 remission refers to a state in which the symptoms and markers of Type 2 diabetes are significantly improved or eliminated, allowing individuals to maintain normal blood glucose levels without the need for ongoing treatment or interventions.

Medically it’s defined as an HbA1c level should be less than 6.5% without any medicines for a minimum period of 3 months.

Diabetes Type 2 is a significant public health concern in India. The country has been experiencing a rapid increase in the prevalence of diabetes in recent years, primarily driven by factors such as urbanization, sedentary lifestyles, unhealthy diets, and genetic predisposition. Here are some key points regarding the severity of Type 2 diabetes in India:

1. High Prevalence: India has one of the highest numbers of people with diabetes in the world. According to the International Diabetes Federation (IDF), approximately 77 million adults in India were living with diabetes in 2019. This number is projected to increase to 101 million by 2030.
2. Growing Epidemic: The prevalence of diabetes in India has been rising at an alarming rate. The country has witnessed a significant increase in the prevalence of Type 2 diabetes, particularly among urban populations. Rapid urbanization and lifestyle changes, such as unhealthy diets, physical inactivity, and obesity, have contributed to the increasing burden of the disease.
3. Early Onset: Diabetes Type 2 in India often occurs at a relatively young age compared to other parts of the world. It is not uncommon to see individuals in their 30s and 40s being diagnosed with the condition, which has long-term implications for their health and quality of life.
4. High Risk Factors: Several risk factors contribute to the prevalence of Type 2 diabetes in India. These include genetic predisposition, family history of diabetes, sedentary lifestyle, unhealthy dietary habits (such as consumption of high-calorie, high-sugar, and high-fat foods), obesity, and stress.
5. Complications and Health Burden: Diabetes complications can have a significant impact on the healthcare system and individuals’ quality of life. Uncontrolled Type 2 diabetes can lead to various complications, including cardiovascular disease, neuropathy, retinopathy, kidney disease, and increased risk of infections. These complications pose a substantial economic burden on individuals, families, and the healthcare system.

Several medical organizations recognize bariatric surgery as a treatment option for individuals with Type 2 diabetes who are obese or have a high body mass index (BMI). Here are some of the organizations that have approved or acknowledged the potential benefits of surgery for Type 2 diabetes:

1. American Diabetes Association (ADA): The ADA recognizes that metabolic or bariatric surgery can be considered as an option for certain individuals with Type 2 diabetes and a BMI of 40 or higher (or a BMI of 35 or higher in the presence of other significant comorbidities).
2. International Diabetes Federation (IDF): The IDF acknowledges that bariatric surgery may be an appropriate treatment option for individuals with Type 2 diabetes and obesity who have not achieved glycemic control despite optimal medical management.
3. American Association of Clinical Endocrinologists (AACE): The AACE acknowledges that metabolic surgery is a viable treatment option for patients with Type 2 diabetes who have inadequately controlled blood glucose levels despite lifestyle modifications and optimal medical therapy.
4. National Institute for Health and Care Excellence (NICE): NICE guidelines in the United Kingdom recommend considering bariatric surgery as an option for adults with Type 2 diabetes and a BMI of 35 or higher when other treatments have not been effective or are not suitable.
5. The Obesity Society (TOS)
6. American Society for Metabolic and Bariatric Surgery (ASMBS)
7. Canadian Diabetes Association (now Diabetes Canada).
8. Australian Diabetes Society (ADS)
9. Australian and New Zealand Metabolic and Obesity Surgery Society (ANZMOSS)
10. Obesity Surgery Society of Australia and New Zealand (OSSANZ)

1. Heart Complications (Cardiovascular disease): Uncontrolled diabetes increases the risk of heart disease, including coronary artery disease, heart attacks, and strokes.
2. Kidney Complications (Nephropathy): Diabetes can damage the kidneys over time, leading to diabetic nephropathy, a condition that can progress to chronic kidney disease and kidney failure.
3. Nerve Complications (Neuropathy): High blood sugar levels can damage the nerves, resulting in peripheral neuropathy, which often affects the feet and legs. It can cause numbness, tingling, pain, and loss of sensation.
4. Retinopathy: Diabetes can damage the blood vessels in the retina, leading to diabetic retinopathy. This condition can cause vision problems, including blurred vision, floaters, and eventually, vision loss if left untreated.
5. Foot complications: Diabetes can lead to poor blood circulation and nerve damage in the feet, increasing the risk of foot ulcers, infections, and, in severe cases, amputation.
6. Skin conditions: Uncontrolled diabetes can cause various skin problems, including bacterial and fungal infections, itching, dry skin, and slow wound healing.
7. Gastroparesis: This condition affects the digestive system, causing delayed stomach emptying. It can lead to symptoms like nausea, vomiting, bloating, and problems with blood sugar control.
8. Sexual dysfunction: Diabetes can contribute to sexual problems in both men and women, including erectile dysfunction in men and reduced libido and difficulty with arousal in women.
9. Increased risk of infections: High blood sugar levels impair the immune system, making individuals with uncontrolled diabetes more susceptible to infections, such as urinary tract infections, skin infections, and respiratory infections.
10. Increased risk of complications during pregnancy: Uncontrolled diabetes during pregnancy (gestational diabetes) can increase the risk of complications for both the mother and the baby, including preeclampsia, preterm birth, birth defects, and macrosomia (a large baby).

It’s important to note that these complications are not inevitable and can be minimized or prevented with proper diabetes management, including medication, blood sugar monitoring, a healthy diet, regular exercise, and lifestyle modifications.

The results of diabetes remission can vary depending on the individual and the specific treatment approach. Here’s an overview of the potential outcomes associated with different treatment modalities:

• Surgery:
  • Metabolic or bariatric surgery, such as gastric bypass or sleeve gastrectomy, has shown promising results in achieving diabetes remission.
  • Studies have reported very good rates of diabetes remission following surgery, ranging from 50-90% of patients experiencing improved blood sugar control and long-term follow-up and lifestyle modifications are necessary for sustained results.
  • Now, there are positive results of diabetes surgery even for mild-form of obese patients (BMI Between 30-35%).

• Medications:
  • Medications are the first line of treatment for newly diagnosed cases of diabetes.
  • The goal of medicines of diabetes is to control blood sugar levels and prevent complications.
  • Limitation: While medications can effectively manage diabetes, they generally do not lead to complete remission or cure.

• Diet Therapy:
  • While diet therapy alone may not reverse diabetes entirely, it can contribute to improved glycemic control and weight management.
  • Adhering to a diabetes-friendly diet, such as one that focuses on whole foods, portion control, and carbohydrate monitoring, can have a positive impact on diabetes management.

Regular monitoring of blood sugar levels, routine medical check-ups, and ongoing support from healthcare providers are vital components of diabetes management, regardless of the chosen treatment modality.

There are three ways to reverse type 2 Diabetes.

• Diet
• Medicines
• Surgery

Metabolic surgery, also known as bariatric surgery, can help control diabetes through various mechanisms. While the exact mechanisms are not fully understood, several factors contribute to the beneficial effects of metabolic surgery on diabetes control. Here are some key ways metabolic surgery works to control diabetes:

• Weight Loss:
  • Metabolic surgery promotes significant weight loss, which can have a positive impact on diabetes control.
  • Excess weight is often associated with insulin resistance, and losing weight can improve insulin sensitivity, allowing better regulation of blood sugar levels.

• Hormonal Changes:
  • Metabolic surgery affects the release of gut hormones involved in glucose metabolism and appetite regulation. Procedures like gastric bypass and sleeve gastrectomy alter the gastrointestinal anatomy, leading to changes in the production and secretion of hormones such as glucagon-like peptide 1 (GLP-1) and peptide YY (PYY).
  • These hormones help stimulate insulin secretion, enhance glucose uptake, and promote satiety, resulting in better blood sugar control.

• Improved Insulin Secretion:
  • Metabolic surgery can enhance insulin secretion by improving the function of pancreatic beta cells.
  • It has been observed that after surgery, there is an increase in the early phase insulin response to glucose, which helps manage blood sugar levels more effectively.

• Changes in Intestinal Microbiota:
  • Metabolic surgery can influence the composition and activity of the gut microbiota, the collection of microorganisms residing in the digestive tract.
  • These changes in the microbiota have been associated with improved glucose metabolism and insulin sensitivity.

• Reduced Inflammation:
  • Obesity and diabetes are often accompanied by chronic low-grade inflammation. Metabolic surgery has been found to reduce systemic inflammation, which can have a positive impact on insulin sensitivity and blood sugar control.

It’s important to note that the specific effects of metabolic surgery on diabetes can vary among individuals. and long-term success depends on adherence to lifestyle changes, such as maintaining a healthy diet and regular exercise.

Monitoring blood sugar levels, ongoing medical care, and support from healthcare professionals are essential components of post-surgery diabetes management.