Type 2 Diabetes and obesity continue to be most prominent problems in terms of world healthcare.  Fatness requiring medical treatment which is called obesity is the most important cause for Type 2 Diabetes.

Treatment approaches created for Diabetes and Obesity have diversified and changed gradually during last 20 to 30 years.  The underlying cause of this change is acknowledgement that both diabetes and obesity have threats for lives and health of individuals before diagnosis stage medically and early diagnosis increases treatment options.  In other words, it is not enough anymore to diagnose Diabetes by indicating your blood glucose elevation and analysis over 126 mg/dl.  Because risks and damages of diabetes may start to appear before your blood glucose increase to such level.

	Cellular Treatment of Diabetes

Because of this, it was understood that individuals who seem normal and are not assessed as diabetic may have tendency to diabetes and treatment of this is required.  We do not interest in people who present diabetes findings and are diagnosed with diabetes.  People who are not at diabetes stage yet need our interest and treatments.

Diabetes specialists do not diagnose an individual who has insulin resistance and may keep blood glucose within normal limits with high insulin doses.  They call these people on pre-diabetes stage.  In fact, majority of these individuals rapidly progress to diabetes stage.

The most important cause for insulin resistance, failure of insulin hormone function is fatness.  Obesity in other words.  Even most of fat people have normal blood glucose levels, their insulin levels was found increased.  Their muscles use sugar difficultly.  Because these individuals do not exercise much, muscles can not consume glucose without need of insulin.

General approach is to apply diets, exercise programs and prescribe drugs which will help to break down insulin resistance including metformine (Glucophage i.e.).  Well, how many patients do loose their weights with this treatment permanently and beat insulin resistance?  Unfortunately, very less… Very less of us.

In this case, we generally face with a turnout divided into two.  Our diet and exercise are loaded and we are forced to follow these or we give up.  The first choice is to replace diets with foods including less calories.  Your meal portions reduce and your stress to comply with these increases.  Most of us do not obey these diets.  We abstain to go a dietician or to our doctor.  Because we are guilty.  Right?  Diets which work for everyone were difficult for us.  We have overdone sometimes.  We are the guilty… Is it really so?

No:

• It is not your fault to experience difficulty to follow the diets given.
• Because you can not control you sense of hunger like normal people.
• Because your insulin levels are high.
• Because insulin is a hormone which triggers hunger and prevents loss of hunger sense.
• Even your blood glucose seem normal, your muscles can not use glucose sufficiently.  Your muscles starve for glucose.  The most important obstacle to assuage your hunger is hunger for sugar.
• You are not spineless, your hormones prevent to feel full.
• You are not guilty, your hormones are.  First, hormones should function well so that you may assuage your hunger normally like every people.

Treatments which do not consider your hormonal status and load more than you can handle can not be succesful.  Those who provide some weight loss can not preserve this for long.  Ratio to preserve weights lost with diet and exercise is very low.   All patients regain weights that they have lost within 1 year.  Many patients regain more than lost.

This process, diet failure or weight loss and gain drags you up and down like a yoyo and tires your metabolism more.  Uncontrolled diets which cause excessive weight loss and regaining these within a short period accelerate appearance of diabetes.

If you have obesity, if you can not loose sufficient weight with diets or if you regain these weights, do not go through this way.

Obesity and metabolic surgical methods perform most efficient, reliable and permanent treatment of fatness.

The earlier treatment and strong and permanent control of obesity completely eliminates insulin resistance. It provides to utilize sugar (glucose) by muscles without need of insulin.  Permanent treatment of obesity definitely prevents diabetes.

Obesity treatment is the most efficient, strongest and radical treatment of obesity solely and Type 2 Diabetes which appears with obesity.

Obesity and metabolic surgery operations fix blood glucose problems and accompanying conditions before loosing weight for diabetic patients whose body mass index is 35 kg/m2 and over.

These findings has determined metabolic surgery as the most efficient treatment for diabetic patients whose BMI >35 kg/m2.

FUTURE OF DIABETES AND METABOLIC SURGERY

Recovery of diabetes which appears on the basis of obesity within hours after obesity surgery was applied has broaden horizons for diabetic patients.

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	Future of Diabetes and Metabolic Surgery

• Blood glucose decrease within normal limits,
• Insulin use is not necessary anymore,
• Blood pressure is within normal limits and
• Blood fats start to be regulated.

None of these effects were related with weight loss.  It was totally associated with hormonal regulation and strong effect of these operations created on the body.

These obesity surgery methods applied for treatment of morbid obesity (fatness causing fatal diseases) actually show their effects by condemnation of small intestine in some parts.  After these operations, foods are absorbed from small intestines which are shorter and therefore foods eaten are absorbed and utilized less by the body.  In other words, absorption restriction appears.  This restriction also changes progress of meals eaten through intestines.  They do not reach to the first parts of intestines and reach earlier to last parts.  This different progress provides different stimulation of hormones.

By indication of these, these effects are started to be searched worldwide on diabetic patients whose weight is less or normal.  Due to these effects, definition of obesity surgery (fatness surgery in other words) was insufficient to explain results.  Because of these reasons;

• These operations were called as METABOLIC SURGERY by
• Recovery of diabetes by obesity operations without providing weight loss,
• And by indicating that diabetes may be fixed with operation for diabetic patients who are not fat.

Metabolic surgery methods are applied successfully for many diabetic patients who are slim or slightly over weighted in many countries.   Operations applied on these patients do not cause weight loss like fat patients.  Absorption restriction is less in these patients.  Diabetes and diabetes-dependent problems are actually fixed on these patients.

Operations for diabetes (metabolic surgery) will exist more and stronger in future of Type 2 Diabetes.  Methods which do not cause absorption restriction, weight loss, stimulates hormones strongly and control diabetes for longest period are developed now.

Ileal Interposition operation applied by Brasilian surgeon Dr. Paula in November, 2003 first has a history of ten years now.   The achievement on efficiency of the results and control of diabetes has caused to apply the operation by many teams and countries.  The most important strength and superiority of ileal interposition surgery is that this operation never causes absorption disorder in opposite of these operations.   A replacement procedure performed in small intestine provides foods to reach to last part of small intestine earlier and then to initial parts of small intestines after stimulating hormones.   This interposition procedure of last and first part of small intestine preserves small intestine length and no absorption restriction occurs.   To take last part of small intestine to the beginning both stimulates hormones and suppresses sense of hunger more efficient than all current methods.

Ileal interposition operation has created an ear on surgical treatment of Type 2 Diabetes and Obesity.  It has become problematic that requirement to load risk of severe absorption disorder onto the patients even for obesity only.

No matter how operations causing absorption disorder called malabsorptive operations are efficient, when these are compared with ileal interposition, they will start to stay back in terms of life quality.  Ileal interposition is the most efficient and strongest operation which is candidate to be future of obesity and diabetes.