Advanced Centre For Metabolic Surgery at Fortis Hospital Bangalore

About Diabetes

Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot make optimum use of the insulin it produces. Responsible for regulating blood sugar levels, Insulin provides us with the energy which we need to survive. Furthermore, if insulin is not burned effectively by the cells, it results in blood glucose levels building up to harmful levels. Over a period of time, high glucose levels in the blood can cause serious damage to almost every major organ system in the body. This may result in heart attacks, strokes, nerve damage, kidney failure, blindness, impotence and infections that may even lead to amputations.

Diabetes might be one of the most spoken about diseases around the world today. But with as many as 50 million people suffering from type-2 diabetes, India has officially taken over the mantle of the diabetes capital of the world and has a challenge to face. Diabetes is usually classified under two main forms; type 1 and type 2. Individuals diagnosed with type 1 diabetes are unable to produce their own insulin and therefore need the help of insulin injections to survive. Individuals suffering from type 2 diabetes, on the other hand, are able to produce their own insulin but not in adequate quantities. They also comprise nearly 90% of cases.

In India, about 5 per cent population suffers from diabetes which is an alarming statistic given our population. According to the International Journal of Diabetes in Developing Countries, India has been witnessing an alarming rise in the incidence of diabetes. As per the latest studies conducted by WHO, Diabetes is now responsible for an estimated 3.4 million deaths annually.

Symptoms of Diabetes

Diabetes is on the rise in countries all over especially in low- and middle-income countries. A diabetic person has a lifestyle entirely different from those of not suffering from the endemic.  Individual generally experience diverse signs and symptoms of diabetes, and at times there may be no signs. it's important to understand your body, watch out for any changes, and alert your healthcare provider if you notice any new unusual symptoms or problems. Some of the signs generally experienced consist of:

• A burning sensation or a feeling of numbness in the hands or feet

• Increased fatigue and constant irritability

• Increased hunger (especially after eating)

• Nausea and abdominal pain

• Frequent thirst

• Issues with the blood vessels – such as narrowing of the arteries

• Unusual weight loss or weight gain

• Cuts and bruises that don't heal properly or take an unusually long time to heal

• Recurrent infections and loss of consciousness

• Frequent urination and dry mouth

• Itchy skin, swollen gums, & frequent gum infections

• Blurred vision

• Sexual dysfunction – especially among men

• Skin and Yeast Infections

• General lack of awareness and inattentiveness

The more you understand about the factors that influence your blood sugar levels, the better prepared you are to keep diabetes at bay. A large proportion of diabetes cases are preventable and therefore, if you happen to notice any possible of the above-mentioned signs or symptoms, you should immediately contact your doctor. Diabetes is a serious condition and hence, the sooner the condition is diagnosed, the earlier treatment can begin. More often, Diabetes could only be a part of a more serious Metabolic Syndrome

What is Metabolic Syndrome?

Metabolic syndrome – also termed as syndrome X – can be described as a group of conditions including the likes of type 2 diabetes mellitus, hypertension, increased levels of lipids in the blood, as well as abdominal obesity all of which increases the risk of heart diseases.  In most cases, barring a large waistline, there aren't any visible symptoms associated with this disorder. The reality is that, in this day and age, we are witnessing an alarming and increasing trend of people of all age groups – especially youngsters – falling prey to heart diseases. While genetics and pre-existing disorders do have a role to play, environmental/lifestyle factors such as sedentary lifestyle, low activity levels, the fast-food lifestyle, etc. have started to lead to progressive weight gain all of which greatly contribute to the risk of developing the metabolic syndrome. Moreover, the prevalence of increased morbidity along with mortality has also played a key role in affecting the health of youngsters. 

Several people have raised blood sugar levels that can lead to diabetes, yet are still unaware of it. Diabetes, for instance, has become a major menace. As per the latest studies conducted by WHO, Diabetes is now responsible for an estimated 3.4 million deaths annually. Living with diabetes is a challenge that several people across the globe are facing on a day-to-day basis. Diabetes can be caused due to a whole gamut of reasons, the most common being hereditary reasons coupled with lifestyle choices people choose to take. Diabetes is akin to a slow poison which, when not properly taken care of, can result in a myriad of severe health complications as it affects several organs in the body. Some of these complications include heart and kidney diseases, blindness, digestive problems, gas bloat, constipation, irritable bowel syndrome, nerve damage, burning sensation in the feet and hands, and in some cases, even amputations owing to gangrene. 

Troubling Diabetes Pattern in India

Diabetes is undoubtedly one of the most spoken about diseases around the world today. In India, about 5 percent population suffer from diabetes which is an alarming statistic given the sheer size of our population. When it comes to diabetes, being on top of things is extremely crucial as diabetes is a condition that needs active planning and complete awareness of one's body. Diabetes in itself is a manageable condition if adequate precautions are taken. However, there has been a massive spike in diabetes-related cases around the country and contrary to popular belief, its no longer just an urban phenomenon. Diabetes in India has started affecting rural areas as much as urban areas as well. However, what's really concerning that as compared to other parts of the world, there's a troubling pattern which has started to emerge – statistics have gone on to reveal that earlier age of onset of diabetes is now a common trend. As a matter of fact, there are ever increasing reports of diabetes starting to affect youngsters as young as 20 to 25 years' old. Worse still, being diagnosed with diabetes at a young age is associated with more major complications including various cardiovascular complications along with a higher risk of premature death. There is absolutely no doubt that Metabolic syndrome has increasingly become a big curse to patients not just in India, but all around the world. 

Symptoms of Metabolic Syndrome

In the case of individuals suffering from metabolic syndrome, they don’t showcase any prominent or visible symptoms. Some of the most common signs are similar to the one displayed by a diabetic person as listed below:

• Increased thirst

• High levels of blood triglycerides

• A large waist circumference – usually over 40 inches in men and more than 35 inches in women

• Fatigue

• Frequent urination

• Blurred Vision

• High levels of HDL cholesterol

The Concern with Obesity

Obesity is becoming a huge global concern and increasingly becoming a complex issue to address. Essentially a medical anomaly, Obesity is a condition where a person has amassed so much fat that it becomes precarious to their health and results from a variety of behavioural causes and contributing genetic issues. There are several other factors such as food habits, peer pressure, depression, certain medications, lack of sleep, physical inactivity, dietary patterns and even the influence of media which can also lead to obesity.

When an individual consumes more calories than they are able to burn off, simply put, they will invariably end up putting on weight. Similarly, if an individual burn off more calories than they are able to consume, they will end up shedding some kilograms, and in turn, lose weight. Undoubtedly, obesity has spiralled into a serious concern not only in the world but in India as well.

Obesity has many damaging effects on physiological processes and is also linked with a marked drop in the quality of life accompanied by a marked increase in mental health issues as well. An obese individual simply is unable to partake in activities or lead a normal life. It's also a leading cause of multiple deaths including heart diseases, gall bladder disease, diabetes, High LDL cholesterol, low HDL cholesterol, Osteoarthritis and some types of cancer as well. The truth of the matter is that with every passing year, more and more people are killed by obesity than by being underweight. At Fortis, our aim is to ensure that everyone should be able to lead a healthier and happier life and thereon have several treatments for obesity that can really help. We are 100 percent committed to helping our patients in their fight against obesity so that even they can finally go on to experience an enriched quality of life.

Areas of Care/Types of Condition

When you have tried out various forms of diet and exercise which haven't yielded the desired results or have led to the development of certain life-threatening medical problems owing to the excess weight gain, then it's prudent that you seriously consider a weight loss surgery. Bariatric and Metabolic surgery for obesity have been proven to effective tools in helping you lose excess weight by altering the digestive process and thereon, limiting how much you eat and changing how your body metabolizes food.

As opposed to bariatric surgery, the term Metabolic Surgery is used to describe surgical procedures to treat metabolic diseases that fail to respond to lifestyle and medication changes, such as, type 2 diabetes. While bariatric surgery is usually recommended in individuals with a BMI in excess or equal to 40 kg/m2, metabolic surgery, on the other hand, has been suggested for individuals having a BMI as low as 27 kg/m2 as well. Our team of health experts and surgeons will sit with you and evaluate whether metabolic surgery is appropriate for you. This evaluation is basically used in order to gauge if you're medically ready to undergo the procedure.

The most popular form of metabolic surgery is the Gastric Bypass which is designed to reduce the overall food intake by decreasing the size of the functional area of the stomach. What this helps in achieving is restricting the quantity of food that an individual can ingest thus helping him/her feeling full after consuming a limited amount of food. The surgery is carried out by performing a few small laparoscopic (keyhole) incisions which lead to the creation of a smaller pouch. In addition, as the food consumed by the patient bypasses a part of the small intestine, the body, in turn, tends to absorb fewer nutrients and calories thus helping in achieving quick and sustained weight loss. This surgery is usually recommended for individuals suffering from poorly controlled Diabetes or Dyslipidaemia (high cholesterol).

Biliopancreatic Diversionis another efficient weight loss procedure which has proven effective for weight loss. Described as a restrictive/malabsorptive surgical procedure, Biliopancreatic Diversion is usually offered as a second-stage operation in severely obese patients having a BMI exceeding 50 kg/m2. Similar to the Gastric Bypass, a pouch is created – by removing a portion of the stomach – which leads to the lower absorption of food. There are two distinct types of biliopancreatic diversion surgeries: a biliopancreatic diversion with or without Duodenal Switch. More often than not, a duodenal switch surgery is not opted for except in severely obese individuals. This form of surgery has yielded the best weight loss results vis-à-vis other forms of surgeries while also helping achieve continued weight loss even 18-24 months' post-surgery. 

Some of the prominent surgeries which are carried out in order to reverse the metabolic syndrome are the Roux-en-Y gastric bypass, Mini gastric bypass, Ileal interposition along with several novel procedures such as Duodeno-jejunal bypass SADI, SASI, and BPD-DS. You can discuss all of these metabolic surgeries, their various pros and cons and accordingly decide the best course of action after consulting with our team.

Treatment at Fortis Centre For Bariatric & Metabolic Surgery

At Fortis, we provide patients with compassionate care and comprehensive metabolic and bariatric surgery alternatives which have helped thousands of patients across India achieve healthier, fuller and more active lives. We believe that any sort of treatment, such as for metabolic Surgery, is indeed a boon.  The major goal of the surgery is not only to treat the underlying cause of the syndrome but also to prevent the development of diabetes, and also any heart diseases. 

Metabolic Surgery is the term given to a group of surgeries that are performed with the help of minimally invasive techniques such as small keyholes ranging from 5 mm to 15 mm cavities. These keyholes are created on the abdomen while the surgery is done on the digestive tract region. Results of this surgery have proven to be highly successful as it is proven to have helped in reversing the incidence of diabetes. Moreover, nearly 85-90 per cent of patients have reportedly stopped consuming any medications related to keeping their diabetes under control after undergoing this surgery. In fact, most patients have also stopped taking insulin shots as soon as the very next day post surgery which further reiterates the effectiveness of this revolutionary surgery. The surgery helps in regulating the glucose levels in the blood and post-operation, the blood glucose levels have been shown to immediately come back to normal levels.

As with any key-hole surgeries, tiny skin incisions are made which allows for more accurate diagnosis as well as a more precise surgery. Moreover, this type of surgery results in less pain, less wounds complications while also requiring a shorter hospital stay which allows patients a quick return to normal life activity – within a week following the surgery. Besides helping regulate blood-sugar levels, metabolic surgery also helps in reducing the lipids in the blood. Many patients suffering from very high cholesterol levels who have witnessed very little results from taking medications have reportedly had greater improvements in their lipid levels as well. Even before any weight loss occurs, insulin resistance which seems to be a common occurrence amongst obese and overweight individuals has also seemingly reversed. This factor alone plays a vital role in helping reverse the incidence of diabetes. 

Besides the risk of diabetes being controlled or completely eliminated, we have also observed that microangiopathy (a condition of the blood vessels resulting in narrowing of small vessels across several organs in the body) associated with diabetes also tends to get completely arrested post Metabolic Surgery. As a matter of fact, several patients have also reportedly witnessed a complete reversal in symptoms or issues linked with microangiopathy. Patients suffering from blurry or unclear vision, for instance, have recovered their vision or have noticed improve vision outcomes. Other symptoms such as a burning sensation coupled with pain in the feet and hands due to neuropathy, microalbuminuria – described as a moderate increase in the level of urine albumin – owing to nephropathy have also seen major reductions. Patients have also witnessed a massive improvement in their overall renal function as well. As mentioned earlier the most common surgeries which are carried out in order to reverse the metabolic syndrome are the Roux-en-Y gastric bypass, Mini gastric bypass, Ileal interposition along with several novel procedures such as Duodeno-jejunal bypass SADI, SASI, and BPD-DS. It needs to be mentioned that these surgeries are usually performed on patients with a BMI of more than 27.5 as per the recent guidelines of the American Diabetes Association.

Leading Metabolic & Bariatric Surgeon

At Fortis, our team of multidisciplinary experts seeks to establish and facilitate comprehensive management of obesity and metabolic syndrome. Our team of experts and top-notch professionals are fully committed to providing patient-centric and personalized care that has helped our patients in losing excess body weight and enjoying a better quality of life. 

While we understand that the journey toward improved health and enjoying a fulfilling life isn't a walk in the park, we are there to help you overcome your weight issues. Besides offering several surgical options to choose from, our experts also provide dietary and nutritional advise by creating personalized plans that meet patients' individual needs. These plans are crafted after carefully considering our patient's lifestyle, emotional, and health needs to ensure safe, nutritionally sound, and effective weight loss that works for a longer time frame. Our comprehensive weight loss program goes beyond the operating room as every patient receives a thorough preoperative screening as well as detailed information about the procedure, post-operative care and follow-up information, multidisciplinary expertise, nutrition and dietary advice, and psychological counselling to ensure the best fit for reaching their individual health goals.