Garbed in a blue surgical robe, mask, and cap, Dr. Julio Teixeira stands over a supersize operating table where Nancy Rubio’s orblike belly erupts through a rectangular opening in sterile blue sheets. He grips two long metal rods, looking as if he were poised for a game of foosball, but his actions are methodical and gentle while his eyes intensely study one of the two large, flat screens that flank Rubio’s body. Teixeira, an expert at this kind of minimally invasive procedure, is performing gastric bypass surgery, one of America’s most common operations. But he also may be curing his patient of type 2 diabetes, literally overnight.
At just under five feet, Rubio is an obese 208 pounds, nearly double the 120- to 130-pound healthy weight for a person her height. The 52-year-old native of Ecuador developed type 2 diabetes after her children were born more than two decades ago. Her condition worsened as a fast-food diet packed on the pounds: Pizza and Chinese food were her favorites. Obesity increases type 2 diabetes risk, and often the two go hand in hand.
Over many years, Rubio’s body broke down her calorie-packed diet into glucose, a sugar, which was absorbed into her blood. Her pancreas produced insulin that unlocked her cells so the glucose could enter and produce the energy she needed to function. If the body cannot produce insulin (as is the case in people with type 1 diabetes), or if the cells ignore or resist insulin (as is common in type 2 individuals), blood glucose levels rise, sparking the crippling complications of diabetes. In Rubio’s case those complications included arthritic knee pain as her joints struggled with her heft, high blood pressure, elevated cholesterol, and high blood sugar.
With more than 25 million cases nationally, type 2 diabetes is America’s leading cause of blindness in adults under age 75, kidney failure, and amputation. It also raises the risk of nerve damage, heart disease, and stroke. In 2007 diabetes treatment and indirect medical costs ran to $174 billion in the United States. As obesity spreads across this country and across the world, those costs are rapidly on the rise.
The best way to combat type 2 diabetes, doctors traditionally say, is through diet and exercise-induced weight loss, which sometimes remedies insulin resistance. But many patients never manage to sustain the changes for long, and improvements can take months or years, if they come at all. When lifestyle changes fail, patients must control their blood glucose with regular insulin injections or oral medications. The medical costs for an individual with diabetes are typically 2.3 times higher than for someone without the disease. The day before her operation, Rubio told me she had tried dieting but could not shed weight, even though she understood the consequences. “I was afraid diabetes would affect my feet and cause gangrene,” she explained through a translator, her eyes welling with tears.
