Pancreatogenic (type 3c) Diabetes
1. Definition Pancreatogenic diabetes is a form of secondary diabetes, specifically that associated with disease of the exocrine pancreas. The most common disease of the exocrine pancreas associated with the development of diabetes is chronic pancreatitis. Analogous to chronic pancreatitis-associated diabetes is cystic fibrosis-related diabetes (CFRD), in which pancreatic exocrine insufficiency pre-dates the pancreatic endocrine insufficiency responsible for the development of diabetes. Because diabetes in cystic fibrosis is associated with worse nutritional status, more severe inflammatory lung disease, and greater mortality from respiratory failure, CFRD has long been recognized as a distinct form of diabetes requiring a specified approach to evaluation and treatment (30) now recognized by the American Diabetes Association (28). While the distinct pathogenesis of diabetes in chronic pancreatitis has also long been appreciated, only recently have guidelines been developed supporting a specified diagnostic and therapeutic algorithm (37). Finally, other less common forms of pancreatogenic diabetes exist, such as that due to pancreatic cancer (18), as well as post-pancreatectomy diabetes, with each requiring individualized approaches to care. 2. Classification Pancreatogenic diabetes is classified by the American Diabetes Association and by the World Health Organization as type 3c diabetes mellitus (T3cDM) and refers to diabetes due to impairment in pancreatic endocrine function related to pancreatic exocrine damage due to acute, relapsing and chronic pancreatitis (of any etiology), cystic fibrosis, hemochromatosis, pancreatic cancer, and pancreatectomy, and as well rare causes such as neonatal diabetes due to pancreatic agenesis (1). Prevalence data on T3cDM are scarce b Continue reading >>
Common Disorders Of The Pancreas
There are a variety of disorders of the pancreas including acute pancreatitis, chronic pancreatitis, hereditary pancreatitis, and pancreatic cancer. The evaluation of pancreatic diseases can be difficult due to the inaccessibility of the pancreas. There are multiple methods to evaluate the pancreas. Initial tests of the pancreas include a physical examination, which is difficult since the pancreas is deep in the abdomen near the spine. Blood tests are often helpful in determining whether the pancreas is involved in a specific symptom but may be misleading. The best radiographic tests to evaluate the structure of the pancreas include CAT (computed tomography) scan, endoscopic ultrasound, and MRI (magnetic resonance imaging). Tests to evaluate the pancreatic ducts include ERCP (endoscopic retrograde cholangiopancreatography) and MRCP(magnetic resonance cholangiopancreatography). There are also instances in which surgical exploration is the only way to confirm the diagnosis of pancreatic disease. Acute Pancreatitis Acute pancreatitis is a sudden attack causing inflammation of the pancreas and is usually associated with severe upper abdominal pain. The pain may be severe and last several days. Other symptoms of acute pancreatitis include nausea, vomiting, diarrhea, bloating, and fever. In the United States, the most common cause of acute pancreatitis is gallstones. Other causes include chronic alcohol consumption, hereditary conditions, trauma, medications, infections, electrolyte abnormalities, high lipid levels, hormonal abnormalities, or other unknown causes. The treatment is usually supportive with medications showing no benefit. Most patients with acute pancreatitis recover completely. For more information on acute pancreatitis, please visit here. Chronic Pancreatitis Continue reading >>
Diabetes Occurs More Often In Acute Pancreatitis Patients
Diabetes Occurs More Often in Acute Pancreatitis Patients by Joyce Frieden Joyce Frieden, News Editor, MedPage Today This article is a collaboration between MedPage Today and: Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal. Note that this observational study, relying on a large administrative database, suggested that an episode of acute pancreatitis is associated with the subsequent incidence of type 2 diabetes. Be aware that the cause of pancreatitis (ie alcohol vs. hypertriglyceridemia) was not determined. WASHINGTON -- Diabetes occurred at a higher rate among patients suffering an episode of acute pancreatitis, according to a researcher here. About 20% of patients with acute pancreatitis developed diabetes within 5 years of their pancreatitis episode, reported Peter Lee, MD, of University Hospitals Cleveland, and colleagues. Of those, three-fourths were on an anti-diabetic regimen and half were on insulin therapy. This compares with 7% of metabolic syndrome patients without pancreatitis, for example, who develop diabetes within a single year. Acute pancreatitis is very common, causing over 250,000 admissions each year, and its incidence seems to be increasing worldwide, said Lee in a presentation at Digestive Disease Week . "Although the mortality has decreased substantially over the years, survivors of acute pancreatitis still may experience recurrence, progression to chronic pancreatitis, decreased quality of life, and exocrine pancreatic insufficiency," he stated. Until recently, chronic pancreatitis was thought to increase the risk of diabetes, but new evidence suggests that an episode of acute pancreatitis also increases Continue reading >>
Diabetes Mellitus Secondary To Acute Pancreatitis In A Child With Wolf-hirschhorn Syndrome
Diabetes Mellitus Secondary to Acute Pancreatitis in a Child with Wolf-Hirschhorn Syndrome Correspondence should be addressed to Asma Deeb ; [email protected] Received 30 July 2017; Accepted 25 September 2017; Published 24 October 2017 Copyright 2017 Asma Deeb. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Wolf-Hirschhorn Syndrome (WHS) is a rare genetic disease caused by deletion in the short arm of chromosome 4. It is characterized by typical fascial features and a varying degree of intellectual disabilities and multiple systemic involvement. Epidemiological studies confirmed the association of acute pancreatitis with the development of diabetes. However, this association has not been reported in WHS. We report an 18-year-old girl with WHS who presented acutely with nonketotic Hyperglycemic Hyperosmolar Status (HHS) in association with severe acute pancreatitis. Her presentation was preceded by febrile illness with preauricular abscess. She was treated with fluids and insulin infusion and remained on insulin 18 months after presentation. Her parents are cousins and the mother was diagnosed with type 2 diabetes. She had negative autoantibodies and no signs of insulin resistance and her monogenic diabetes genetic testing was negative. Microarray study using WHS probe confirmed deletion of 4p chromosome. Acute pancreatitis is uncommon in children and development of diabetes following pancreatitis has not been reported in WHS. HHS is considerably less frequent than diabetes ketoacidosis in children. We highlight the complex presentation with HHS and acute pancreatitis leading to diabetes that required long t Continue reading >>
Acute Pancreatitis
Background The bile duct and main pancreatic duct meet at the sphincter of Oddi before emptying their contents into the small intestine. In 1856 Claude Bernard suggested that pancreatitis might be due to reflux of bile into the pancreatic duct. In 1901 Eugene Opie, the father of pancreatic pathology, described two patients in whom pancreatitis was due to blockage of the pancreatic duct by gall stones, and proposed that pancreatitis was caused by migration of gall stones down the bile duct.[1] Acute pancreatitis is of interest to diabetologists for three main reasons. First, because it may be a cause of diabetes. Second, because people with type 2 diabetes may be at increased risk of acute pancreatitis. Third, because acute pancreatitis has been associated with glucagon-like peptide-1 (GLP-1)-based therapies. This section considers acute pancreatitis as a cause of diabetes. Epidemiology There are about 200,000 cases each year in the USA, and the incidence of acute pancreatitis is estimated at 35–45 per 100,000 per year in California and rising. A rising incidence has also be reported in Europe. The incidence may vary from one population to another in proportion to obesity (predisposing to gallstones), alcohol consumption and possibly ethnicity. Clinical features The diagnosis of acute pancreatitis is based upon the triad of symptoms, enzyme elevation and radiological signs. Severe cases are readily diagnosed, but the diagnosis may be open to differences of clinical interpretation at the milder end of the spectrum, thus complicating estimates of its incidence. Acute pancreatitis typically presents with severe upper abdominal pain radiating through to the back and prostration. On palpation the abdomen shows tenderness but not rigidity (sometimes referred to as the 'plato Continue reading >>
Pancreatic Diabetes Mellitus
Diabetes mellitus caused by pancreatic exocrine disease is a unique clinical and metabolic form of diabetes. The diagnosis of pancreatic diabetes caused by chronic pancreatitis may be elusive because it is occasionally painless and often not accompanied by clinical malabsorption until after hyperglycemia occurs. Diabetic patients with pancreatic calcification or clinically demonstrable pancreatic exocrine dysfunction will manifest the unique aspects of pancreatic diabetes described herein. Like other forms of diabetes, the primary hormonal abnormality in pancreatic diabetes is decreased insulin secretion. Patients with this disorder are unique in that they have low glucagon levels that respond abnormally to several physiological stimuli, blunted epinephrine responses to insulin-induced hypoglycemia, and malabsorption. In addition, they often have concomitant alcohol abuse with hepatic disease and poor nutrition. These characteristics result in increased levels of circulating gluconeogenic amino acids, decreased insulin requirements, a resistance to ketosis, low cholesterol levels, an increased risk of hypoglycemia while on insulin therapy, and the clinical impression of brittle diabetes. Retinopathy occurs at a rate equal to that of insulin-dependent diabetes but may be less severe in degree. Other complications of pancreatic diabetes have been less well studied but may be expected to be seen more frequently as these patients survive longer. The characteristics of pancreatic diabetes suggest that a conservative approach be taken in regard to intensive insulin therapy and tight blood glucose control. We developed a computer program for the simulation of plasma insulin and glucose dynamics after subcutaneous injection of insulin. The program incorporates a pharmacokinetic Continue reading >>
- Women in India with Gestational Diabetes Mellitus Strategy (WINGS): Methodology and development of model of care for gestational diabetes mellitus (WINGS 4)
- Mice Have Had Their Diabetes Reversed After Receiving Pancreatic Tissue Grown in Rats
- Bitter Melon Can Treat Pancreatic Cancer and Diabetes (According To A Research)
Pancreatic Diabetes Mellitus.
Department of Medicine, Fitzsimons Army Medical Center, Aurora Colorado 80045-5001. Diabetes Care. 1989 Nov-Dec;12(10):715-24. Diabetes mellitus caused by pancreatic exocrine disease is a unique clinical and metabolic form of diabetes. The diagnosis of pancreatic diabetes caused by chronic pancreatitis may be elusive because it is occasionally painless and often not accompanied by clinical malabsorption until after hyperglycemia occurs. Diabetic patients with pancreatic calcification or clinically demonstrable pancreatic exocrine dysfunction will manifest the unique aspects of pancreatic diabetes described herein. Like other forms of diabetes, the primary hormonal abnormality in pancreatic diabetes is decreased insulin secretion. Patients with this disorder are unique in that they have low glucagon levels that respond abnormally to several physiological stimuli, blunted epinephrine responses to insulin-induced hypoglycemia, and malabsorption. In addition, they often have concomitant alcohol abuse with hepatic disease and poor nutrition. These characteristics result in increased levels of circulating gluconeogenic amino acids, decreased insulin requirements, a resistance to ketosis, low cholesterol levels, an increased risk of hypoglycemia while on insulin therapy, and the clinical impression of brittle diabetes. Retinopathy occurs at a rate equal to that of insulin-dependent diabetes but may be less severe in degree. Other complications of pancreatic diabetes have been less well studied but may be expected to be seen more frequently as these patients survive longer. The characteristics of pancreatic diabetes suggest that a conservative approach be taken in regard to intensive insulin therapy and tight blood glucose control. Continue reading >>
- Women in India with Gestational Diabetes Mellitus Strategy (WINGS): Methodology and development of model of care for gestational diabetes mellitus (WINGS 4)
- Mice Have Had Their Diabetes Reversed After Receiving Pancreatic Tissue Grown in Rats
- Bitter Melon Can Treat Pancreatic Cancer and Diabetes (According To A Research)
Diabetes Mellitus And Pancreatitis Cause Or Effect?
Diabetes mellitus and pancreatitis cause or effect? Please review our Terms and Conditions of Use and check box below to share full-text version of article. I have read and accept the Wiley Online Library Terms and Conditions of Use. Use the link below to share a full-text version of this article with your friends and colleagues. Learn more. Diabetes mellitus and pancreatitis are two distinct diseases encountered commonly in small animal practice. Whilst the clinical signs of diabetes mellitus are usually unmistakeable, a firm diagnosis of pancreatitis can prove more elusive, as clinical signs are often variable. Over the past 10 to 15 years, despite the fact that the clinical signs of diabetes mellitus are remarkably consistent, it has become more apparent that the underlying pathology of diabetes mellitus in dogs and cats is heterogeneous, with exocrine pancreatic inflammation accompanying diabetes mellitus in a number of cases. However, the question remains as to whether the diabetes mellitus causes the pancreatitis or whether, conversely, the pancreatitis leads to diabetes mellitus as there is evidence to support both scenarios. The concurrence of diabetes mellitus and pancreatitis has clinical implications for case management as such cases may follow a more difficult clinical course, with their glycaemic control being brittle as a result of variation in the degree of pancreatic inflammation. Problems may also arise if abdominal pain or vomiting lead to anorexia. In addition, diabetic cases with pancreatitis are at risk of developing exocrine pancreatic insufficiency in the following months to years, which can complicate their management further. Continue reading >>
- Diagnosis and treatment of diabetes mellitus in chronic pancreatitis
- Effect of Probiotics on Glucose and Lipid Metabolism in Type 2 Diabetes Mellitus: A Meta-Analysis of 12 Randomized Controlled Trials
- The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus
Acute Pancreatitis In Patients With Type 2 Diabetes Mellitus Treated With Dipeptidyl Peptidase-4 Inhibitors - Sciencedirect
Acute pancreatitis in patients with type 2 diabetes mellitus treated with dipeptidyl peptidase-4 inhibitors Author links open overlay panel Tzu-LinYanga Mei-ChiouShena Ming-LungYubc Yaw-BinHuangad Chung-YuChenad Open Access funded by Taiwan Food and Drug Administration Dipeptidyl peptidase (DPP)-4 inhibitors are approved for use in monotherapy or in combination therapy for patients with type 2 diabetes mellitus for <1 decade. However, numerous reports of DPP-4 inhibitors induced acute pancreatitis were made through the US Food and Drug Administration Adverse Event Reporting System, and this led to a revision in the prescribing information for these drugs. Therefore, this study is designed to evaluate DPP-4 inhibitors induced acute pancreatitis via the spontaneous adverse drug reactions (ADRs) reporting system in a medical center. In four of 2305 ADR cases, it is suspected that DPP-4 inhibitors induced moderate to serious acute pancreatitis. Beyond drugs, other factors also contribute to acute pancreatitis and affect the possibility of ADRs assessed using the Naranjo algorithm. Finally, our results indicate that the incidence of DPP-4 inhibitors induced acute pancreatitis is low. Continue reading >>
Diabetes May Be Warning Sign Of Pancreatic Cancer
A presentation to the European Cancer Congress in Amsterdam reports that 50% of people in two sample groups who had been diagnosed with pancreatic cancer had been diagnosed with type 2 diabetes in the previous year and been given their first medication to control it. Fewer than 5 out of 100 people can expect to be alive 5 years after being diagnosed with pancreatic cancer. Survival rates are poor because the cancer doesn't usually cause any symptoms until late in the disease. The American Cancer Society estimates more than 53,000 people will be diagnosed with pancreatic cancer in 2017. "Although it has been known for some time that there is an association between type 2 diabetes and pancreatic cancer, the relationship between the two conditions is complex," Alice Koechlin, from the International Prevention Research Institute in Lyon, France, told the conference. The pancreas contains cells that make insulin. Type 2 diabetes happens when these cells are unable to make enough insulin or the insulin doesn't work properly. The study involved 368,377 people with type 2 diabetes in Belgium and 456,311 in Italy. Among these patients over a 5-year period, there were 885 and 1,872 cases of pancreatic cancer diagnosed respectively. The researchers found that patients had a 3.5 times higher risk of being diagnosed with pancreatic cancer compared to those on other non-insulin, non-incretin diabetes treatments in the first 3 months after their first prescription for a class of diabetes medications known as incretins. The risks decreased with time. These are hormones that stimulate the pancreas to produce more insulin. Among patients who already had type 2 diabetes, the need to switch to injecting insulin because their condition got worse was associated with a seven-times-higher risk Continue reading >>
Pancreatitis And Diabetes
Tweet Pancreatitis is a condition in which the pancreas becomes inflamed, which can be very painful in the short term and could lead to complications including secondary diabetes. Alcohol and gall stones are the main risk factors for pancreatitis but some medications, including certain diabetes medications, may increase the risk of pancreatitis. Types of pancreatitis Acute pancreatitis is when the pancreas becomes inflamed for up to a few days. Chronic pancreatitis is if inflammation of the pancreas persists over a long period of time, say years. Symptoms The main symptom of acute pancreatitis is a strong pain in the upper abdomen, where the pancreas is located. Other symptoms that may be present include: nausea vomiting or diarrhoea fever If you have chronic pancreatitis you may experience regular pain within the upper part of the abdomen and possibly some of the following symptoms, caused by difficulty in digesting food properly: Stomach cramps Bloating and wind Foul smelling stools Unexplained weight loss Jaundice Seek medical help if you experience sudden severe pain in your abdomen. Causes The NHS notes that pancreatitis may be caused by a digestive enzyme becoming prematurely activated within the pancreas, causing the pancreas to become inflamed. Having two or more alcoholic drinks a day Gallstones An automimmune response Hypertriglyceridemia – high levels of triglyceride blood fats in the blood Genetic mutation of MCP-1 gene The following medications may also raise the risk of pancreatitis: Oestrogens Corticosteroids Thiazide diuretics Certain diabetes medications – see below for more info Treatment Treatment for pancreatitis will need to be carried out in hospital. You may need to be given oxygen and intravenous fluids, and may be given strong painkillers, s Continue reading >>
The Connection Between Diabetes And Your Pancreas
A direct connection exists between the pancreas and diabetes. The pancreas is an organ deep in your abdomen behind your stomach. It’s an important part of your digestive system. The pancreas produces enzymes and hormones that help you digest food. One of those hormones, insulin, is necessary to regulate glucose. Glucose refers to sugars in your body. Every cell in your body needs glucose for energy. Think of insulin as a lock to the cell. Insulin must open the cell to allow it to use glucose for energy. If your pancreas doesn’t make enough insulin or doesn’t make good use of it, glucose builds up in your bloodstream, leaving your cells starved for energy. When glucose builds up in your bloodstream, this is known as hyperglycemia. The symptoms of hyperglycemia include thirst, nausea, and shortness of breath. Low glucose, known as hypoglycemia, also causes many symptoms, including shakiness, dizziness, and loss of consciousness. Hyperglycemia and hypoglycemia can quickly become life-threatening. Each type of diabetes involves the pancreas not functioning properly. The way in which the pancreas doesn’t function properly differs depending on the type. No matter what type of diabetes you have, it requires ongoing monitoring of blood glucose levels so you can take the appropriate action. Type 1 diabetes In type 1 diabetes the immune system erroneously attacks the beta cells that produce insulin in your pancreas. It causes permanent damage, leaving your pancreas unable to produce insulin. Exactly what triggers the immune system to do that isn’t clear. Genetic and environmental factors may play a role. You’re more likely to develop type 1 diabetes if you have a family history of the disease. About 5 percent of people with diabetes have type 1 diabetes. People who ha Continue reading >>
Can Pancreatitis Cause Diabetes?
Pancreatitis is an infection or inflammation of the pancreas, an endocrine organ. It sits just behind the stomach in the abdomen and has a duct that connects to the common bile duct which empties into the duodenum. The pancreas is both an endocrine and an exocrine gland. The exocrine gland function produces enzymes that are important for digestion of proteins. These enzymes are released into the pancreatic duct and exit into the duodenum. The endocrine gland function produces the hormones, insulin and glucagon, which are important to help the body regulate blood sugars. These hormones are released directly into the blood stream to produce their actions on the body’s cells. Pancreatitis can develop in several ways. Occasionally, gallbladder stones can get out into the common bile duct and will travel down to the junction of the common bile duct and pancreatic duct. If the stone becomes trapped in the duct it can cause the pancreatic enzymes released into the duct to back up and cause damage to the pancreas. There are also viruses that can infect the pancreas and cause inflammation and damage to the pancreas. Heavy alcohol consumption and pancreatic cancer can also cause pancreatitis. Treatment of pancreatitis is generally bowel rest and intravenous feeding to reduce the production of pancreatic enzymes which allows the pancreas to heal. More severe infections or frequent infections can lead to pseudo cysts, pockets of fluid in the pancreas that can affect the function of the pancreas and may require surgical excision. If the pancreas were to become damaged severely enough that it could no longer produce insulin, then Diabetes would result. This is the mechanism that leads to the development of adult onset type I diabetes. Pancreatitis is the inflammation of the pancrea Continue reading >>
What Is Chronic Pancreatitis-associated Diabetes?
Note: This article is part of our library of resources for Forms of Diabetes. Chronic pancreatitis-associated diabetes is caused by chronic pancreatitis, a prolonged inflammation of the pancreas, which causes extensive damage to exocrine tissue. When acute hyperglycemia develops, the islet cells of the organ become damaged and can no longer produce insulin, causing the person to become insulin dependent for life. According to the NHS, this occurs in around 50% of people with chronic pancreatitis (Diabetes.co.uk). In rare cases, if the pancreas is so severely damaged, parts of organ may need to be removed. Chronic pancreatitis may occur after an episode of acute pancreatitis. What are symptoms chronic pancreatitis? Acute upper abdominal pain radiating to the back Swollen and tender abdomen Vomiting Nausea Fever Increased heart rate Sometimes weight loss What causes chronic pancreatitis? Anyone can get chronic pancreatitis, but it is more prevalent in people with these risk factors (WebMD): Heavy alcohol drinking for a long time Gallstones Cystic fibrosis (hereditary) Medications Infections Surgery Trauma Metabolic disorders Cause is unknown (about 20-30% of cases) Read After They Took My Pancreas by Wanda Morrow Clevenger. Continue reading >>
The Connection Between Pancreatitis And Diabetes
Share: As a diabetes educator and author, I have been asked many times about the connection between pancreatitis and diabetes. I thought I would share the answer with all of my readers. First we need to define pancreatitis. I will also tell you about the most common forms and tell you about the connection with diabetes. The Definition of Pancreatitis When a word ends with “itis”, it is a suffix used to let us know that there is inflammation. (1) So…. pancreatitis is an inflammation of the pancreas. There are two common kinds of pancreatitis, acute and chronic. Acute pancreatitis- The definition of “acute” is a condition that comes on suddenly and is severe. (2) Acute pancreatitis is therefore an inflammation and swelling in the pancreas that comes on suddenly! (3) The Pancreas The pancreas is a unique organ that has many functions. People with diabetes usually are taught that the beta cells in the islets of Langerhans of the pancreas makes the hormone insulin. They are also taught that the pancreas makes other hormones like glucagon. The job that the pancreas has in making hormones and controlling blood glucose is referred to as pancreatic endocrine functions. Hormones are released by the pancreas and go directly into the blood stream. They travel through the body to get to the sites needed. The pancreas which is located behind the stomach and very near to the small intestine also has what we call exocrine functions. Enzymes are produced as needed to help with the digestion of fats, proteins and carbohydrates. These enzymes are not released into the blood but they travel through a series of ducts that end in the small intestines where they usually become active. (3, 4) In acute pancreatitis, there is a problem when these enzymes are prematurely activated insid Continue reading >>
