Who Stops Having Diabetes - Common Denominator

• (A) Women with fat hips tend not to get diabetes. Women with fat bellies do. Men with fat bellies do (few men gain weight on the hips).

• (B) People with stomach bypass surgery (Roux en Y, RYGB), which bypasses both most of the stomach and the first part of the small intestine, who had diabetes, lose their diabetes within a week or two after surgery - before they lose significant weight. (As reported by Leslie Stahl on 60 Minutes)

• (C) People with bariatric banding (putting a band around the stomach) get diabetes reversal after they lose weight. (Large article in NY Times said this. Also here.)

• (D) Mice with diabetes lose their diabetes when the first part of the small intestine alone is bypassed (bilio pancreatic diversion – BPD). Their stomachs are still in the food path. (60 Minutes)

• (E) Pregnant women sometimes get diabetes. After they deliver the baby, these diabetic pregnant women oftentimes revert to not having diabetes. (Wikipedia)

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The common denominator is when there is pressure on the first part of the small intestine, and hence the pancreas, due to abdominal fat or baby, diabetes comes about. Fat all by itself (A) does not cause diabetes. If the pressure is removed surgically (B, D), by losing weight (C), or by delivering the baby (E), then diabetes is reversed.  (Note:  this pressure from fat or fat plus baby need not be applied directly.  The fat might move the stomach, which would cause the duodenum to tighten near the ligament of treitz, which would pull and twist the arteries, and thus strangle the blood flow to the pancreas.  See my "Anatomy of a Strangle" post.)