World Diabetes Day falls on 14th November every year. Purpose of this one day is to raise awareness of a condition that millions of people all around the world live with every day.
What Is Diabetes?
Diabetes is about the body’s inability to produce the required amount of a hormone called insulin to control glucose levels in the blood. Diabetes occurs when your body doesn’t make enough of the hormone insulin which causes your blood sugar levels to go too high.
There are broadly three types of diabetes: Type 1 requires daily administration of artificial insulin through injection or insulin pump. Type 2 is more generally managed by a combination of dietary control and medication in the form of tablets. Type 3 – Pancreatic diabetes (secondary to pancreatic diseases)
How does diabetes affect the body?
Overtime high blood sugar levels, also called hyperglycemia, can lead to kidney disease, heart disease and blindness. The excess sugar in the bloodstream can damage the tiny blood vessels in eyes and kidneys and can harden or narrow arteries.
What is Pancreatic Diabetes?
Diabetes mellitus secondary to pancreatic diseases (such as chronic pancreatitis) is classified as the pancreastogenic diabetes or type 3c diabetes mellitus according to the current classification of diabetes mellitus.
Why does pancreatic diabetes occur?
The most common disease of the exocrine pancreas associated with the development of diabetes is chronic pancreatitis. It is somewhat related to cystic fibrosis-related diabetes(CFRD). In CFRD, the low nutritional status & associated lung disease overwhelms clinical picture. Other less common forms of the pancreastogenic diabetes exist, such as that due to pancreatic cancer, as well as post-pancreatectomy diabetes, with each requiring individualised approaches to care.
What happens in pancreatic diabetes?
In almost 80% of patients with type 3c diabetes have chronic pancreatitis. Pancreatic diabetes usually occurs late in the course of chronic pancreatitis and is accompanied by pancreatic exocrine dysfunction. Alcohol abuse, smoking, and pancreatic calcification are known risk factors for diabetes in patients with chronic pancreatitis. Diabetes that develops as a complication of chronic pancreatitis is due to deficient insulin secretion caused by reductions in both the number of islet cells and their function. Release of glucagon and pancreatic polypeptide (PP), as well as insulin from islet cells, is impaired, and secretion of insulin‐releasing hormones (i.e., incretins) also decreases.
How is pancreatic diabetes diagnosed?
The diagnostic criteria for pancreatic diabetes are the same as for other forms of diabetes. Still, evaluation of pancreatic exocrine function and an absent or weak PP response after ingestion of a meal is recommended.
Is pancreatic diabetes more serious than type-2 diabetes?
The incidences of retinopathy and neuropathy in calcified chronic pancreatic and alcoholic chronic pancreatitis are high, but diabetic coma and ketoacidosis are relatively rare.
What is the treatment for pancreatic diabetes?
Treatment should begin with lifestyle modifications in the form of weight control, daily exercise, abstinence from alcohol, and smoking cessation. Insulin replacement therapy is the only effective treatment in patients with advanced pancreatic diabetes and severe malnutrition.
Such patients are susceptible to hypoglycemia and metabolic dysfunction because counter regulatory hormones are lacking. Metformin therapy should be considered first in patients with mild hyperglycemia. Insulin secretogouges may be selected, but they often induce severe prolonged hypoglycemia. Other oral hypoglycemic agents cannot be recommended because of safety concerns and adverse effects.
Pancreatic enzyme replacement is crucial in pancreatic diabetes patients with exocrine pancreatic insufficiency, and their impaired fat‐soluble vitamin absorption and incretin release improve after pancreatic enzyme replacement.
Dr Harsh Shah
Liver, Pancreas & Cancer specialist Doctor in Ahmedabad, India