Ocasionally when a obese patient comes to a meeting with his doctor, he would find he suffered from Diabetes Mellitus Type 2 or "non-insulin dependent". A general conception was that diabetes was caused by obesity and that once a patient had reduced his weight, he would be cured of diabetes. Diabetes Mellitus consists of a raise in glucose level in blood level during fast and requires a low calorie diet and medicine to help lower leves of sugar in blood. The main cause, a uneficient production of insuline to "burn" carbs or a resistance to insuline, something found commonly in obese patients. Between the normal individual and the diabetic, exists one that has intolerance to glucose and it shows high levels of glucose in blood but not high enough to consider a diabetes diagnosis. This patients can be handled with a diet, but they are warned that in the future they can develop the disease with all its complications.

Since more then 30 years ago a surgery to correct obesity is being performed. This procedures can be gastric bypass, gastric sleeve, gastric band, biliopancreatic derivations, etc. It is interesting to know that obese patients that had surgery and besides were diabetic, show an improvement of their diabetes in a porcentage between 85% and 95%. A thesis that has always been considered is that diabetes will be cured once you loose weight and reduce rich calorie foods. Some years ago, investigator noticed that patients improve their glucose level way before loosing weight, which implies that when "the stomach and intestines, the diabetes had been corrected". The small intestine its not just a obligatory step of food and a place where digestion takes place. Lately, it has been demostrated that the intestine produce a series of hormones and active biological substance that can stimulate the insuline secretion from the pancreas, responsible for the production of insuline. One of them is the Peptyde 1 - similar to the glucagon (GLP-1). This peptyde is produced by L cells, in the final part of the small intestine called ileon. Its main stimulus are the nutrients most of all the carbohydrates and their liberation activates the secretion and insuline production, as well as the proliferation of beta cells from the pancreas, responsible for insuline production. Another peptyde is the glucose dependant insulintropic polypeptide (GIP). This peptyde is found in the first portions of the small instestine, usually the duodeno and first centimeters of the yeyuno. In the same way, stimulates the production of insuline of the pancreas. When the nutrients arribe at the end of the small intestine, the GLP-1 productino is stimulated and this hormone increases the production of insuline from the pancreas. This is feasible in obese or not obese patients.

The last studies have demostrated that when surgeries are performed on obese patients, the transit of food through the intestine is altered increasing the ammount and quality of the nutrients that go to the ileon, therefore, increasing the ammount of GLP-1 that is produced and improving or healing the diabetes. There are already investigators in the whole world that realize a gastrointestinal reorganization surgery to resolve metabolic problems like colesteros, trigicerides and eleveated glucose with amost a 100% of good results. In this cases, the patients haven't been morbidly obese, but discretely overweight. The best of this, is that the surgery is performed in a laparoscopic way, with 5 little holes without the necesity of a big hound in the stomach. For a laparoscopic surgeon that is used to perform intestinal and gastrointestinal ties, this is an easy procedure.

Its obvious that many clinical colleagues would reject the posibility that diabetes would be cured with a surgery, but short term studies show a resolution on the glucose leves in the blood with just reorganize the transit trought the intestine and allowing nutrientes to arrive at the final ileon, therefore increasing the levels of the GLP-1 hormone. Its posible that this is the main cure for mellitus diabetes int he future, once every part involved recognize the weight of this cientific evidence.