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Pancreas Surgery For Diabetes Type 2

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Who Donates The Pancreas

SSM Health Medical Minute Pancreas transplant offers new hope for Type II diabetes

A pancreas donor is usually someone whos declared brain-dead but remains on a life-support machine. This donor has to meet common transplant criteria, including being a certain age and otherwise healthy.

The donors pancreas also has to match immunologically with the recipients body. This is important to help reduce rejection risk. Rejection occurs when a recipients immune system reacts adversely to the donated organ.

Occasionally, pancreatic donors are living. This may happen, for example, if the transplant recipient can find a donor whos a close relative, such as an identical twin. A living donor gives part of their pancreas, not the whole organ.

Diabetes Care After Pancreatic Surgery

  • Laura Woodcock
  • Page: 69

First performed in 1942 for a patient with a symptomatic insulinoma , total pancreatectomy is now used for a number of indications, including hereditary pancreatitis, end-stage chronic pancreatitis, pancreatic adenocarcinoma, neuroendocrine tumours and neoplasia with malignant potential, such as intraductal papillary mucinous neoplasm . Diabetes induced by TP is characterised by complete insulin deficiency, similar to typical cases of type 1 diabetes . Insulin deficiency secondary to TP is inevitable, and it can result in wide, fast, unpredictable and inexplicable swings in blood glucose concentration, often resulting in ketoacidosis or hypoglycaemic coma .

In order to improve its recognition, Ewald and Bretzel have proposed diagnostic criteria for type 3c diabetes. According to their criteria, the diagnosis requires the following:

  • Presence of pancreatic exocrine insufficiency.
  • Evidence of pathological pancreatic imaging .
  • Absence of autoantibodies associated with type 1 diabetes.
  • The diagnosis may be further supported by evidence of deficiencies in pancreatic polypeptide, incretin or insulin.

    Distal pancreatectomyDistal pancreatectomy is a surgical operation for resection of both neoplastic and non-neoplastic lesions of the body and tail of the pancreas . The resection may include splenectomy or liver resection, depending on the nature and anatomical position of the lesion.

    Who Develops Type 2 Diabetes

    About 90 to 95 percent of people with diabetes have Type 2. The symptoms of type 2 diabetes develop gradually. Symptoms may include fatigue, frequent urination, increased thirst and hunger, weight loss, blurred vision, and slow healing of wounds or sores. Some people have no symptoms.

    Type 2 diabetes is most often associated with older age, obesity, family history of diabetes, previous history of gestational diabetes, physical inactivity, and certain ethnicities. Type 2 diabetes is increasingly being diagnosed in children and adolescents, especially among African American, Mexican American, and Pacific Islander youth.

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    Type 2 Diabetes And Obesity

    Type 2 diabetes can contribute to eye disorders and blindness, heart disease, stroke, kidney failure, amputation, and nerve damage. It can affect pregnancy and cause birth defects, as well.

    About 80 percent of persons with Type 2 diabetes are overweight.

    Of those, some are severely or morbidly or obese. A standard way to define overweight, obesity, and morbid obesity is with the body mass index , a measure of body fat based on height and weight. The average BMI is 25. Morbid obesity is defined as:

    • A BMI of 40.0 or higher is considered severely obese
    • A BMI of 35.0 or higher in the presence of at least one other significant co-morbidity is also classified as morbid obesity.

    An individual can determine whether they are obese or morbidly obese using aBMI calculator.

    Pancreas Transplantation For Type 2 Diabetes At Us Transplant Centers

    Enhanced Lifestyle with Pancreatic Islet Transplantation ...
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  • Amy L. Friedman, Eli A. Friedman Pancreas Transplantation for Type 2 Diabetes at U.S. Transplant Centers . Diabetes Care 1 October 2002 25 : 1896.

    Pancreas transplantation, the most effective method of normalizing glucose control in type 1 diabetes, is not commonly used in type 2 diabetes, although patient and graft survival rates are equivalent . We conducted a mail survey of American transplant programs on 15 September 2000 characterizing the approach to pancreas transplantation in type 2 diabetic end-stage renal disease patients.

    A total of 44 centers responded. The mean center-specific cumulative volume was 70 ± 227 cases , with a total of 6,014 procedures. The collective experience of 872 cases in 1999 represents 71% of the 1,237 American pancreas transplants reported to the United Network for Organ Sharing.

    Diabetes is classified at more programs than renal transplantation . Of pancreas recipients in 1999, 1.8% had type 2 diabetes they were intentionally selected .

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    What Is The Outlook For People Who Have Bariatric Surgery To Treat Diabetes

    The improvements to blood glucose may start right after the surgery. You will probably be able to reduce the dosage of the diabetes medications. You might even be able to stop taking medications entirely. You will reduce your chances of heart attacks, strokes, and heart and kidney failures. You might be able to stop taking medications for those conditions as well. Sleep apnea and fatty liver should improve.

    You will lose weight in the short term and over the long term if you follow the instructions on when to eat, what to eat, and how much to eat. At first, you will have a liquid diet. Over the first month, the diet will transition to solid food with the help of your dietitian.

    Depending on the type of surgery and how you heal, you can probably return to work in 3-4 weeks.

    You will be asked to keep the scheduled appointments after the surgery for

    • Follow-up after surgery
    • Lab work
    • Dietary counseling
    • Psychological counseling and exercise counseling .
    • Routine healthcare with your primary healthcare provider
    • Monthly support group attendance

    Availability Of Data And Materials

    The datasets generated and/or analyzed during the current study are not publically available because our database contains highly sensible data which may provide insight in clinical and personnel information about our patients and lead to identification of these. Therefore, according to organizational restrictions and regulations these data cannot be made publically available. However, the datasets are available from the corresponding author on reasonable request.

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    What Are The Risks

    The procedures risks are infection and organ rejection. Rejection happens when the bodys immune system attacks the new organ as a foreign invader. To reduce the chances of rejection, the healthcare team tries to match the blood and tissue type of the organ donor to the person getting the transplant.

    After the transplant, healthcare providers prescribe special medicines that suppress the immune system, such as azathioprine and cyclosporine, to help prevent rejection of the new pancreas. However, these medicines make it more likely for people with a transplanted organ to pick up infections like colds and the flu. Over time, the medicines may also increase the risk for certain cancers. Because of the higher risk for skin cancer, for example, its important to cover up and wear sunscreen. If you get a pancreas transplant, you must take special medicines as long as you have the transplanted organ in your body. You will also need tests over the years to be sure that your pancreas transplant is still functioning adequately. Its also crucial to keep all your healthcare provider appointments.

    What Should I Expect After The Operation

    Pancreas Transplant for Type II Diabetes Mellitus Patients | UAB MedCast

    The care after a kidney/pancreas transplant is very similar to a kidney transplant alone. One difference is that after a kidney/pancreas transplant you may spend a day or so in the intensive care unit for close watching to make sure both kidney and pancreas are working well. If there are no problems such as rejection or infection, you should be able to go home in seven to ten days.

    Remember that you will need to take special medicines, called immunosuppressive or anti-rejection medications, following your transplant operation to help prevent your body from rejecting your newly transplanted organs. You need to take these medicines exactly as the doctor prescribes for the rest of your life.

    In addition, you will have regularly scheduled tests as an outpatient to check the function of your transplanted organs and you will be told to follow a healthy lifestyle through diet and exercise.

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    Data Sources And Searches

    The review was performed according to the PRISMA guidelines for conducting and reporting of systematic reviews and meta-analyses. Medline and Embase databases were searched for original articles written in English, published from 1990 to 13th May 2018. Abstracts were excluded. The databases were queried using one keyword from group A in addition to one keyword from group B . Figure illustrates the search strategy.

    Figure 1

    Does Bariatric Surgery Treat Type 2 Diabetes

    Doctors have found that weight-loss surgery can treat type 2 diabetes by controlling the level of sugar in the blood. Diabetes is a disease that happens when blood sugar levels are too high. Blood sugar is the primary source of energy for your cells. The glucose is able to get into cells because of the hormone called insulin. Insulin is made by the pancreas.

    If your body does not make insulin or make enough insulin, the glucose cannot get to your cells and so stays in the blood. This situation, if it lasts a long time, can cause certain health problems. Complications of diabetes can be very serious. They can affect the eyes, kidneys and nerves.

    Obesity is an important factor in developing diabetes. People who are severely obese have 10 times the risk of developing the disease. Foods that are high in fats and carbohydrates increases fatty acids in the blood and lipid build-up in the liver and muscles. This increases insulin resistance and inflammation. Over time, the pancreas stops making enough insulin.

    Weight-loss surgery is also called bariatric surgery. There are several types. Most of the procedures can be done in a minimally invasive way, via laparoscopy. Laparoscopic surgeries involve only small incisions and very tiny instruments.

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    What Happens During A Pancreas Transplant

    A pancreas transplant needs to be carried out as soon as possible after a donor pancreas becomes available.

    The operation is performed under general anaesthetic, where you’re asleep.

    A cut is made along your tummy. The donor pancreas is then placed inside and attached to nearby blood vessels and your bowel.

    The new pancreas should start producing insulin straight away. Your old damaged pancreas will be left in place and will continue to produce important digestive juices after the transplant.

    And Could Hot Baths Cut The Risk

    Blocking Hyaluronan Pancreas Buildup Prevents Type 1 Diabetes

    Taking a hot bath at least four times a week may cut your risk of diabetes.

    Researchers found that those who do are slimmer, have lower blood pressure and lower blood sugar levels.

    They concluded: ‘Our results indicate that daily heat exposure through hot-tub bathing has beneficial influences on cardiovascular risk factors in patients with type 2 diabetes.’

    The research, led by Kohnodai Hospital in Japan, was based on a study of 1,300 patients.

    They were divided into four groups based on how many baths they took a week.

    Those who bathed at least four times a week had slimmer waists, a lower body mass index and lower blood glucose levels than those who did not take at least one bath a week.

    Lucy Chambers of Diabetes UK said the study raised more questions than answers, adding: ‘It could be that people who bathe more frequently have a healthier lifestyle perhaps they are more physically active we just don’t know from the limited data.

    ‘That shouldn’t stop you from running a bath and enjoying some relaxing ‘me’ time.’

    Experts said the new findings add to mounting evidence that those with type 2 diabetes should be urged to follow radical low-calorie diets.

    Professor Roy Taylor of Newcastle University, who led the study, said the findings will be ‘enormously encouraging’ for patients.

    Earlier this month the NHS announced that thousands of type 2 diabetics will be offered a three-month 850 calorie soup and shake daily diet to beat the disease.

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    Is A Pancreas Transplant Worth It

    Successful pancreas transplantation has been demonstrated to be efficacious in significantly improving the quality of life of people with diabetes, primarily by eliminating the need for exogenous insulin, frequent daily blood glucose measurements, and many of the dietary restrictions imposed by the disorder.

    Diabetes And Pancreatic Cancer

    Pancreatic cancer is a type of cancer that starts in the pancreas. Type 2 diabetes can have a link to it as either something that raises your risk of having it or as a symptom.

    If you have type 2 diabetes, you’re up to twice as likely to have pancreatic cancer as someone who doesn’t have the condition. It’s more likely to happen if youâve had diabetes for a while — 5 years or longer — than if you donât have it at all. If you have pancreatic cancer, but have had type 2 for less than 5 years, research hasn’t figured out if the disease plays a role in the cancer or if the abnormal cells cause the diabetes.

    It’s rare, but pancreatic cancer can also cause diabetes, because it destroys the cells in the organ that make insulin. If you get type 2 diabetes when you’re over age 50, it may be a symptom of pancreatic cancer. If you had it before this age, it could be a red flag if your blood sugar levels suddenly change after you’ve had them under control. Symptoms of this type of cancer don’t usually happen until its later stages.

    If doctors have taken out all or part of your pancreas to treat your pancreatic cancer , you can’t make insulin anymore, and you’ll end up with diabetes.

    Several things make it more likely that you’ll get pancreatic cancer. You can change some of them, but others are out of your control. They include:

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    Scope And Impact Of Diabetes

    Diabetes is widely recognized as one of the leading causes of death and disability in the United States. In 2006, it was the seventh leading cause of death. However, diabetes is likely to be underreported as the underlying cause of death on death certificates. In 2004, among people ages 65 years or older, heart disease was noted on 68 percent of diabetes-related death certificates stroke was noted on 16 percent of diabetes-related death certificates for the same age group.

    Diabetes is associated with long-term complications that affect almost every part of the body. The disease often leads to blindness, heart and blood vessel disease, stroke, kidney failure, amputations, and nerve damage. Uncontrolled diabetes can complicate pregnancy, and birth defects are more common in babies born to women with diabetes.

    In 2007, diabetes cost the United States $174 billion. Indirect costs, including disability payments, time lost from work, and reduced productivity, totaled $58 billion. Direct medical costs for diabetes care, including hospitalizations, medical care, and treatment supplies, totaled $116 billion.

    Type 1 Diabetes Andtpancreas Transplantation

    Pancreatic Cancer Symptoms Awareness – New Onset Type 2 Diabetes

    Monday, November 4, 2019

    Pancreas transplant hospitals in Hyderabad have transplanted pancreas successfully to type 1 diabetic patient.Pancreas transplant is a surgical procedure where the healthy organ of the deceased donor is replaced with the pancreas that is no longer functioning properly.Most of these transplants are done to cure Type 1 Diabetes. Such transplants have significantly improved the lives of the patients and the complications that come with the disease such as:

    • Need not have dietary restrictions
    • No need to measure blood glucose levels
    • Eliminates severe hypoglycaemia and hyperglycaemia

    Location and the role of Pancreas :

    Location: The pancreas lies behind the lower part of the stomach

    Role: Produces a hormone called insulin that regulates the absorption of sugar in the cells

    One becomes a victim of type 1 diabetes when the pancreas fails to produce enough insulin leading to a rise in the blood sugar levels.

    The same pancreas transplant procedure cannot be adopted for the type 2 diabetic patients as in this case the pancreas produces enough insulin but the bodys inability to use insulin adequately.

    Pancreas Transplant Treatment :

    • When the patient is suffering from acute hypoglycaemia, hyperglycaemia.
    • Severe clinical and emotional problems and when the insulin therapy is failing
    • Imbalance in insulin leading to acute complications.

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    Types Of Pancreatic Transplant

    Severe Type 1 diabetes is often associated with chronic kidney failure. As a result, a person who needs a pancreas transplant may also need a kidney transplant.

    Pancreas transplantation is carried out in three forms:

    • Simultaneous Pancreas- Kidney Transplantation: Meant for a diabetic patient on or approaching dialysis.
    • Pancreas transplant after kidney transplant: Meant for diabetic patients who have had a successful kidney transplant but have ongoing complications from diabetes.
    • Pancreas Transplant alone: Meant to benefit patients with diabetic complications, but who have adequate kidney function.

    Bpd With Duodenal Switch

    The BPD with duodenal switch includes a sleeve vertical gastrectomy , which leaves a 150- to 200-ml gastric reservoir . The duodenum is closed 2 cm distal to the pylorus, and a duodeno-ileal anastomosis is performed . Hence, the gastric fundus is almost entirely resected, and the antrum, pylorus, and a very short segment of duodenum are preserved, along with the vagus nerve. Bowel continuity is restored as in BPD however, the entero-entero anastomosis is performed more proximally on the alimentary limb, leaving a longer common channel of 100 cm, as opposed to 50 cm in the original procedure of Scopinaro et al. The BPD-DS operation was conceived by Hess et al. , but first reported by Marceau et al. in 1998.

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    Effect Of Bariatric Surgery On Type 2 Diabetic Subjects With Bmi > 35 Kg/m: The Evidence

    A systematic review and meta-analysis of the English literature reported complete resolution of type 2 diabetes in 78.1% of cases. This percentage increased to 86.6% when counting patients reporting improvement of glycemic control, and diabetes resolution occurred in concomitance with an average weight loss of 38.5 kg ).

    Two large case-series studies, by Pories et al. and Schauer et al. , focused principally on diabetes outcomes after RYGBP. In the former study, mean fasting blood glucose decreased from clearly diabetic values to near normal levels , and HbA1c fell to normal levels without diabetes medicines in 89% of patients. In the latest study by Schauer et al., researchers provided the in-depth evaluation of the clinical outcome in 240 diabetic morbidly obese bariatric patients with a follow-up rate of 80%. The authors noted that after surgery, weight and BMI decreased from 308 lbs and 50.1 kg/m2 to 211 lbs and 34 kg/m2 for a mean weight loss of 97 lbs and mean excess weight loss of 60%. Fasting plasma glucose and HbA1c concentrations returned to normal levels or markedly improved in all patients. A significant reduction in use of oral antidiabetic agents and insulin followed surgical treatment. Patients with the shortest duration , the mildest form of type 2 diabetes , and the greatest weight loss after surgery were most likely to achieve complete resolution of type 2 diabetes.

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