Pancreatogenic diabetes mellitus: symptoms and treatment

What is Pancreatogenic diabetes mellitus

Pancreatogenic diabetes mellitus diabetes in chronic pancreatitis is called type 3 diabetes.

Diabetes mellitus occurs in approximately 10-90 percent of individuals with chronic pancreatitis, with insulin-dependent diabetes mellitus occurring in half of the cases, according to various sources. Transient hyperglycemia develops in roughly half of cases of acute pancreatitis, and chronic hyperglycemia following acute pancreatitis occurs with a frequency of up to 15%. As the pancreatic attack resolves, blood glucose levels return to normal more often.

Pathogenesis. The growth and destruction of the inventory apparatus as chronic pancreatitis develops explains the pathophysiology of pancreatogenic diabetes. An autoimmune impact on islet cells, on the other hand, cannot be ruled out. 

Constitutionally established tissue resistance, which is significantly more frequent in persons with obesity and hyperlipidemia, is particularly important in the development of diabetes in chronic pancreatitis. 

Obesity worsens the course of chronic pancreatitis and its prognosis. An increased risk of developing complications of chronic pancreatitis, including endocrine pancreatic insufficiency, has been shown to increase with the degree of obesity. In addition, patients with acute obesity pancreatitis often develop hyperglycemia. With exacerbation of chronic pancreatitis,

Clinic. Violation of carbohydrate tolerance usually develops in the early stages of chronic pancreatitis. Diabetes mellitus can develop at the start of the clinical manifestations of chronic pancreatitis, but it is more common that a persistent impairment of carbohydrate metabolism develops on average 5 years after the underlying illness.

Endocrine disorders in chronic pancreatitis are clinically manifested in the form of two possibilities: hyperinsulinism (hypoglycemia) and pancreatogenic diabetes mellitus. Hyperinsulinism occurs with typical seizures that are accompanied by a feeling of hunger, cold sweat, weakness, anxiety, shivering all over the body. In one-third of patients, episodes of hypoglycemia are accompanied by convulsions, loss of consciousness. With chronic hypoglycemia or with frequent seizures, memory deteriorates, disorientation occurs, mental disorders are possible.

Diabetes mellitus in chronic pancreatitis has a number of clinical and pathogenetic features:

 (1) patients are more likely to have a normal or thin body, often have a choleric temperament; 

(2) there is no association with obesity, insulin resistance, or familial predisposition;

 (3) good tolerance to hyperglycemia up to 11.5 mmol / l; (

4) lack of manifestation or late manifestation, which is explained by mild during diabetes mellitus, as well as the low need for endogenous insulin due to reduction of total caloric content of food, malabsorption in case of exocrine pancreatic insufficiency; 

(5) the onset of diabetes symptoms, usually several years after the onset of abdominal pain; 

(6) predisposition to hypoglycemic conditions; 

(7) frequent infections and skin diseases; 

(8) less often and later than in "ordinary" diabetes mellitus, development of microangiopathy, ketoacidosis, hyperosmolar conditions; 

(9) treats diet, exercise, sulfonylureas (biguanides and acarbose are not effective); 

(10) the need for insulin treatment is small.

Pancreatogenic diabetes mellitus is diagnosed by standard diagnostic tests.

Treatment. Proper nutrition is recommended (carbohydrates - 50-60%; protein - 20%; fat - 20-30%). Attention should be paid to correcting the lack of protein and energy and weight, treating hypovitaminosis and electrolyte disorders. Exocrine pancreatic insufficiency needs to be compensated. For this purpose, as well as for the purpose of eliminating protein-energy deficiency, enzyme preparations should be prescribed (replacement therapy with enzyme preparations is considered an adjunctive method for the treatment of pancreatogenic diabetes). Equally important is pain relief with the same enzyme preparations (e.g., Creon) or predominantly non-toxic analgesics.

If surgery is indicated, distal pancreatectomy should be avoided. If necessary, fractional doses of simple insulin are prescribed, its dose usually does not exceed 30 units and depends on the level of glycemia, the nature of the diet, physical activity of the patient, the number of carbohydrates consumed. Due to the risk of hypoglycemia, blood glucose should not fall below 4.5 mmol / L. With the stabilization of carbohydrate metabolism, the patient should be switched to oral hypoglycemic drugs. Autotransplantation of the islet of Langerhans with subsequent resection of the pancreas or pancreatotomy is performed in specialized centers.

Pancreatogenic diabetes mellitus: symptoms and treatment

In the case of pancreatic dysfunction, there are 2 types of diabetes: hyperinsulinism and pancreatogenic diabetes mellitus. The latter type is also called secondary or types 3 diabetes. The illness has distinct features that set it apart from other kinds of diabetes.

Features of the disease

Pancreatogenic diabetes is caused by sclerosis, destruction of inventory tissue, and autoimmune mechanisms. If a person is obese, then a disease of this type is also characterized by insulin resistance (see what insulin resistance syndrome is).

The disease is characterized by the absence or late manifestation of obvious clinical symptoms, frequent infection, capillary damage, a tendency to glucose deficiency.

The risk of developing the disease depends on the characteristics of the course of chronic pancreatitis and not all of them occur. With alcoholic pancreatitis, the risk of the disease is much higher.

Symptoms of pancreatogenic diabetes

This form of diabetes cannot be attributed to the first or second type, because its clinical picture is somewhat different.

The disease has nothing to do with obesity, patients usually have a thin body. There is also no reliance on genetics and no insulin resistance. Hyperglycaemia is tolerated up to 11.5 mmol / L.

There are no pronounced clinical manifestations or they appear at a late stage. This kind of diabetes is considered to be very simple.

Symptoms may appear only years after the onset of abdominal pain. Patients often suffer from infectious, skin diseases, and are prone to hypoglycemic conditions. With the pancreatogenic type, microangiopathies, hyperosmolar conditions, ketoacidosis rarely and much later develop (see diabetic ketoacidosis).

Patients have little need for insulin therapy. The disease responds well to drug therapy, diet therapy, physical activity.

Although pancreatogenic diabetes mellitus is a very basic disease, it severely lowers human life quality.

Type 3 diabetes is diagnosed much less frequently. These patients are usually diagnosed with type 2 diabetes. This is because doctors did not pay attention to the underlying cause of the disease (chronic pancreatitis) and only hyperglycemia succumbed to the therapeutic effect, i.e. the consequence rather than the cause.

The diagnosis of chronic pancreatitis requires the following laboratory and instrumental tests:

• general and biochemical analysis of blood and urine;
• coprological research;
• determination of pancreatic enzyme activity in urine and blood;
• study of exocrine pancreatic function;
• assessment of external and intracecretory function of the pancreas;
• radiography;
• fibrogastroduodenoscopy;
• endoscopic retrograde cholangiopancreatography;
• ultrasound procedure;
• endoscopic ultrasonography;
• CT scan;

The above tests are needed to identify the pancreatic function. After the diagnosis of chronic pancreatitis, standard diagnostic tests for diabetes can be performed. The disease was confirmed by blood and urine tests for glucose.

It is important to diagnose chronic pancreatitis, as pancreatogenic diabetes mellitus is just a secondary disease, unlike the other two types.

Treatment of pancreatogenic diabetes

The disease has no special treatment. A diet is prescribed in which protein-energy insufficiency, lack of body weight, elimination of hypovitaminosis, and electrolytic disorders are corrected.

To compensate for exocrine pancreatic insufficiency, enzyme drugs, especially creon, are prescribed. Thanks to this, it is possible to improve carbohydrate metabolism, control blood glucose levels and reduce the risk of various complications.

After an attack of pain in chronic pancreatitis, patients may begin to be afraid to eat food, which will lead to the development of hypoglycemia. You can take creon or non-narcotic analgesics to relieve pain.

If necessary, a slight application of insulin (not more than 30 units) is prescribed. Its dosage depends on the level of glycemia, the quality of the food consumed, the number of carbohydrates, and the motor activity of the person.

After the indicators of carbohydrate metabolism stabilize, the patient has prescribed drugs with the hypoglycemic effect of oral administration.

Specialized clinics perform transplantation of the islet of Langerhans by further resection of the pancreas or its removal.

Diet

The main purpose of the diet is the regulation of easily digestible carbohydrates. The patient should forget about sweets and flour products. In patients, the fiber in the body is difficult to digest.

The daily diet of a patient with secondary diabetes should consist of 20% protein foods, 20 to 30% fat, and 50-60% carbohydrates. It is also important to completely give up the use of alcohol and tobacco.

The diet is developed by the physician based on the individual characteristics of the patient, taking into account body weight deficiency, hypovitaminosis, electrolyte disturbance, protein, and energy deficiency.

It is strictly forbidden to violate the diet and it must be observed for life.

In the future, due to eating disorders, complications or worsening of the condition may occur.

Prognosis

The prognosis is favorably provided that you visit the doctor early, correctly diagnose the disease, and meet all medical requirements.

Pancreatogenic diabetes is clinically milder than other types of disease. Nevertheless, it worsens the condition of patients with chronic pancreatitis and significantly affects the quality of human life. It is important to treat not only the secondary disease but also the underlying causes of its occurrence.

Pancreatogenic diabetes mellitus

Pancreatogenic diabetes mellitus is an endocrine disease that occurs on the background of a primary pancreatic lesion of various origins (more commonly, pancreatitis). It is manifested by dyspeptic disorders (heartburn, diarrhea, periodic epigastric pain) and the gradual development of hyperglycemia. Diagnosis is based on glycemic profile research, blood biochemistry, ultrasound, and pancreatic MRI. Treatment includes a low-fat diet and "fast" carbohydrates, the use of enzymes and drugs to lower sugar, and the rejection of alcohol and smoking. After radical surgery, insulin replacement therapy was prescribed.

Pancreatogenic diabetes mellitus

Pancreatogenic diabetes mellitus (type 3 diabetes mellitus) is a secondary violation of glucose metabolism that develops as a result of damage to the endocrine pancreas (pancreas). The disease occurs in 10-90% of patients with chronic pancreatitis. Such data variability is associated with the complexity of predicting the development of pancreatic endocrine dysfunctions and the difficulty of differential diagnosis of pathology. After acute pancreatitis, the risk of type 3 diabetes is 15%. The disease more often affects men who drink excessively alcohol, fatty foods.

Causes of pancreatogenic diabetes

The illness is caused by a disruption in the pancreas's endocrine and exocrine processes. The following causes of injury to the gland's islet apparatus are identified:

• Chronic inflammation of the pancreas. Frequent exacerbations of pancreatitis increase the risk of developing diabetes. Chronic inflammation causes the gradual destruction and sclerosis of the islets of Langerhans.
• Pancreatic surgery. The incidence of postoperative diabetes varies from 10% to 50%, depending on the volume of surgery. The disease most often develops after total pancreatectomy, resection of pancreatoduodenum, longitudinal pancreatojejunostomy, caudal resection of the pancreas.
• Other diseases of the pancreas. Pancreatic cancer, pancreatic necrosis cause endocrine disorder with the development of permanent hyperglycemia.

There are risk factors that trigger pancreatogenic diabetes in patients with pancreatic dysfunction. That includes:

1. Alcohol abuse. Systemic use of alcoholic beverages increases several times the risk of pancreatitis of alcoholic origin with the development of transient or permanent hyperglycemia.
2. Malnutrition. Excessive consumption of foods rich in fats, easily digestible carbohydrates contributes to the development of obesity, hyperlipidemia and impaired glucose tolerance (prediabetes).
3. Long-term use of drugs (corticosteroids) is often accompanied by the appearance of hyperglycemia.

pathogenesis

The pancreas' endocrine function is the release of insulin and glucagon into the circulation. Hormones are generated by the Langerhans islets, which are situated in the gland's tail. Prolonged external influences (alcohol, drugs), frequent exacerbations of pancreatitis, gland surgeries lead to impaired insulin function. 

The progression of chronic inflammation of the gland causes destruction and sclerosis of the islet apparatus. During the exacerbation of inflammation, pancreatic edema occurs, the content of trypsin in the blood increases, which inhibits the effect on insulin secretion.

 As a result of damage to the endocrine apparatus of the gland, transient and then persistent hyperglycemia occurs, diabetes develops.

Symptoms of pancreatogenic diabetes

The pathology often occurs in people of thin or normal physique with increased excitability of the nervous system. Pancreatic damage is accompanied by dyspeptic symptoms (diarrhea, nausea, heartburn, bloating). 

Painful sensations during exacerbation of glandular inflammation are localized in the epigastric zone and are of varying intensity. The onset of hyperglycemia in chronic pancreatitis occurs gradually, on average after 5-7 years. 

As the duration of the disease and the frequency of exacerbations increase, the risk of developing diabetes increases. Diabetes can also debut as a manifestation of acute pancreatitis. Postoperative hyperglycemia occurs simultaneously and requires correction with insulin.

Pancreatogenic diabetes is mild with a moderate rise in blood glucose and frequent bouts of hypoglycemia. Patients are satisfactorily adjusted to hyperglycemia up to 11 mmol / L. Further increase in blood glucose causes symptoms of diabetes (thirst, polyuria, dry skin). Pancreatogenic diabetes responds well to treatment with diet therapy and sugar-lowering drugs. The course of the disease is accompanied by frequent infectious and skin diseases.

complications

Ketoacidosis and ketonuria are rare in patients with type 3 diabetes. Patients with pancreatogenic diabetes are characterized by frequent brief attacks of hypoglycemia, which are accompanied by a feeling of hunger, cold sweat, pale skin, excessive excitement, shivering. A further drop in blood glucose levels causes blurring or loss of consciousness, development of seizures, and hypoglycemic coma. During the long course of pancreatogenic diabetes, complications occur in the part of other systems and organs (diabetic neuropathy, nephropathy, retinopathy, angiopathy), hypovitaminosis A, E, impaired metabolism of magnesium, copper, and zinc.

Diagnostic

The diagnosis of pancreatogenic diabetes is difficult. This is due to the long-term absence of symptoms of diabetes, difficulty in recognizing inflammatory diseases of the pancreas. With the development of the disease, the symptoms of pancreatic damage are often ignored, prescribing only hypoglycemic therapy. Diagnosis of carbohydrate metabolism disorders is carried out in the following areas:

1. Endocrinologist counseling. An important role is played by a thorough study of the history of the disease and the relationship of diabetes with chronic pancreatitis, pancreatic surgery, alcoholism, metabolic disorders, taking steroid medications.
2. Glycemic monitoring This includes determining the concentration of glucose on an empty stomach and 2 hours after a meal. In type 3 diabetes, voice glucose levels will be within normal limits and will increase after meals.
3. Assessment of pancreatic function. It is performed using biochemical analysis to determine the activity of diastase, amylase, trypsin, and lipase in the blood. Data on OAM are indicative: in pancreatogenic diabetes, traces of glucose and acetone in urine are usually absent.
4. Instrumental methods of visualization. Ultrasound of the abdominal cavity, MRI of the pancreas allows you to assess the size, echogenicity, structure of the pancreas, the presence of additional formations and inclusions.

In endocrinology, the differential diagnosis of the disease is made with type 1 and type 2 diabetes. Type 1 diabetes is characterized by a sharp and aggressive onset of the disease at a young age and severe symptoms of hyperglycemia. The blood test detects antibodies to pancreatic beta cells. The difference in type 2 diabetes will be obesity, insulin resistance, the presence of C-peptide in the blood and the absence of hypoglycemic attacks. The development of diabetes of both types is not associated with inflammatory diseases of the pancreas, nor with surgical interventions on the organ.

Treatment of pancreatogenic diabetes

For best results, it is necessary to conduct a joint treatment of chronic pancreatitis and diabetes. It is necessary to abandon the use of alcoholic beverages and tobacco forever, to adjust the diet and lifestyle. Combination therapy has the following instructions:

• Diet. Diet for pancreatogenic diabetes includes correction of protein deficiency, hypovitaminosis, electrolyte disorders. Patients are advised to limit their intake of "fast" carbohydrates (butter products, bread, sweets, cakes), fried, spicy and fatty foods. The main diet consists of protein (low fat varieties of meat and fish), complex carbohydrates (cereals), vegetables. Food should be taken in small meals 5-6 times a day. It is recommended to exclude fresh apples, legumes, rich meat soups, sauces and mayonnaise.
• Compensation for pancreatic enzyme insufficiency. Drugs containing enzymes amylase, protease, lipase in different ratios are used. Medications help to establish the digestive process, eliminate the lack of protein and energy.
• Taking sugar-lowering medications. In order to normal carbohydrate metabolism, the appointment of sulfonylurea-based drugs gives a good result.
• Postoperative replacement therapy. After surgical interventions on the pancreas with complete or partial resection of the tail of the gland, it was shown that the fractional administration of insulin does not exceed 30 units per day. The recommended blood glucose level is not lower than 4.5 mmol / l due to the risk of hypoglycemia. With the stabilization of glycemia, the appointment of oral hypoglycemic drugs should be started.
• Autotransplantation of island cells. It is performed in specialized endocrinological medical centers. After a successful transplant, patients undergo a pancreatotomy or pancreatectomy.

Prognosis and prevention

With complex treatment of pancreatic damage and correction of hyperglycemia, the prognosis is positive. In most cases, it is possible to achieve a satisfactory condition of the patient and normal blood sugar values. In severe oncological diseases, radical gland surgeries, the prognosis will depend on the intervention and the rehabilitation period. The course of the disease is exacerbated by obesity, alcoholism, abuse of fatty, sweet and spicy foods. To prevent pancreatogenic diabetes, it is necessary to lead a healthy lifestyle, give up alcohol, and in the presence of pancreatitis undergo a timely examination by a gastroenterologist.

Pancreatitis and diabetes

The painful condition of the pancreas, when its work is disturbed, is called pancreatitis. Pancreatitis and diabetes mainly affect obese people and people with gastrointestinal diseases. The pancreas is responsible for absorbing all food and secretes protein hormones (glucagon, insulin). If inflammation is diagnosed, it means that iron-secreting enzymes have stopped delivering to the duodenum. Therefore, enzymes will act precisely in the gland, leading to the self-destruction of organs.

Why does it occur?

Damage to the pancreas is a major cause of metabolic disorders. The damaged gland will stop supplying the required dose of hormones, and a lack of insulin poses a danger to humans. This is a hormone that reduces the level of glucose produced by the interaction of carbohydrates. The diseased organ becomes inflamed, due to which the production of hormones is insufficient, so as a result of these processes, blood sugar rises. This will cause type 2 diabetes in 25% of cases. Stress, malnutrition, lack of daily routine, excitement - all this is the path to weight gain and the appearance of parallel ulcers.

Symptoms of the disease

Pancreatitis may be associated with diabetes. This condition is also called pancreatic diabetes.

The disease is often manifested by pain in the pancreas.

Due to excessive glycemia in diabetics, sugar has a destructive effect on blood vessels and even causes necrosis. There is no reverse effect. Often, chronic pancreatitis due to diabetes causes the development of type 1 diabetes. Pancreatic diabetes in the stage where inflammation of the pancreas occurs is accompanied by pain (of various forms of intensity). In the first phase, remissions and periods of deterioration are still possible. This phase can last for years.

The next stage is followed by symptoms of gastrointestinal disorders in humans:

• flatulence;
• heartburn, stopped by porridge;
• upset stool, diarrhea;
• loss of appetite.

Complete destruction of the islet of Langerhans (deviation of autoimmune nature) is the main and main reason for the development of type 1 insulin-dependent diabetes. Such islets are located in the tail of the pancreas and weigh about 2% of its mass. In the onset of diabetes, the human body begins to release antibodies that destroy insulin-producing pancreatic cells. Diabetes with chronic pancreatitis causes the development of hypoglycemia if treatment is accompanied by insulin preparations. It is rarely accompanied by damage to small vessels (microangiopathy).

Treatment of pancreatitis for diabetes

Treatment for type 2 diabetes is often carried out by adjusting the diet, including low-carbohydrate foods. Treatment of chronic pancreatitis in type 2 diabetes is reduced to tablets with antidiabetic drugs, but only in the initial stage of the disease. It will later lose all benefits due to insulin formation. Insulin therapy betrays difficult reading and large doses of insulin.

The treatment of the pathology is long, especially if the patient has pancreatitis and diabetes. During therapy, the doctor prescribes the use of replacement therapy to normalize carbohydrate metabolism and enzyme deficiency, which is expressed by limited secretion or weak activity of pancreatic enzymes. Also prescribe the use of special enzymatic and hormonal drugs, for example, take "Pancreatin". Treatment of pancreatitis is to prescribe a diet at the very beginning of the disease to prevent the development of type 2 diabetes. Treatment of chronic pancreatitis takes a long time.

The doctor also explains to the patient errors in lifestyle and diet, which caused the creation of pathology. The deviation is often associated with stress. The doctor working on the treatment helps determine the schedule of intake of the right food and may recommend that you consult a psychologist and nutritionist for help. The patient must adjust to the positive wave, avoid everything negative, focus on their daily routine, adhere to the doctor's prescriptions. It is important that the people around maintain the psychological comfort of the patient until his complete recovery.

Diet and the right menu

It is important for diabetics to follow a proper diet and menus. A balanced diet is considered, and is rightly an important part of the drug. Too much carb intake is a way to be overweight. And pancreatitis develops in diabetes mellitus much faster than in a healthy person. It would be more realistic to call it not a diet, but a system of general and proper nutrition. The amount of fat in this case, in order to participate in the synthesis, is gradually reduced, which always leads to an improvement in the patient's condition. You need to develop the habit of eating real food regularly. The diet for pancreatitis and diabetes includes:

• minimum consumption of fast carbohydrates;
• rejection of spices, condiments, and alcohol;
• reduction of starch and sugar;
• refusal to bake confectionery, pasta, beer and sweet carbonated drinks;
• maximum restriction of flour and starchy foods;
• minimally sweet fruit.

In large quantities, without restrictions, nutritionists recommend eating vegetables, herbs, seeds, nuts, poultry, and fish.

Cooking recipes should be studied carefully and the water regime should be adhered to. During the day you need to drink 2 or more liters of water without gas (without liquid food and fruit). Taking a multivitamin will help a person get used to the new menu very quickly. A diabetic should switch to a proper diet to avoid negative consequences. A low-carbohydrate diet is contraindicated in children, adolescents, pregnant women, nursing mothers, and men.

Pancreas and diabetes

With low weight and small size, the pancreas is characterized by the fact that it plays one of the leading roles in metabolism and during digestion. Diabetes mellitus - this disease of the endocrine system, is characterized by an increase in blood sugar due to lack of insulin produced in the pancreas. Insulin opens all the "doors" that are closed in the body, bringing glucose - an important "food" for a person's entire life. In the case of pancreatic disorders, the amount of insulin produced decreases and can be stopped completely. Thanks to insulin, glucose enters the liver, muscle, and fat cells, and is completely processed in the blood.

Mechanism of pancreatic diabetes development

Primary pancreatic diabetes is caused by impaired functionality of the pancreatic islet apparatus and lower hemoglobin. It occurs due to the use of large amounts of alcohol, gallstones or after surgery on the pancreas. Pancreatic diabetes occurs in patients with metabolic disorders and is prone to acid-base imbalance.

Diabetes develops on the background of the inflammatory process of the pancreas with a series of the following symptoms:

• the patient feels abdominal pain;
• Abdominal nervousness;
• diabetes.

In more detail, the symptoms are as follows:

• The symptoms of the primary form of the inflammatory process of the pancreas occur due to painful sensations, which have different localization and intensity. The primary phase can last up to 10 years.
• The next stage is followed by vomiting, heartburn, bloating, nausea and diarrhea.
• In the advanced stage, cell destruction occurs and glucose dependence is created. The patient's blood glucose level rises after a meal when that level is normal on an empty stomach.
• In the last stage, diabetes mellitus develops, which in the history of the disease is referred to as chronic pancreatitis in almost a third of patients.

symptoms

With pancreatic diabetes, the following symptoms are observed:

• The pain of constant and intense form is localized to the right or left below the ribs. For severe pain, if you do not seek medical help in time, pain shock may follow.
• Increase in body temperature and change in pressure (increase or decrease). With acute inflammation, the patient's health deteriorates, the temperature rises and a change in blood pressure occurs.
• The skin becomes pale.
• The patient feels sick, feels a dry mouth.
• The inflammatory process of the pancreas is accompanied by vomiting of bile. A patient with such a diagnosis is strongly discouraged from eating food in the first days of illness.
• Pancreatic diabetes is characterized by diarrhea or, conversely, constipation.
• Shortness of breath, excessive sweating caused by loss of electrolytes after vomiting.
• In addition to pain, the patient is bothered by bloating, which occurs due to the inability of the stomach and intestines to contract during the attack.
• Inflammation of the pancreas can also be determined by the blue skin tone in the navel or lower back.

Manifestation of the inflammatory process of the pancreas in type 2 diabetes

Often, type 2 diabetes can develop after inflammation of the digestive system. It can occur if the inflammation is accompanied by an increased rate of glucose concentration in the bloodstream. Patients with such diabetes complain of acute abdominal pain and impaired digestive process.

Medical experts distinguish three stages in the development of type 2 pancreatic diabetes:

• pancreatitis alternately worsens and progresses to remission;
• metabolic disorders;
• 2 forms of diabetes begin and develop.

Treatment and diet

A patient with an inflamed pancreas is prescribed not only medication but also a strict diet, which is a major part of the therapy and must be observed in the same way as drinking medication. It is difficult to treat a patient with pancreatitis and diabetes. Therapy is based on the intake of hormonal drugs and enzymes, but adherence to a proper diet plays a big role, which is why unacceptable products should be excluded from the patient’s menu. Treatment will be successful provided the doctor's recommendations are followed.

Drug therapy can avoid some problems:

1. When the abdominal region hurts, the doctor prescribes painkillers like No-Shpa, Papaverine, etc.
2. To relieve the pancreas, prescribe enzymes such as pancreatin, Mezim, Digestal, etc ..
3. With pancreatitis, an infection can develop and, to avoid this, antibacterial therapy based on taking light antibiotics can be prescribed.

The patient's menu should contain a strict ratio of protein, carbohydrates, and fats.

Treating a patient diagnosed with pancreatic diabetes is not that simple. The condition for a speedy recovery is not only taking medication but also a proper diet, based on the following principles:

• The patient's diet should include a strict ratio of protein, carbohydrates, and fats. Carbohydrates, as the main component of the diet, should be within 350 g per day, in a smaller amount include protein, only about one hundred grams, and fat, part of which should not exceed 60 g per day.
• Meals should be at least four times a day, ideally 6 times, but in small meals.
• Use a double boiler for cooking. Fried foods should disappear from the patient's menu for a long time. Cooking is allowed and sautéing and baking is allowed in remission.
• It is highly recommended not to add spices, garlic, vinegar, other products that irritate the intestinal mucosa to food.
• In the phase of deterioration and renewal of the pancreas, it is necessary to exclude fatty, salty, spicy, smoked, or rich foods.

A more detailed ratio of food products and their caloric content can be described by the doctor who manages the disease and has the necessary research. The menu is compiled individually for each patient and depends on lifestyle, physical activity, and whether the woman is pregnant or breastfeeding. The products that should be included in the patient's diet are the following:

• fish, lean meat, and also soups, steamed cutlets;
• vegetable-based soups or milk soups with cereals (rice, oatmeal, buckwheat);
• egg omelet;
• milk porridge or on the water to which no butter and sugar are added;
• pasta, stale bread;
• no more than 100 milliliters of milk per day;
• Dairy Products;
• baked or raw fruits, berries, vegetables;
• as a dessert, when the disease takes a milder form, you can include sugar, honey or jam in your diet;
• soft drinks with milk, fruit and vegetable juices, but not sour, are allowed from drinks.

Of these products, the menu for acute pancreatic diabetes is as follows:

• for breakfast the patient is offered an egg omelette, oatmeal, boiled in water and butter for no more than 10 years;
• the patient's lunch will consist of steamed chicken and beef chops and buckwheat porridge;
• afternoon tea is considered a small snack, so do not overload the pancreas, but offer the patient a weak tea with a spoonful of honey and crackers;
• for dinner the fish is steamed or, if the patient's condition, baked in the oven, boiled green beans allow;
• for another dinner, you can offer kefir and crackers.

In the chronic stage of the disease, a light salad of fresh tomatoes and cucumbers seasoned with sunflower or olive oil, vinaigrette, candy-based sweets and carrot and cabbage salad can be added to the previous menu