Gut-lining op that can beat diabetes
It’s designed to help you lose weight, but it has another amazing health benefit ...
ALAN THACKERAY, 61, a transport manager, underwent a new procedure to lose weight and help him reverse his diabetes, as he tells OONA MASHTA.
WTHE PATIENT
HEN I was in the Army more than 25 years ago, I was fit and just a little overweight. Then I developed a boil on my bottom that the GP said could have been caused by too much sugar in my blood — apparently diabetes can make you more susceptible to infections, because high blood sugar levels can weaken the immune system.
A blood test showed I was prediabetic (my sugar levels were higher than they should have been but not high enough to be classed as diabetic).
After I left the Army in the 1990s, I started suffering more symptoms.
I always felt tired, run-down and often had a cold. I went back to the GP who checked my blood sugar levels and said they were much higher, about eight when normal is about four to six: I had full-blown diabetes.
I was advised to make lifestyle changes including eating a healthier diet and taking more exercise, but it didn’t make any difference. By then I weighed about 18st (I am 6ft 3in) so I was overweight — I love my food, especially burgers.
But the doctor said it may also have been in the genes: my sister has diabetes and she has very similar symptoms to me.
I was prescribed two injections of the drug Victoza a day to stop my liver making too much sugar, but they made me feel sick 24 hours a day.
Then I developed another boil in the same place, then a third that burst — they were painful, ugly and I couldn’t sit comfortably.
I started having insulin injections. Initially, these worked but, over the years, I had to take higher and higher doses as my body was becoming resistant to its effects.
At one point I had four insulin injections a day and the more insulin I took, the more weight I put on (it’s a common side-effect). It was a vicious circle.
My kidneys were starting to pack up and I was told if they got worse I would have to go on dialysis.
I have four grown-up children and nine grandchildren and it got to the stage where I couldn’t do anything with any of them.
I weighed 20st 11lb (132kg) and my kidney function was down to 13 per cent.
LAST year my consultant mentioned a trial he was involved in with a new treatment that could help you lose lots of weight and potentially reverse diabetes.
A thin, flexible plastic tube-like liner, called an EndoBarrier, is put inside the first 60cm of your small intestine to reduce the amount of food your body absorbs.
It is reversible so if I got sideeffects, they would take it out — it could only be in for a year anyway, as that was the length of the trial.
I was desperate to try it to improve my kidney function and was worried my diabetes could kill me. So last June, I had a 30-minute procedure to fit the EndoBarrier.
While I was under a general anaesthetic, the surgeon inserted it into my gut via my mouth.
When I woke I had a slight sore throat — but I was able to go home later that day with my wife, Lynn, 61.
For the first couple of weeks I could only drink fluids, then I built up to eating solids and over the next year I felt full quicker, so I ate smaller portions and gradually the weight came off. I was also eating healthier food — fewer burgers! And I had no side-effects; in fact I didn’t know it was there.
By the time they removed it a year later — under a general anaesthetic, the same way it went in — I’d lost nearly 4st (25kg), my kidney function was back up to 25 per cent and my blood sugar levels were healthier. I’ve reduced my insulin injections to two a day and hope I will be able to reduce them even more now I’m in the habit of eating less.
Overall, I feel so much better. I have more energy and can manage the stairs with no problems.
If it were up to me I would have kept it for one more year.
THE SPECIALIST Dr BOB RYDER is a leading diabetes consultant.
AN ESTIMATED 225,000 people in Ireland have diabetes and the number is rising fast — mainly due to obesity caused by bad eating habits and lack of exercise.
Type 2, which accounts for 90 per cent of cases, is usually caused by a combination of the body’s failure to produce enough insulin and to respond to it properly.
It is true that there can be a genetic susceptibility, too. Most people affected by type 2 are overweight, though not all. And in up to 58 per cent of cases, the condition can be controlled through diet, a healthy lifestyle and weight loss. But it is a progressive condition and most people will need medication. When other treatments, including insulin, fail EndoBarrier offers a non-invasive, reversible alternative.
To place it is a simple procedure. A doctor inserts the tube, which is like a thin plastic sheath or liner, via the patient’s mouth using an endoscope — a long tube with a camera at the end that relays images to help guide us.
The EndoBarrier is placed at the opening of the small intestine, just below the stomach, and is secured with nickel and titanium hooks.
Once in place, the liner conforms to the shape of the patient’s intestine and works immediately, creating a physical barrier between the intestinal wall and food. Because food comes into contact with the intestine 60cm further down than usual, gut hormone signals are released sooner, so you feel full more quickly and eat less.
This means you lose weight; it also rapidly reduces blood sugar levels and reliance on diabetes medications. The EndoBarrier is a temporary procedure, with the device being removed after 12 months, leaving no permanent changes to the anatomy.
Earlier this month, at the European Association for the Study of Diabetes meeting in Lisbon, Portugal, I presented data from the first trial of EndoBarrier. So far, 50 patients have received this treatment at our hospital and results for the first 31, who have now had their devices removed, showed that on average they lost 15.6kg (2st 6lb), had improved blood sugar control, lower blood pressure and less liver fat.
The patients had type 2 diabetes for an average of 13 years, and 17 were taking insulin. Those on insulin were subsequently able to reduce their dose while six were able to stop taking the drug altogether.
We also monitored 17 patients for six months after having an EndoBarrier removed and found 11 (65 per cent) managed to keep losing weight and improve diabetes control, showing that the surgery also teaches valuable lessons that can last beyond the operation.
This first EndoBarrier service demonstrates the therapy is highly effective in patients with obesity and diabetes.
EndoBarrier could be a safe and cost-effective treatment — it doesn’t involve surgery and patients don’t have to stay in hospital, cutting infection risks.
The device is still being studied but we hope it will be reviewed by the European regulators and the US Food & Drugs Administration. It could be carried out everywhere.
Patients in Ireland can be referred by specialists for EndoBarrier treatment. It costs around €3,700 privately