Can surgery reduce my need for diabetes medications?

Question

Hello doctor,

I am a 51-year-old man with uncontrolled diabetes for the past 12 years. My A1C levels have been fluctuating between 9.8 and 10.2, despite taking the maximum doses of Metformin, Glimepiride, and weekly Ozempic injections.

My fasting blood sugar levels typically range from 190 to 230. I am already experiencing early signs of neuropathy in my feet, with constant tingling and occasional pain.

My current weight is 287 pounds, and I am 5 feet 10 inches tall, resulting in a BMI of 41.2. Despite multiple attempts, long-term dieting has not been successful for me.

My cardiologist is concerned as my blood pressure remains elevated at 158/92, even though I am on two medications. Additionally, my most recent lipid panel showed triglyceride levels of 375 and LDL cholesterol of 158.

He suggested that metabolic surgery may be the most effective way to control my diabetes and prevent further complications. However, I am genuinely terrified of undergoing surgery. At the same time, I am also afraid of the possibility of dialysis or amputations if my diabetes remains uncontrolled.

I would like to understand more about metabolic surgery. Can you please guide me on the following:

What does the procedure involve?
How risky would it be for someone with my health conditions?
Is there a possibility that I could reduce or eliminate my diabetes medications after the surgery?
What type of tests and evaluations would be necessary before I could be cleared for metabolic surgery?

My kidneys are already showing signs of damage, with an eGFR of 58 and the presence of microalbuminuria. Additionally, my brother underwent gastric bypass surgery eight years ago and experienced nutritional deficiencies, which adds to my concerns.

Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I can understand your concern.

Metabolic surgery, such as gastric bypass or sleeve gastrectomy, can significantly reduce blood sugar levels and often leads to diabetes remission or a decreased need for medication. While all surgical procedures carry risks, metabolic surgery is generally considered safer than the long-term complications of uncontrolled diabetes, which can result in kidney failure, heart disease, and amputations.

Given your eGFR (estimated glomerular filtration rate) of 58, a thorough preoperative evaluation would be essential, including assessments of your cardiac health, kidney function, and nutritional status.

Would you like assistance in comparing different surgical options and understanding their long-term effects?

I hope this information helps you.

Please let us know if you have any further queries.

Thank you.