Metabolic Surgery for Diabetes
Latest Interview with Dr Ganesh Ramalingam for Epoch Times September Issue.
Diabetes is a medical condition in which the blood glucose levels remain persistently higher than normal. It affects 11.3 percent of the adult population in Singapore now, but this is expected to rise to 15 percent in the future.
Obesity is one of the most important factors in the development of diabetes, and weight loss with diet and exercise remains a cornerstone in the management of diabetes.
The most common metabolic surgery operations for all poorly controlled diabetics are the laparoscopic sleeve gastrectomy and the laparoscopic gastric bypass.
What kind of patients do you see? Are they mostly just overweight or morbidly obese?
Most of them are overweight and about 10% are morbidly obese.
We use BMI as a guide for obesity. The guidelines for morbid obesity are a BMI of 32.5 with associated medical problems related to obesity, or a BMI of 37.5 without these medical problems.
Has there been an increase in obesity and weight loss issues?
There has been a steady increase in Singapore and worldwide. This is likely due to a more sedentary life-style and poor dietary choices.
How does obesity lead to diabetes?
Insulin is a hormone that is produced by the pancreas. Insulin is needed to distribute glucose in the blood to the organs. When a person is obese, he is likely to be consuming more calories than is required. This will cause the pancreas to work harder to produce more insulin. If the pancreas continues to work hard over a long period of time, it will slowly start to burn out.
Therefore, eating a high calorie diet and being obese over a long period of time will cause the pancreatic function to start breaking down and the pancreas cannot produce enough insulin for the body’s needs. This is the beginning of type 2 diabetes.
How can we best manage and treat diabetes?
The best way to manage early type 2 diabetes is diet and lifestyle modification. Consuming small meals many times a day along with a balanced diet of carbohydrates protein and fat, with a total calorie intake of 2,000 kcal per day are key changes required.
An active lifestyle with regular exercise three times a week is also important.
However, in more advanced stages of diabetes, medication is required. Bariatric surgery is an acceptable option at this stage of type 2 diabetes.
What is metabolic surgery?
The term Metabolic Surgery is used to describe surgical procedures to treat metabolic diseases, especially, type 2 diabetes, hypertension, high cholesterol and obesity.
Who would qualify for metabolic surgery?
Patients with metabolic syndrome will qualify for metabolic surgery.
Metabolic syndrome includes type 2 diabetes, hypertension, high cholesterol and obesity.
What are the metabolic surgical options available for diabetes and metabolic syndrome patients?
Laparoscopic Roux en Y Gastric Bypass
This procedure is done via the laparoscopic or keyhole technique. A small pouch at the upper stomach is created and separated from the rest of the stomach using specially designed surgical staplers. This allows the patient to eat a smaller amount.
Food is then directed further down the path of the small intestine. The length of intestines left to absorb calories is shorter causing a certain degree of malabsorption and reducing the amount of calories and nutrients absorbed.
Laparoscopic Sleeve Gastrectomy
During sleeve gastrectomy, the stomach is stapled and divided vertically. This procedure requires specially designed surgical staplers, using the keyhole or laparoscopic method. By doing this, about 2/3 or 60% of the stomach will be removed. The remaining stomach is now in the shape of a long narrow tube resembling a shirt sleeve. The much smaller size of the stomach restricts the amount of food the stomach can hold at a time. The appetite for food is also reduced.
Why Laparoscopic Sleeve Gastrectomy?
The results of this procedure are very good. About 60% of excess weight will be lost over one or two years. More importantly, this can be maintained for at least five to ten years with close follow-up with the doctor and a dietitian for the proper nutrition.
Complications such as leaking of the staple line or bleeding are very low.
Do you have any other thoughts to share about your area of specialty?
I strongly believe in diet and lifestyle for most gastrontestinal problems and this is no different in obesity
weight management A high fibre diet with less oil, sugar and carbohydrates, coupled with a good exercise regime is the cornerstone of our ethos of weight management.
Singapore has the second highest proportion of type 2 diabetics in the world The main risk factors for diabetes are age, genetics weight and ethnicity. As people age, they tend to put on weight and exercise less, which increases their risk of developing type 2 diabetes.
Genetics is another major risk factor. Your chance of developing diabetes is greater if you have a close relative, a parent, sister or brother with the condition. A child who has a parent with diabetes has a one-in-three risk of developing it.
Diabetics have an increased risk of developing a number of serious conditions, including coronary heart disease, stroke, and some types of cancer. It is best to treat diabetes at its early stages.
Dr Ganesh is a Fellow of the Royal College of Surgeons Edinburgh. He did a year of fellowship in Trauma at Beilinson Hospital, Rabin Medical Centre, Israel where he was trained to manage a wide range of surgical emergencies, complex trauma and surgical critical care.
Dr Ganesh is a General Surgeon with specialty interests in Trauma, Laparoscopic and Obesity Surgery. He was formerly Consultant at Khoo Teck Puat Hospital where he helped develop the Weight Management and Bariatric Surgery Centre in Alexandra Hospital and KTPH since 2001.
He is a founding committee member of the Obesity and Metabolic Surgical Society of Singapore and is a member of the National Trauma Committee of Singapore. He is also an Adjunct Assistant Professor at the NUS Yong Loo Lin School of Medicine and is part of the adjunct teaching faculty. His interest in sports related injuries stems from his time served as a Commando Medical Officer during National Service. He keeps a sporting interest and is currently a member of the Football Association of Singapore.