Some think of glycaemia and think no further. Others see cardiovascular disease and amputated legs. Some others cringe thinking about pain and slow death. Whatever your personal horror may be, diabetes signifies a complex disease process with ramifications that go beyond glucose level rise in the blood. Easy to understand, easy to choose to forget. Reminding patients of this is half the stuff that happens in diabetes clinics, or atleast should be happening.
If there is a disease, there must be a cure. After all we can put man on the moon. Once we put one on mars, there will be absolutely no more excuse. Everything will need to have a cure. Something we can pop to be rid of diabetes. To make glucose levels normal? To prevent the deposition of cholesterol on blood vessels? To reduce glycosylation of Hemoglobin? To reduce AGE ?(Sorry, I meant Advanced Glycosylation Endproducts, and no, there is no cure for the one you are having trouble with). To prevent changes in eyes, kidneys, nerves, and blood vessels? What are you looking for in a cure? The works! I hear you say. Would you like weight loss with that? (Dont even think of fries with that then).
Have this discussion with a surgeon and you will have to bear with pontification about bariatric surgery as God's gift to mankind. Finally a diabetes cure. The only way to cure diabetes. Or so you are led to believe. Why not believe? Afterall belief is what gets you through life. It gives you hope. Hope that we will be finally be free of this vicious soul destroying disease that eats you up from the inside. Or will you be? will you have "normal" good glucose levels after bariatric surgery? Tick. What about blood pressure normalisation after bariatric surgery? Possibly. Will glycosylation, AGE and atherosclerosis halt and regress? Maybe? Will it reverse the mortality risk conferred on you by years of excesses? What about reversal of complications? What about preventing further complications? Are these a requirement to define "Cure" of diabetes? Or are you happy with glucose levels normalisation? When leukemia is treated, we hear about remission, not cure. Why? Because we live in fear of recurrence, recrudescence, resurgence, reappearance of the enemy within. So does bariatric surgery offer remission or cure?
(....to be continued)