CHENNAI:Obese people with diabetes often undergo bariatric surgery to lose weight and get their sugar levels under check. But what about those who cannot afford to lose 25-30 kg in a jiffy?
By adapting a method pioneered in Brazil over a decade ago, a city-based surgeon has cut 170 cm off a 36-year-old diabetic’s intestine and moved it closer to the stomach to cure him of diabetes. “That particular segment of the ileum or smaller intestine secretes hormones which are anti-diabetic in nature. But food gets there only after 5-6 hours. So when we move this section closer to the stomach, it acts on the food a lot better and insulin is secreted almost instantaneously,” explained Dr J S Rajkumar, chief surgeon at Lifeline Rigid Hospital. Called sleeve gastrectomy ileal transposition, or SGIT, the procedure comprises a reduction of stomach size, followed by cutting the 6-foot section of intestine that secretes enzymes like ghrelin, GLP 1, GLP 2 and PYY. “We make three cuts and join it in three sections again,” he added.
The patient from Tirupati was diagnosed with diabetes four years ago and was not able to get a handle on it. “The sugar level was hovering around 400 or so and he needed over 30 units of insulin a day to stay safe. The problem was that unlike a lot of diabetics who are fat, this guy had BMI of 24.5,” said Dr Dinakar, diabetologist at Lifeline.
Having a BMI that low and weight of 72 kg meant cutting his stomach and making it a small pouch was not an option. “The only other place in India where SGIT’s been tried is the Kirloskar Hospital in Hyderabad, where close to 50 cases have been documented since 2008. Because it’s technically challenging, no one else has tried it here,” said Rajkumar. Incidentally, at least 24 per cent of India’s burgeoning 178 million strong diabetic population is not obese, making them strong candidates for this surgery.
Three weeks after the surgery, the patient’s diabetes has come down and he only needs three shots of insulin a day now. Unlike other bariatric procedures, SGIT doesn’t yield immediate results — it can take up to 6 months and only 50 per cent of patients are completely cured.
SHED KILOS, FIGHT SUGAR
■ In the US, 2,00,000 bariatric surgeries are performed annually, especially for people battling diabetes and obesity
■ In India, less than 15,000 surgeries are performed because only 223 surgeons are trained in laparoscopic bariatric surgery
■ Most diabetes control clinics have huge crowds, but only a few have begun favouring the surgical option
■ Dr Mohan’s Diabetes Specialities Centres is one of the few to have started a bariatric surgical suite