Diabetes surgery (Gastric Bypass) It is an effective surgical procedure to get rid of type 2 diabetes. This booklet in your hand contains detailed information about sugar surgery (gastric bypass). However, other than these, you can consult your doctor and dietitian about the things you are curious about.
What is Diabetes?
Diabetes mellitus (Diabetes) is a chronic metabolic disorder caused by high blood sugar levels. Sugar taken with food passes into the stomach, from there to the intestines, and is absorbed into the blood. Insulin is absolutely necessary for sugar to enter the cell. Insulin acts as the key that opens the cell’s door for sugar to enter the cell. When the pancreas cannot produce enough insulin or insulin cannot perform its key function (insulin resistance), sugar cannot enter the cell and turn into energy. Therefore, sugar begins to rise in the blood.
Diabetes mellitus caused by insulin deficiency is Type 1 Diabetes and cannot be treated with surgery. Today, the most effective treatment method for this disease is to use insulin. When insulin production in the pancreas decreases or insulin production is sufficient, it cannot show sufficient effect at the level of tissues and organs, that is, with insulin resistance, ‘type 2 diabetes’ develops and the most effective treatment method is ‘diabetes surgery (gastric bypass). 90% of diabetics have type 2 diabetes. Type 1 diabetes occurs as a result of the development of antibodies against the insulin-secreting beta cells in the pancreas and usually begins to appear in childhood. Type 2 diabetes is mostly seen after the age of 25 due to insulin resistance. More than half of type 2 diabetes patients are also obese.
What is Diabetes Surgery (Type 2 Diabetes Surgery)?
Some mistakes in eating habits, obesity and sedentary life cause a decrease in insulin secretion from the pancreas or the development of resistance to insulin in the cell, which in turn causes Type 2 Diabetes (Diabetes) due to an increase in blood sugar.
50% of diabetic patients also have obesity problem. In other words, there are 4 million four hundred thousand both obese and diabetic patients in Turkey. In people with these diseases, we call co-morbidities; sleep problems, high blood pressure, heart diseases, knee pain, high blood values, fatty liver, sexual and hormonal problems, some types of cancer are common. After diabetes surgery, patients get effective and permanent results by getting rid of insulin and diabetes medications. If other patients who cannot stop the drug also use insulin, they switch to a lower dose or blood sugar control is provided with oral anti-diabetic drugs.
Which Type of Surgery Can Be Performed for Diabetics?
Today, the most frequently applied and most effective surgeries are Omega Loop Gastric BY Pass, Roux-en-Y Gastric By Pass, Biliopancreatic diversion and Jejunoileal by Pass methods. The success rates of these surgical methods are close to each other. Surgeons apply the method that they think will get the best result with the least risk from these methods. Associate Professor. İbrahim Sakçak revised the Omega Loop Gastric Bypass method and made it more perfect and applies this method to all his patients.
Can Every Diabetic Patient Be Healed With Surgery?
Currently, there is no treatment method that provides acceptable success and completely eliminates the disease in type 1 diabetes patients with congenital absence of insulin.
It is very important to identify the patient with type 2 diabetes and who will benefit from the surgery. In order for the patient to be suitable for surgery, he must have the following characteristics.
- Must have type 2 diabetes
- Must be between 18-65 years old
- Tests showing insulin resistance and insulin secretion from the pancreas are suitable for surgery
- Diabetes-related kidney failure, blindness, non-healing wounds on the legs should not have developed.
- The person should be 25 – 30 kg more than their ideal weight.
- HbA1c above 7,
- C peptide level is normal,
- High HOMA-IR index
To Whom Can Metabolic Surgery (Diabetes Surgery) Not Be Performed?
- People with type 1 diabetes
- Those who have had previous surgery on the digestive system
- Chronic bowel diseases such as Crohn’s disease
- A condition that prevents anesthesia
- This surgery cannot be performed on people who have kidney failure, blindness, and non-healing wounds on the legs due to diabetes.
Nutrition after Obesity and Type-2 Diabetes (T2 DM) Surgery
On the day after the operation, water colored with methylene blue is drunk, then 1-2 sips of water and compote are started every 15 minutes. On the 2nd day after the operation, it is continued with soup and yoghurt. After discharge, the first month is gradually switched to normal nutrition.
After the operation, the size of the stomach becomes very small and is approximately the volume of a tea glass. At the same time, the part that allows the passage of food from the stomach is also very narrow. For this reason, when adding a new food to the diet, you should first take only one or two bites or sips and then wait for 10-15 minutes. This method will help you understand your limit and food tolerance. While eating your meals, you should chew slowly and pay attention to the portion. Since the stomach volume is reduced, saturation is felt quickly.
FIRST 1 WEEK AFTER OPERATION – LIQUID PERIOD
- Water, freshly squeezed fruit juice, ready-made fruit and vegetable juices without added sugar, herbal teas, compote and compote can be consumed without sugar.
- The fat layer is removed, chicken and broth
- Milk, yogurt, ayran, kefir
- Probiotic yogurt such as protein milk, yogurt, activia
- If milk bothers you, choose lactose-free milk, soy and almond milk.
- Soft milky desserts such as rice pudding with little rice, pudding, keşkül, Kazandibi, trilice without sauce, ice cream
- Watery mashed potatoes
- Soups prepared with broth and chicken stock without grains, without spices, a pinch of salt and tomato paste
POST SURGERY 7-10. DAYS – PURE PERIOD
- Pureed vegetables (such as carrots, zucchini, potatoes, etc.) can be consumed, boiled in hot water or with broth, and taken from a blender.
- You can consume the grains of home-made vegetable dishes by pulling them from the blender.
- You can consume tomatoes and cucumbers in small pieces, peeled and crushed.
- You can eat hard fruits such as apples, pears, quince, peeled and grated.
- You can eat banana, kiwi, melon, watermelon by chewing or crushing well in your mouth.
- You can cook ground plain oatmeal with milk and consume it in a warm and slightly watery consistency. If you don’t like the taste, you can add fruit puree.
- You can add crushed or very finely chopped or grated fruit into the yogurt.
- Continue to consume soups without tomato paste, spice and grains extracted from blender. You can add eggs and floury dressings to soups.
- Onions and garlic may upset your stomach during this period, and you can use them in cooked vegetables and soups.
- If you do not have the means to cook at home, you can choose baby products that are sugar-free, fruit purees and vegetable purees.
POST SURGERY 10-15. DAYS
You can start eating breakfast. To try the food, first consume it alone.
- You can start with the egg white for the first egg try.
- Do not consume egg yolk if your gallbladder has been removed.
- You can try poached egg, it is a boiled and immature egg prepared by breaking the egg into boiling water, it should be prepared with low oil and without adding spices. If desired, you can eat it with yogurt.
- Eat by trying eggs one day and cheese the next. If you don’t mind, consume a small amount of both in the same day.
- You can consume 1 cup of tea for breakfast, but your priority should be eggs and cheese.
- After having eggs and cheese for breakfast, you can consume bread and cheese as a snack.
POST SURGERY 15 – 30. DAYS
At first, your food should be juicy and soft. In order for us to understand which food may disturb you, do not consume the foods you are just starting to eat on the same day. Chew your food a lot and wait a while between two bites while you eat. Liquid should not be consumed during the meal, 30 minutes before and after the meal should be waited for fluid consumption.
WHAT CAN BE CONSUMED?
- Try to consume 1.5 liters of water a day.
- You can eat juicy meatballs, boiled meatballs without pain and sour, not intensely spicy.
- Try to use chicken stock or broth in your meals.
- You can consume soups such as tarhana, lentils, highland, ezogelin with less tomato paste, less spice and without filtered grains.
- You can eat up to 1 tea glass of chickpea a day as a snack to prevent your hunger and nausea.
- For meatballs and fish, use grilling, baking, boiling, steaming, low-fat cooking techniques.
- You can try pureed legumes, chickpea puree (humus), juicy broad bean puree (watery fava) and bean puree, which are sources of protein.
- You can consume 1 slice of bread or 1-2 crackers or grissini during the day.
WHAT SHOULD NOT BE CONSUMED IN THE FIRST 1 MONTHS AFTER THE SURGERY?
- Red meat (large piece, cutlet, cubed)
- Chicken, turkey meat
- Rice, bulgur, pasta
- Alcoholic and Carbonated Drinks
- Chocolate and sorbet desserts
- Pastry, pastry, pastry, bagel
THINGS YOU SHOULD CONSIDER 1 MONTH AFTER THE SURGERY
- You can eat small amounts of any food, as long as it doesn’t bother you.
- You can consume meat dishes, minced meat dishes, vegetable dishes, rice pilaf, bulgur pilaf, soups, chicken dishes.
- Try the legs and wings of the chicken first. If it doesn’t bother you, you can try the chest part.
- You can start large pieces of meat and chicken when you feel ready. Do not try both in the same day.
- You can also eat boiled and other types of eggs.
- You can start eating olives and other breakfast foods.
- You can drink tea, coffee.
- Now, you can consume all soups with grains and tomato paste. Be careful not to use too many spices other than salt and mint.
- Your priority should be protein-containing foods: meat, chicken, fish, eggs, cheese, legumes, yogurt, milk.
- You should eat a protein-containing food at every meal of the day.
- You can consume nuts such as walnuts, hazelnuts, almonds as snacks.
- Do not consume carbonated and sugary drinks such as soda, cola, fanta, ice tea, soda as they are high in calories and can cause stomach expansion.
- Do not consume alcoholic beverages in the first 2 months.
- When you stay away from chocolate, sherbet sweets and sugary foods, you will lose weight in a healthier way.
ASSOC. DR. İBRAHİM SAKÇAK
OBESITY AND DIABETES SURGERY