Karina Pastore

In seven years, diabetes ruined the health of the public official Legínia Miranda. With the body weakened by the disease, she was nearly blind. Her blood pressure was always high. Legínia lived, killed by a permanent fatigue and a deep depression. The disease established a painful routine - antidiabetic pills, injections of insulin, strict diet . Even then, her blood glucose was around 300 mg of glucose per deciliter of blood, but often came to 520 (normal is 100).

Bariatric Surgery in Hyderabad

 In 2005, at 54 years of age and about to retire on disability, Legínia agreed to undergo an experimental treatment even against type 2 diabetes. At 7 am on November 5, she was admitted to the Hospital of the surgical specialities, in Goiania. Nine hours later, the disease was already showing signs of cooling off. Without any medicine, her blood glucose fell to 160 - a level never reached in previous years. Legínia experienced an improvement that in other times, would be called a miracle. Today, her blood pressure is normal and the blood glucose revolves around 70 milligrams of glucose per deciliter of blood. With the vision recovered, she will no longer need glasses - not to read. At the dining table, despite the balanced diet, she enjoys herself without fear, inspite of pudding with milk and quindim. Nothing, however, compares to her happiness as she is able to accompany and spend time with Ana Carolina, her granddaughter of 1 year and 2 months. Legínia now is breathtaking. "I was born again," says a public official.

Legínia’s true story is one of the most daring and fascinating events in the treatment of type 2 diabetes - the surgical intervention. The operation to contain the diabetes is different from any other. It is not intended to replace a body part that is malfunctioning by another in good condition, like in transplants. Nor is it made for the deployment of a foreign body in the body so as to make it work better. The surgery of diabetes combines simplicity and ingenuity. The doctors are able, with small changes in the anatomy of the small intestine, to regulate the production of insulin in the pancreas, thereby restoring the blood glucose to normal levels. In other words, they can reverse the diabetes. The surgery is the result of a new and surprising finding: that the diabetes is a disorder whose origins go beyond the borders of the pancreas ( the producer of insulin - the hormone responsible for removing molecules of glucose from the bloodstream and lead them into the cells, where they are converted into energy). Diabetes is the lack or the inefficiency of insulin, which leads to the accumulation of glucose in the blood. And what does the small intestine has to do with it? Everything.

With 6.5 meters long and 4 centimeters in diameter, filled with folds and recesses, the small intestine, promotes digestion and absorption of food, serves as a kind of factory to produce incretins, the family of hormones capable of enhancing secretion of insulin. They help lower the levels of glucose in the blood, especially after meals, when these levels tend to explode. The discovery of the crucial role of incretins GIP and GLP-1 in control of type 2 diabetes, dates back to the 90s. In diabetics, the amount of GIP is normal but, in the presence of high glucose, it cannot stimulate the pancreas to produce insulin. In contrast, the diabetic suffers from absence or low levels of GLP-1. A patient tends to produce a tenth of the volume of GLP-1 secreted by a healthy person. The scalpel enters, to correct these failures and restore the balance between the hormone and insulin from the digestive tract.

To understand exactly how the surgery of diabetes works, we must remember the lessons of biology from school. The small intestine is divided into three regions - duodenum, jejunum and ileum. During digestion, after going through the stomach, the food arrives in the first portion of the small bowel, duodenum. At that point, GIP molecules of the duodenum, act on the pancreas to stimulate insulin secretion. When the food reaches the ileum, the GLP-1 molecules are immediately secreted and they reach the pancreas, where they leverage the synthesis of insulin. The two surgical techniques that are being tested facilitate the action of incretins, shortening the period of digestion of foods (Click here to see Table) alt="Laparoscopic Surgery Cost in Hyderabad" title="Obesity Treatment in Hyderabad".

 

Fabiano Accorsi

Best Bariatric Surgeon in Hyderabad

"WAS A BENÇÃO" After losing two toes because of diabetes, Divaldo de Mello controlled the disease through surgery Experience with one of the methods was reported in the August edition of the journal Surgical Endoscopy, the American Society of Surgeons and Digestive Endoscópists. The author of the article is the surgeon Aureo Ludovico De Paula, from the Hospital of Specialties of Goiania. He is the creator of this technique of bringing a part of the ileum, by laparoscopy, near the stomach, so as to enhance the production of GLP-1. This also requires for reduction of 20% of stomach, which drastically reduces the production of ghrelin, the appetite hormone.This leads to loss of some weight and thereby reduces the resistance to insulin. Of the 39 patients cited in the article of the American magazine, almost 90% were completely free of diabetes. Many left the hospital without any need for anti-diabetic medication - an almost instant cure.

 "If only half of these results can be repeated, we will have a revolution in the treatment of diabetes," says Alfredo Halpern, endocrinologist at the University of São Paulo. The surgery takes effect, albeit on a number of other diseases associated with diabetes - hypertension, high cholesterol and triglycerides. Three weeks ago, a team of researchers from Mount Sinai School of Medicine in New York, was in Brazil to learn the technique created by De Paula. They will start to test it in the United States. The success of the Brazilian experience served as an incentive for Americans. Until then, they had not taken this initiative because, there, the protocols of research with humans are much more rigorous and lengthy. Now the excellent results are the proof of success.

History and Future

Who first raised the hypothesis that type 2 diabetes might be controlled through surgery was the American physician Walter Pories, a professor of surgery and biochemistry at the University of the East Carolina, USA. In an article published in August 1995 in the journal Annals of Surgery, under the title "Who imagined?", Pories examined the evolution, over fourteen years, from 608 morbidly obese submitted to the reduction of stomach. Of the surgical patients, 165 were people with type 2 diabetes. Thanks to the surgery, most showed remission of the disease. In his article, Pories drew attention to the fact that the reversal of diabetes took very little time after the operation - in some cases, the following day. That is, the control of the disease happened regardless of weight loss. This led the researchers to investigate the matter. It was only then, that it came to light the relevance, in the genesis of the disease, the incretins produced in the small intestine.

With 200 million patients worldwide, 10 million of them in Brazil, diabetes was described for the first time in the second century by the doctor and philosopher Areteus of Cappadocia. This is a disease whose causes have not been fully mapped, despite all the advances. "The new studies show that the disease is much more complex than previously thought," says endocrinologist Freddy Eliaschewitz of Sao Paulo. Besides the pancreas and small intestine, other organs are involved in controlling levels of glucose in the blood (Click here to see table). More than a dozen substances interfere with the balance of blood glucose, until the primary part of the synthesis of insulin is done. The team led by researcher Gerard Karsenty, of Columbia University in the United States proved in experiments with rats that osteocalcina, hormone-producing cells produced by bone, has the power to stimulate the secretion of insulin. If it is proven that the osteocalcina has similar function in humans, this could lead to the creation of a new treatment for the disease.

Some experts tend to be alarmed with what would be an epidemic of type 2 diabetes already under way in the world. According to World Health Organization, in 2025 the sick numbers would rise to 330 million people. In the United States, it is estimated that half of black and Hispanic children born in 2000 will develop the disease at some point in their lives. No matter the mechanism by which disorder arises, the fact is that the external stimuli are crucial. In particular, diet rich in fats and sedentary lifestyle. For this reason, the type 2 diabetes is a disease caused culturally. Overcoming cultural causes, therefore, may be, for most patients a potentially, less painful way than taking daily minced or synthetic insulin or the surgical knife.

With reporting by Adriana Dias Lopes, Anna Paula Buchalla