Diabetes Mellitus is a life threatening disease which progresses with high blood sugar and causes many vital organs to be damaged because of high sugar levels.  We do not know the exact cause of Diabetes Mellitus.  However, many risk factors that may cause Diabetes Mellitus have been detected.  No matter what the stage is, obesity is the most important trigger for Type 2 Diabetes which appears during adult age.  Independently from the cause, Diabetes Mellitus is a progressive disease which creates fatal damages on vital organs of the body and disrupts the life comfort and is impossible to treat with drugs.

Diabetes Mellitus appears by uncontrolled blood sugar elevation.  Sugar is called “glucose" in medicine.  This resistant blood sugar elevation is called as "hyperglicemia” in medicine.  Uncontrolled high blood glucose continuously (hyperglycemia) destroys or damages normal functional mechanisms of the tissues and organs.  Patients with Diabetes Mellitus have disorders on carbohydrate, lipid and protein systems.  These substances are used or stored in an uncontrolled or disproportional manner.  Failures on these operations cause fatal disorders insidiously on eyes, kidneys, vessels and heart.

	What is Insulin?

What is Insulin?

There are substances called hormones which adjust to burn or store blood sugar (glucose)and other energy resources including lipids, carbohydrates and proteins. The most important of these is “insulin” which is secreted from pancreas.  Insulin is secreted by pancreas immediately after absorption of foods from intestines and mixing with blood and this hormone provides blood sugar (glucose) to be deposited by the liver and to be used as energy after burning by the muscles.  If insulin hormone can not function like this way completely, blood sugar (glucose) always remains high and Diabetes Mellitus appears.

In fact, Diabetes Mellitus appears when insulin looses its effect on the body.  Insulin efficiency exists congenitally in some Diabetes Mellitus types.  The body is insensitive to insulin although insulin is more than required in some patients.  Very much insulin exists in the blood, however, tissues do not respond to insulin.  In this case, blood sugar (glucose) remains high. We call this INSULIN RESISTANCE.

What are Symptoms For Diabetes Mellitus?

No matter what the cause is, patients’ complaints are very similar.  Diabetes Mellitus

• Thirst,
• Frequent and much urinating,
• Eating a lot but loosing weight,
• Blurry vision

Patients may refer to hospital with severe problems up to coma in some rare cases.

	Blood Sugar Measurement from Fingertip

Symptoms are not severe and may progress secretly.  It may not provide any finding in some stages.  Therefore, when Diabetes Mellitus is diagnosed, some disorders start to appear clinically in the patients.  Blood sugar has already started to remain high before the diagnosis. Increased blood sugar (glucose) is detected in routine blood and urine tests and diagnosis is put in these patients.

Sometimes, Diabetes Mellitus appears periodically and may disappear then.  The best samples for this is Gestational Diabetes Mellitus which occurs during pregnancy period.  These patients may have a complete diabetes and they may have a mild glucose intolerance in the blood sugar.  Therefore, all pregnant women are tested and gestational diabetes is searched.

Tendency for Diabetes Mellitus may be detected in some individuals even no disruption exists in the blood sugar.  For example, in Type 1 Diabetes Mellitus which appears in the earlier period of life, disorders of immune system which will cause a disease may be detected in the blood without any finding of the disease.  Some specific genetic or hereditary disorders may be transmitted from mother or father to the children.  These disorders are strongly associated with Diabetes Mellitus and cause Diabetes Mellitus in earlier ages.  These hereditary disorders may always be detected independently from Diabetes Mellitus.

Although causes of some rare types are known, we have limited information on exact cause of common Diabetes mellitus types.  Majority of patients with Diabetes Mellitus are examined under two main groups:

• Type 1 Diabetes (Childhood Diabetes Due to Insulin deficiency)
• Type 2 Diabetes (Adulthood Diabetes Due to Insulin Resistance)

Type 1 Diabetes

Type 1 Diabetes appears because of a disorder on insulin producing cells (β- beta cells).  Insulin production is almost none in these patients.  It appears in very early ages.  Type 1 Diabetes is diagnosed by detection of substances called antibodies in the blood although no clinical sign is present.  These proteins called antibodies are produced by the immune system.  They kill β-beta cells in the pancreas and stop insulin production.  Therefore, patients with Type 1 Diabetes can not live without insulin since the disease reveals itself.  They must use insulin for lifetime.  Therefore, Diabetes Surgeries are not useful for patients with Type 1 Diabetes.  For a successful diabetes operation, your own insulin depot should not be emptied.

Type 2 Diabetes

	Type 2 Diabetes is seen during adulthood

It is the most common form.  It appears because of a disorder on insulin secretion or insulin effect onto the tissues.  Although the cause is not known, there is not any underlying problem on the immune system.  These patients do not have antibody against insulin or β-beta cells.  It is closely related with obesity.  Morbid obese patients are under risk for Type 2 Diabetes.  Obesity surgery removes very severe diabetes findings completely (100%) in these patients.  Fighting against obesity is a gold standard treatment for fat diabetes patients.  The most efficient, long-term and permanent treatment of obesity-induced diabetes is possible with obesity surgery. Internationally reputable organizations such as ADA (American Diabetes Association), IDF (International Diabetes Federation) ve WHO (World Health Organisation) report that THA most efficient treatment of obesity –induced diabetes is obesity and metabolic surgery even for patients under morbid obesity level (BMI>35 kg/m2).

Type 2 Diabetes is one of the most important risk factors for blood lipid increase, heart attack, stroke and hypertension.  These disorders cause many organ failures.  Type 2 Diabetes is one of the most common causes of visual losses up to blindness. Blurry vision starts in many patients before Type 2 Diabetes is diagnosed.  Type 2 Diabetes is diagnosed by examinations because of this vision problem in many patients.

More than half of the patients with chronic kidney failure who undergo dialysis have such kidney failure due to Type 2 Diabetes induced kidney loss.  The most common cause for dialysis dependent kidney failure is Type 2 Diabetes.

Diabetes may be treated with metabolic surgery.  However, it should not be forgotten that Type 2 Diabetes becomes severer when obesity becomes severer and physical activity reduces.  Benefit of metabolic surgery on Type 2 Diabetes is 100% if it is applied before you tire your body and empty your reserves.