When to consider Surgery for Diabetes?

Obesity with BMI >35 with DM

Shorter duration of DM

With other comorbidity , BMI >40

Needing high doses of insulin , even with BMI 30 TO 35

Why not try diet and exercise?

Only advisable for overweight candidate with full, long term commitment for diet and exercise. Maximum weight loss achieved would be between 10 to 20 % of excess weight.

And once you stop exercise, it rebounds back.

How much does Bariatric surgery cost?

At Kaizen Hospital  we conducts various weight loss procedures at very modest budgets. However, it is impossible to give you a number now. Do you really need surgery? What procedure is the right one for you? How much of disposables, including staplers, are going to be needed? Would you like staple-line buttresses like Seamguard? Would you like to stay in economy or in a suite? Do you need ICU stay? Will you have a complication? As you can see, there are too many variables. If you really, really want to know, email me your data . I will give you a ball park figure, if possible. Provided you are ready with all the details of your medical records.

What is weight loss surgery? is it liposuction?

No. Actually, liposuction is sucking out fat through some cuts made in the belly, butt, thigh or other body part. Usually, 5 to 6 liters of fat are removed. This is purely a cosmetic procedure, and is unsuitable for the severely obese individual. Bariatric surgery (aka weight loss surgery) is different.

What exactly is done in Bariatric surgery?

Bariatric surgery is the name given to a group of surgeries to effect permanent weight loss in severely obese people. The highlights of the surgeries are: It is a laparoscopic approach. The size and/or stomach is altered in some way. Also the digestive tract may be altered in some cases. Minimal hospital stay. Rather painless. Stitch-less. Almost bloodless. Causes permanent weight loss. Relieves and even cures a number of obesity-related conditions like diabetes, high blood pressure, sleep apnea, etc. Is a major undertaking in a patient’s life. This is not your slimming center approach!.

Can I eat normally/everything after this surgery and still lose weight?

If you want to eat like you have always done, this would be the wrong approach. You can’t hope to have a 3000-calorie meal and lose fat at the same time.  You need to be committed to your weight loss goals, not your eating-more-food goals. If this fundamental shift in mindset is not there in you, you need to refocus.

What will happen to the skin folds that will hang after I lose weight?

If you lose a lot of weight, like a hundred kilos, for example, obviously your skin folds are going to hang loose. In some time, usually a year, there is some adjustment of the slack, and the sag is not noticeable in those who have less weight to lose (to begin with). In extreme cases, the redundant skin needs to be trimmed out. Not a big deal, actually, but a small price to pay for a life altering surgery!

Where can we see the before-after pictures of your patients?

You can’t. Not because our patients haven’t had fat loss (we would be out of work if it were so), but because we don’t use our patients’ pictures to attract others. Patient confidentiality, heard of it? We believe in it. Your weight loss story is private.

Is there a cure of diabetes if I am not obese?

We don’t know yet. There is no standard recommendation for non-obese diabetics. So, if your BMI is, say, 27 and you want surgery, we would need to refuse standard metabolic surgery procedures. However, there are a couple of experimental procedures like Ileal Interposition and Duodeno-jejunal bypass that are being done in a couple of centers in India. We do not yet have long term data.

Can you cure type I diabetes?

No. Most Type I diabetics will have to rely on insulin. They are not candidates for surgery. However, there are a few papers that have shown benefit. That said, this is not standard treatment.

How do you prevent fatal clots in the lungs?

Blood can clot in the leg veins in the obese and those undergoing prolonged lying down, as in many post-surgical states. The clot can then migrate to the right side of the heart and into the pulmonary arterial system, where it gets trapped. This blocks the outflow of blood from the right side of the heart and can cause sudden and fatal cardiac arrest. Therefore, it seems logical to say that deep vein thrombosis (DVT) and pulmonary embolism (PE) are better prevented than managed. The three ways we prevent DVT are: 1. Give low-molecular heparin that keeps the blood thin and prevents it from clotting. 2. Use Sequential Compression Devices that pump the veins in the calf to keep blood from stagnating in the veins. 3. Mobilize the patient from the day of surgery. This last is crucial, especially in the patient who is unable to move easily on account of joint or spine problems or even excessive weight.

The lap band is what you do? i had a friend do it, and she had a lot of problems with it, finally ending with another surgery. it scares me!

Lap Band is only one type of bariatric surgery. We do not prefer it, because: 1. It is purely restrictive in nature. 2. Requires a very motivated patient who would stick to a diet. 3. Up to a third of patients end up with another surgery to remove it because of complications. 4. There are better options 5. Weight loss is the least among the various weight loss procedures, though the short term results are excellent. 6. Patients can cheat the surgery by drinking liquid calories.

Why are you recommending the gastric bypass for me?

Gastric bypass is a well tested and proven procedure. It has superb results in terms of weight loss and remission of diabetes, hypertension, sleep apnea, lipid disorders, etc. In addition, it is an anti-reflux procedure par excellence. After the bypass, your eating habits will be corrected favorably when you realize that you can’t tolerate refined sugars and sodas.

Can diabetes be considered a surgically curable disease? how?

Yes, Type II Diabetes Mellitus can be considered as a surgically curable disease. 80% of diabetics are obese, and bariatric surgery gives persistently normal blood glucose levels in 75-100% of patients. The reason why operations like the gastric bypass or sleeve gastrectomy are so successful is not only that weight loss improves the blood glucose levels, but increases insulin sensitivity. Additionally, incretins are secreted from the gut, leading to more insulin secretion, and preventing further death of the insulin-secreting cells of the pancreas (“apoptosis of the beta cells” in tech-speak). In obese patients, diabetes cure (or control) is well-known.

The gastric plication is cheap. Can I go for it?

The Plication is a very safe and economical procedure, but we don’t recommend it as a first choice, because it is still new and long term results are not available. Initial reports are encouraging, but that is all we can say. Now, if you need bariatric surgery and cannot afford the standard procedures like the bypass or the sleeve, then this may be considered as a cost-effective procedure that is better than not doing bariatric surgery.

Is bariatric surgery permanent, or is it reversible? that way I don’t need to eat small all my life!

There are procedures that are reversible: the Lap Band is the most popular, while the Gastric Plication is a new-kid-on-the-reversible-block. However, it is important to understand one’s priorities. Is it a priority for you to eat more? Then you are likely to be unhappy with anything other than eating more food. In the process, you will become obese and sick, and depressed, and the last time I checked, depressed people aren’t happy. If you make weight loss and health your priority, then you would not think of reversing your bariatric procedure.

What is my post-operative recovery going to be like?

Normally, you would be in hospital for 48 to 72 hours after surgery. We will get you out of bed as early as the same evening of surgery, and send you home on a liquid diet and minimal medicines.  Liquid diet is continued for 2 to 3 weeks. Don’t worry about this, as you will feel no hunger, and we would often need to encourage  you to drink more! You can be moving around at home once you get back (pain not being a factor in almost all cases), and join work after around ten days. You are allowed to bathe using soap and water all over from Day One.

Is Bariatric surgery safe? Can I die from it?

Yes, bariatric surgery is very safe, as multiple studies and our own experiences have shown. There is a small chance of peri-operative death, around 0.4%. This is almost the same as the mortality rate after other accepted-as-safe procedures like appendectomy.


Your BMI is

BMI Weight status
Below 18.5 Underweight
18.5-23.4 Normal
23.5-27.5 Overweight
27.6-32.4 Obese (Class I)
32.5-37.5 Obese (Class II)
37.5 and higher Extreme obesity (Class III)