Management Of Pancreatogenic Diabetes: Challenges And Solutions

Management of pancreatogenic diabetes: challenges and solutions

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Introduction
Pancreatogenic diabetes is a form of secondary diabetes, classified by the American Diabetes Association (ADA) and the World Health Organization as type 3c diabetes mellitus (T3cDM).1,2 It refers to diabetes due to diseases of the exocrine pancreas: pancreatitis (acute, relapsing, or chronic pancreatitis of any etiology), pancreatectomy/trauma, neoplasia, cystic fibrosis, hemochromatosis, and fibrocalculous pancreatopathy.3 With the exception of cancer, damage to the pancreas must be extensive enough for diabetes to occur.1,2 Rather scarce data on T3cDM suggest that most cases result from chronic pancreatitis, as this condition was identified as the underlying disease in 78.5% of all patients with T3cDM.4
In Western populations, T3cDM is estimated to occur in 5%–10% of all diabetic patients, mostly due to chronic pancreatitis.4–6 True prevalence of T3cDM is unknown – data are scarce, mostly due to challenges with accurate diabetes classification in clinical practice.4,7–9 Many T3cDM patients are initially misclassified due to underrecognized contribution of pancreatic disease to the development of diabetes. In order to improve diagnosis, diagnostic criteria for T3cDM have been proposed by Ewald and Bretzel which include 1) the presence of pancreatic exocrine insufficiency, 2) evidence of pathological pancreatic imaging, and 3) the absence of type 1 diabetes mellitus (T1DM)-associated autoantibodies.6 They may be further supported by additional minor criteria, such as an absent pancreatic polypeptide (PP) response to mixed-nutrient ingestion.6 The Continue reading

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Top 5 Fruit Choices for Diabetes-Friendly Diets

Fruit can be included in a diabetes-friendly diet. They are full of good nutrition—vitamins, minerals, fiber, and antioxidants. They taste good and are refreshing, filling, and add color to your plate. The key to eating fruit is to choose the right kinds and appropriate portion sizes. Because they can contain high amounts of carbohydrates that can affect your blood sugar levels, you cannot eat unlimited amounts of fruit.
Fruit Choices for Different Diabetes-Friendly Diets
What are the best fruits for diabetes? This can be a hard question to answer since people with diabetes adhere to varied diets and philosophies when it comes to diabetes management with food. Some people use exchange lists, whereas others stick to low-glycemic diets or low-carb diets. Assuming most people want to know which fruits have the lowest carbs and offer the best health benefits for diabetes, then the following five berries deserve the spotlight.
Top 5 Fruits for Diabetes
Raspberries: With merely 15 grams of carbohydrate (1 fruit choice) in one cup serving, raspberries offer the highest amount of fiber of any berry, a whopping 8 grams. Fiber is the indigestible carbohydrate that helps to pull cholesterol away from the heart, helps you to feel full, and also slows down how quickly blood sugars rise. Raspberries' ruby-red color comes from anthocyanins. Research suggests that anthocyanins may help fend off certain chronic disease, including cardiovascular disease.
Blackberries: They contain about 15 grams of carbohydrate in a 3/4 cup serving. As with raspberries, they have anthocyanins, as shown by Continue reading

Diagnosis and treatment of diabetes mellitus in chronic pancreatitis

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INTRODUCTION
Chronic pancreatitis is a disease characterized by pancreatic inflammatory and fibrotic injury resulting in irreversible parenchymal damage. Progressive nutrient maldigestion and disturbance of the timing and the interactions between nutrient digestion and absorption is observed and may lead to severe metabolic derangements. Glucose intolerance and diabetes mellitus are observed quite frequently in the course of the disease[1,2].
Development of diabetes mellitus in chronic pancreatitis mainly occurs due to the destruction of islet cells by pancreatic inflammation. Additionally, nutrient maldigestion leads to an impaired incretin secretion and therefore to a diminished insulin release of the remaining beta-cells[3]. In contrast to the autoimmune mediated destruction of the beta-cells in type 1 diabetes mellitus, glucagon secreting alpha-cells and pancreatic polypeptide secreting pancreatic polypeptide-cells are also subject to destruction in chronic pancreatitis leading to a complex deranged metabolic situation.
Diabetes mellitus secondary to pancreatic diseases (such as chronic pancreatitis) is classified as pancreatogenic diabetes or type 3c diabetes mellitus according to the current classification of diabetes mellitus (Table 1)[4,5]. Whereas the awareness of type 1 and type 2 diabetes mellitus is rather good, type 3c diabetes mellitus, however, is a condition rarely considered in everyday practice. Yet, recent data on type 3c diabetes mellitus show that it might be more common than generally thought. Studies also suggest that this important condition m Continue reading

Woman with type 1 diabetes still off insulin one year after cell transplant

Scientists report a step forward in the plan to create a truly artificial pancreas, offering new hope to people with type 1 diabetes.
A 43-year-old single mother with dangerously difficult-to-control diabetes had insulin-producing islet cells transplanted into her omentum -- a fatty membrane in the belly.
The cells began producing insulin faster than expected, and after one year she is doing well and doesn't need insulin injections, the University of Miami researchers said.
"We're exploring a way to optimize islet cell therapy to a larger population. This study gives us hope for a different transplant approach," said the study's lead author, Dr. David Baidal. He's an assistant professor in the university's Diabetes Research Institute.
Others voiced optimism as well. "This study was a good start at evaluating a novel site for transplant," said Julia Greenstein, vice president of discovery research for JDRF (formerly the Juvenile Diabetes Research Foundation).
Type 1 diabetes is an autoimmune disease. That means the body's immune system mistakenly damages healthy cells -- in this case, the islet cells found in the pancreas. This leaves people with type 1 diabetes without enough insulin to convert sugars from foods into energy for the body.
As a result, they must take multiple daily insulin injections, or use a pump that delivers insulin via a tube inserted under the skin that must be changed every few days.
Currently, islet cells from deceased donors are transplanted into the liver, but that's not an ideal option.
This new research was a proof-of-concept study expected to be Continue reading

Intermittent fasting could help tackle diabetes – here’s the science

Intermittent fasting is currently all the rage. But don’t be fooled: it’s much more than just the latest fad. Recent studies of this kind of fasting – with restricted eating part of the time, but not all of the time – have produced a number of successes, but the latest involving diabetes might be the most impressive yet.
The idea of intermittent fasting arose after scientists were wowed by the effects of constant calorie restriction. A number of studies in many different animals have shown that restricted eating throughout adulthood leads to dramatic improvements in lifespan and general health.
The reasons for these improvements aren’t yet clear. Part of it seems to be that going without food gives cells in the body a much needed break to perform maintenance and repair. But the lack of food also forces cells to resort to alternative sources of energy. Some of these, such as ketones – molecules created in the liver from recycled fat – appear to be beneficial.
‘Fasting’ without fasting
The problem is that constant calorie restriction isn’t practical: it’s easy for scientists to impose upon lab animals, but hard for humans to impose upon themselves in the real world. Fortunately, we’ve learned that constant calorie restriction isn’t really necessary. Intermittent fasting seems to have many of the same benefits.
There are two main types of intermittent fasting. One type, known as “time restricted feeding”, requires eating only during a few hours of the day – say between 10am and 6pm. This approach gives the body a long break from food each night, Continue reading