Guide from Marina Weight Loss Center
Why Choose Cedars-Sinai Marina del Rey Hospital for Type II Diabetes Treatment?
Our highly-skilled and experienced bariatric surgeons carefully evaluate every patient to successfully resolve obesity-related conditions such as type II diabetes. Weight loss keeps type II diabetes under control better than any other treatment option. Whether it is achieved through bariatric surgery or lifestyle and behavioral changes, losing fat helps one lead a healthy and longer life. Our dedicated team of surgeons at Cedars-Sinai Marina del Rey Hospital ensures the best care for their patients throughout the course of treatment, during the recovery period, and through post-recovery.
Type II diabetes, once known as adult-onset diabetes, is the most common type of diabetes, making up for about 95% of patients with the disease. Type II diabetes most often develops in middle-aged and older people who are overweight or obese due to an inactive lifestyle. This type of diabetes is more likely to develop at a younger age because of higher incidences of childhood and adolescent obesity. Genetic susceptibility and environmental factors can also trigger the development of type II diabetes. Studies show that the TCF7L2 gene and its variants make a person more susceptible to type II diabetes.
Type II diabetes begins when the body develops resistance to the effects of the insulin hormone produced in the pancreas. This condition is called insulin resistance, which is also linked to excess weight and inefficient use of insulin in the body’s muscles, fat, and liver cells. As a result, the body demands more insulin to speed up the entry of glucose into the cells. Initially, the pancreas will meet this demand by making more insulin, but as time passes, beta cell dysfunction may reduce its capacity to produce sufficient insulin, leading to elevated levels of glucose in the blood (prediabetes or diabetes).
As the symptoms of type II diabetes are subtle and appear slowly, the disease can go undetected for several years. Type II diabetes is a progressive condition that requires strict lifestyle modifications.
Obesity and an inactive lifestyle are major contributors to the development of type II diabetes. For people with genetic susceptibility, these two risk factors greatly increase the likelihood of type II diabetes. Obesity, in particular central obesity (abdominal fat deposition), can lead to a condition called insulin resistance that is common in patients with type II diabetes.
The Interrelationship Between Obesity and Type II Diabetes
Obesity and type II diabetes are interlinked disorders. The severity of type II diabetes varies depending on the patient's body mass index (BMI). Obese people are at a sevenfold higher risk of developing diabetes; overweight individuals are at a threefold higher risk. Apart from the body weight, the location of excessive deposits of fat in the body significantly increases a person's risk of type II diabetes. Being overweight hinders proper production and utilization of the insulin hormone. Obesity and lack of physical exercise can make insulin resistance even worse. As the incidence of obesity and diabetes is rising at an epidemic rate, obesity-dependent diabetes has been described with the new term "diabesity."
Bariatric Surgery Procedures Performed to Treat Type II Diabetes
Significant and sustained weight loss through bariatric surgery is known to cure type II diabetes in most patients. Bariatric surgery makes alterations in the digestive process. For example, certain hormonal changes occur when food passes through the stomach. At Cedars-Sinai Marina del Rey Hospital, bariatric surgery is suggested for patients with a BMI of 35-39.9 and coexisting type II diabetes, when other methods of losing weight have failed.
Bariatric surgery is classified into two broad categories:
- Purely restrictive procedures: Laparoscopic adjustable gastric banding, which improves diabetes through weight loss.
- Metabolic surgery (procedures that bypass the proximal gut): Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy, and biliopancreatic diversion with duodenal switch [BPD/DS] procedures result in more weight loss than gastric banding due to their effect on hormones. These procedures have proved to be more effective than medical therapy in treating diabetes in obese patients. Following metabolic surgery, the production of compounds called incretins increases. The incretins enhance the number of pancreatic cells that secrete insulin, thus restoring the body’s response to insulin. This can improve, and sometimes completely cure, diabetes.
Roux-en-Y Gastric Bypass
This surgical procedure makes an alteration in the gastrointestinal tract so that the food bypasses most parts of the stomach and the upper segment of the small intestine. After this surgery, diabetes remission can occur before the patient loses a significant amount of weight. It resolves type II diabetes in about 80% of patients and improves the condition in 15% of the patients.
This procedure, also called vertical gastrectomy, involves the removal of a very large portion of the stomach. This causes weight loss, as the remaining portion of the stomach becomes very narrow and is unable to hold large amounts of food. This surgery also causes alterations in gut hormones that facilitate the improvement of diabetes.
Adjustable Gastric Band
This procedure involves the placement of a band in the upper part of the stomach. Only after a significant amount of weight loss can remission of diabetes potentially occur. Diabetes resolves in about 45-60% of patients who undergo gastric banding.
This surgery is rarely performed, as it is more complex and puts patients at a higher risk of developing complications. But when performed, it induces fast and sustained remission of type II diabetes.
Drugs and Other Treatment Used for Type II Diabetes
Weight loss is key to achieving remission of type II diabetes in overweight or obese individuals. For this reason, lifestyle modification programs that include diet, exercise, and behavioral changes may be suggested. Moderate weight loss (about 5-10% of body weight) that sustains for a long-term improves insulin action and reduces fasting blood sugar levels. Pharmacotherapy consisting of different medications to treat diabetes may also be recommended.
Dietary Modifications »
Regular Exercise »
Diabetes is divided into three major types: type I, type II, and gestational diabetes.
Type II Diabetes »
Type I Diabetes »
Gestational Diabetes »
Other Types Of Diabetes »
Signs and Symptoms of Type II Diabetes
Most people with type II diabetes have no signs and symptoms at all, or the symptoms are so mild that they remain unnoticed until serious problems, such as blurred vision or heart disease arise. Some of the symptoms of type II diabetes include:
Diagnosis of Type II Diabetes
A doctor may run blood tests to diagnose type II diabetes, as there will be no symptoms in the early stages of the disease. These tests include:
- An A1C test, also called the hemoglobin A1c (HbA1c), or glycohemoglobin test
- A fasting plasma glucose (FPG) test
- An oral glucose tolerance test (OGTT)
The random plasma glucose (RPG) test is used to check for diabetes during regular health checkups.
The A1C test detects type II diabetes and prediabetes. This blood test measures a person’s average blood glucose level over a period of three months. This test can be done at any time of the day and does not require a patient to fast. The result of this test is expressed in percentage. A normal value should be below 5.7%. The higher the value, the higher a patient's blood glucose level.
Risk Factors for Type II Diabetes
Being obese or overweight is considered the major modifiable risk factor for type II diabetes. Over 90% of people with type II diabetes are obese. The risk of type II diabetes increases as your BMI increases. Severely obese people are at a particularly high risk of developing type II diabetes. In addition to obesity, other risk factors contributing to the development of type II diabetes include:
- Increasing age: A clear association exists between age and type II diabetes. People over the age of 45 are at an increased risk of developing diabetes.
- Lifestyle factors: Obesity and type II diabetes are associated with an unhealthy diet and physical inactivity or sedentary behavior.
- Racial/ethnic background: People of Asian, African American, American Indian, Asian American, or Hispanic descent are at a greater risk of developing type II diabetes at lower BMI levels than European populations. This is due to a complex interaction between genetic susceptibility and environmental factors.
- Family history: If your parents or siblings have been diagnosed with type II diabetes, you are at a greater risk of developing type II diabetes.
- Past medical history: If you have had gestational diabetes, polycystic ovary syndrome, high blood pressure (140/90 mmHg or above), or triglyceride levels above 250 mg/dl, you are at a higher risk of developing type II diabetes.
Causes of Obesity-related Type II Diabetes
Type II diabetes is a condition caused by a progressive decrease in insulin secretion over a period of time due to the damage that occurs to the beta cells of the pancreas responsible for making insulin. Research suggests that there is a genetic interlink between diabetes and obesity that is found on chromosome 6, which leads to the recognition of an inhibitor of insulin receptor called ENPP1.
Obesity can lead to the development of type II diabetes by triggering changes in the body’s metabolism, which causes fat cells to release large amounts of fatty acids, hormones, glycerol, pro-inflammatory cytokines, and other substances that make the body less sensitive to insulin. These substances act by interfering with the function of insulin-responsive cells and their ability to react to insulin. Thus, insulin resistance, when combined with malfunctioning pancreatic beta cells, results in a failure to maintain normal blood glucose levels.
A variety of alternative therapies and supplements have shown promising results in reducing blood sugar levels. It is important to consult your doctor before using any dietary supplements, as these can have adverse reactions with diabetes medications. Natural supplements cannot be used in place of standard diabetes treatment. Always consult your doctor before starting any alternative therapy regimen.
Acupuncture is a treatment method in which very thin needles are inserted into specific pressure points on the body. Researchers believe that acupuncture triggers the release of natural painkillers and helps reduce the painful symptoms of neuropathy (damage to the nerves resulting from diabetes). Acupuncture treatment can also offer relief from chronic pain.
Chronic stress may worsen diabetes. Relaxation methods, such as biofeedback, tai chi, and yoga can help patients manage stress better. Stress indirectly increases blood glucose levels by stimulating the nervous and endocrine systems. Biofeedback sessions involve performing techniques that improve awareness and control of the body’s response to stress. Patients with diabetes who participate in biofeedback sessions are more likely to achieve their target blood glucose level.
Herbal supplements and plant-based medications have been used in the treatment of diabetes for several years. Always consult your doctor before considering the use of herbal supplements, as some herbs may interact with blood sugar lowering medications. Herbs that play an important role in the prevention or management of diabetes include:
- Bitter Melon (Momordica Charantia): This herb is used as a remedy for patients with high blood glucose levels. Clinical studies have shown that bitter melon decreases serum glucose levels. This herb should be avoided if you are pregnant.
- Fenugreek Seeds: Fenugreek contains a high amount of fiber and is known to regulate glucose and lipid levels.
- Cinnamon: A clinical study states that the intake of small amounts of cinnamon, whole or in extract form every day, helps in lowering fasting blood glucose levels.
- American Ginseng: This herb has blood sugar reducing effects and is useful to patients with type II diabetes. It regulates both fasting and postprandial blood glucose levels.
Some of the nutritional supplements used to regulate blood glucose levels include chromium, vitamin B1, alpha-lipoic acid, and magnesium. There is no sufficient amount of scientific evidence to support the use of dietary supplements in the management of type II diabetes.
Prevention of type II diabetes can be done by either preventing or treating obesity. It is important to teach children and adolescents about healthy lifestyle choices that will decrease their risk of developing diabetes. Dietary and lifestyle modifications in adults with a high risk of developing diabetes may help prevent diabetes and its complications.
Being active, reducing the intake of fat, and losing excess weight can lower your risk of developing type II diabetes.
If you are overweight or obese, take the following steps:
- Choose your food wisely, avoid intake of fatty substances
- Perform physical exercises every day
- Try to reach and maintain the body weight recommended for your height
If you lead a sedentary lifestyle:
- Be physically active every day by participating in sports activities
If you have high blood pressure:
- Maintain your body weight within recommended limits
- Choose healthy foods
- Lower your intake of sodium and alcohol
- Be physically active
- Take regular medications to control blood pressure as advised by your doctor
If you have high cholesterol or triglyceride levels:
- Avoid oily food substances and make healthy food choices
- Be physically active
- Take medications to control cholesterol levels as directed by your doctor
Are you obese and concerned about diabetes? The bariatric surgeons at Marina Weight Loss can answer questions, discuss weight loss procedures, and help you find the most appropriate treatment solutions for your condition.