What is pancreatogenic diabetes mellitus?

 

Pancreatogenic diabetes mellitus occurs most often after pancreatitis, but it can also be caused by trauma, surgery, and a pancreatic tumor.

The mechanism of development is related to the destruction of cells that produce insulin and other hormones. The course is often hidden and does not manifest symptoms for a long time.

Features: this causes alcoholism, patients are not obese, and there is a tendency to drop sugar (hypoglycemic conditions).

Detection requires a glucose tolerance test (sugar load), a percentage of sugar at speed, and high postprandial rates. Treatment includes diet, use of enzymes (Festal, Mezim), and sugar reduction pills.

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What is pancreatogenic diabetes mellitus?

Pancreatogenic diabetes mellitus is an increase in blood sugar in the presence of pancreatitis (inflammation of the pancreas). Such diabetes is called secondary and differs from type 1 and type 2 in its course.

It is found in 10-90% of cases of a chronic inflammatory process because the link between pancreatitis and diabetes is not always found promptly. It usually affects men who are prone to consuming alcohol and fatty foods. Specific pancreatogenic diabetes mellitus in 15% of cases complicates acute inflammation of the pancreas.

Common causes of pancreatitis and diabetes

The development of pancreatitis and diabetes is caused by:

• alcohol intake (systemic abuse);
• a diet with excess fatty and sweet foods, lack of vegetables, fruits, vegetable fats, and dietary fiber;
• overeating, lack of meal regime;
• hormone administration (prednisone and analogs).

Pancreatogenic diabetes mellitus is also possible during surgery due to pancreatitis, cancer, pancreatic necrosis (partial tissue necrosis), and abdominal trauma.

How pancreatitis and diabetes are related

Acute and long-term chronic pancreatitis leads to diabetes which is explained:

• destruction of pancreatic tissue;
• reduction in the number of cells that produce insulin, glucagon, and pancreatic protein (polypeptide);
• violation of food digestion;
• a decline in the production of intestinal incretins, which are hormones that trigger the release of insulin when food is consumed.

Therefore, diabetes mellitus on the background of pancreatitis appears on the background of insulin deficiency. Hormone deficiency interferes with the absorption of carbohydrates, blood sugar rises after meals and does not decrease enough.

Digestion, there is a lack of many hormones that regulate digestion, and diabetes after pancreatitis. Patients have frequent changes in blood glucose.

Classification

Pancreatogenic diabetes mellitus is once included in the classification called type 3c diabetes, it occurs according to the mechanism of development:

• fibro calculous - on the background of chronic inflammation, areas of compression, scar growth, and calcification (deposits of calcium salts) are formed;
• protein deficiency - occurs on the background of protein deficiency.

Depending on the causes of pancreatitis itself, diabetes can be the result of alcohol intoxication or liver disease, biliary tract (biliary). In the first case, a serious violation of carbohydrate metabolism was recorded.

How does pancreatitis manifest itself in type 1 and 2 diabetes?

In type 1 and 2 diabetes, acute pancreatitis occurs with severe symptoms:

• pain in the epigastric region, in the left hypochondrium, is shingles, gives under the left shoulder blade;
• the attack of pain does not die, and its intensity only increases, it becomes worse when you lie on your back;
• spicy and fatty foods, fried foods, and alcohol worsen;
• vomiting relentlessly does not give relief;
• increase in body temperature;
• fever;
• yellowing of the sclera of the eyes, less often of the skin;
• bloating, heartburn.

In chronic pancreatitis, the symptoms periodically decrease, characterized by alternating diarrhea and constipation, weight loss, and aversion to food. As pancreatitis progresses, exacerbations become more frequent, and periods of remission (pain ceases) shorten.

Course features

Diabetes mellitus during development after pancreatitis has the following features:

• it usually occurs in adulthood in patients of thin or normal build (type 1 occurs in children and adolescents, and 2 in obese);
• there are always pronounced symptoms of indigestion - bloating, bloating, nausea, heartburn;
• there is a pain in the upper abdomen, worsening to worsening;
• the moderate increase in blood glucose;
• sugar often falls, and there is no increase typical of diabetes (hyperglycemic and ketoacidosis condition);
• with sugar, up to 10 mmol / l, there are no symptoms, but only with greater thirst, dry mouth and skin, and excessive urine output.

Patient diagnosis

It is quite difficult to identify the disease because the signs of diabetes are often erased. For diagnosis, all patients with pancreatitis should consult an endocrinologist, who first determines additional risk factors:

• previous surgeries, abdominal injuries;
• alcohol consumption;
• use of hormonal drugs.

Laboratory examination includes:

• general blood test;
• glucose tolerance test: usually empty stomach sugar is normal or slightly elevated and shows a high rate after sugar loading;
• blood biochemistry with the determination of pancreatic enzyme activity (amylase, lipase, trypsin);
• urine analysis (glucose and ketone bodies, usually not).

Instrumental diagnostic methods:

• Ultrasound of the abdominal cavity;
• tomography of the pancreas.

These methods of studying the structure help to find places with heterogeneous tissue, seals, and calcifications.

If an endocrinologist suspects that diabetes is a classic type 1 option, he or she prescribes a blood test for antibodies to pancreatic cells, C-peptide, and insulin.

Type 2 is characterized by obesity, tissue resistance to insulin and attacks of sugar drop are extremely rare.

Diet for diabetes and pancreatitis

The basic rules of creating a diet for diabetes and pancreatitis are similar in dietary principles and prohibitions on foods containing sugar, alcohol, and fatty foods. It is also recommended:

• introduction into the diet of vegetables, and cereals;
• use of lean fish and meat varieties;
• Cooking in the form of boiling, or baking, cannot be fried and sautéed with oil;
• the menu should contain dairy products without acids and non-fatty acids - yogurt, fermented milk, cheese;
• frequent and fractional meals;

in case of deterioration, it is necessary to limit animal fats as much as possible and grind food (puree and cereal soups, the meat is drilled twice through a meat grinder).

Prohibited products

For diabetes, the list of forbidden foods includes:

• alcoholic and carbonated beverages, kvass;
• lamb, pork, salad, fatty and spicy cheese;
• heavy cream and sour cream, butter;
• Navara: meat, fish, mushrooms;
• semi-finished products;
• canned foods, marinades, pickles, smoked meats;
• sausage;
• chocolate;
• ice cream;
• sweets;
• muffin, puff pastry;
• fast food, chips, crackers with salt and spices;
• condensed milk;
• mayonnaise, ketchup, vinegar, horseradish, mustard, pepper;
• radish, spinach, onion, garlic;
• millet, pearl barley;
• sour fruits and berries.
• Permitted products
• What can be included in the diet:
• vegetarian soups;
• meat: beef, veal, chicken, turkey, rabbit;
• fish: pike, pollock, cod, pike, perch;
• cheese of 2-5% fat, 1.5-2% yogurt, fermented baked milk, yogurt, 10% sour cream;
• vegetables: zucchini, pumpkin, cauliflower, broccoli, green beans, young green peas;
• steamed egg eggs;
• cereals: buckwheat, oatmeal, rice, hard flour pasta;
• baked apples, plums, and apricots to add to the compote and spoons;
• dried gray bread;
• compote, sour, weak tea, mint and chamomile;
• stevia or fructose is added instead of sugar.

Example menu for pancreatitis and diabetes

With the worsening of pancreatitis and diabetes, the menu may be as follows:

• breakfast: oatmeal porridge, baked apple without peel, weak tea;
• lunch: steamed protein omelet;
• lunch: zucchini soup, cauliflower, carrots, chicken breast cutlets (steam), viscous buckwheat;
• snack: cheese souffle, yogurt;
• dinner: boiled fish with boiled potatoes, compote;
• before going to bed: fermented baked milk.

Without deterioration, the diet can be expanded:

• breakfast: rice porridge with pumpkin, chicory with milk;
• lunch: dried or yesterday’s bread with Adyghe cheese, tea;
• lunch: vegetable soup with fish meatballs, roasted turkey with carrots and herbs, stewed fruit;
• afternoon snack: cottage cheese with baked apple, and kissel;
• dinner: boiled chicken with buckwheat porridge, boiled cabbage with herbs, weak tea;
• before going to bed: kefir, fructose cookies.

Treatment of diabetes pancreatitis

The most important condition in the treatment of diabetes and pancreatitis is the simultaneous treatment of two diseases. To do this, you must:

• consistently adhere to a diet, not just with deterioration;
• quit smoking and drinking alcohol;
• take drugs with enzymes for replacement therapy (Creon, Festal);
• use sugar-lowering tablets with mandatory daily monitoring of blood sugar levels (Siofor, Glucofage), do not lower it below 4.5 mmol / l.

If pancreatitis is performed (partial or complete removal of the tail), then the patient with diabetes must be switched to insulin. Injections are given in small doses before meals. After stabilizing the sugar level, it is possible to prescribe tablets continuously.

In extremely severe pancreatitis, surgery to transplant your own insulin-producing islet cells may be needed. After that, the pancreas is removed. This method of treatment is available only in large specialized endocrinology centers.

Possible complications in pancreatitis diabetes

If the patient does not adhere to treatment and neglects diet, smokes, and drinks alcohol, then frequent exacerbations of pancreatitis and worsening of the course of diabetes are inevitable. Vascular complications arise from:

• kidneys - diabetic nephropathy;
• retina - retinopathy;
• blood flow - angiopathy;
• nervous system: peripheral (limb) in the form of neuropathy, brain-encephalopathy.

Due to the violation of food digestion, vitamins and minerals are not absorbed properly, so vascular lesions become more difficult. Sharp fluctuations in blood sugar are characteristic of patients with type 3 diabetes.

Attacks of hypoglycemia are caused by a feeling of hunger, sweating, general restlessness, trembling hands, and the skin becoming pale and covered with cold sweat.

If you do not take sweet tea or a spoonful of honey at this time, then there is a loss of consciousness with convulsions, coma is possible.

Prognosis and prevention

If you diagnose diabetes with pancreatitis promptly and follow the therapy recommendations exactly, then the prognosis for a pancreatogenic rise in blood sugar is good.

It is possible to normalize the digestion and metabolism of carbohydrates. The prognosis for tumors and extensive pancreatic surgery is even worse.

Factors that complicate treatment include alcoholism, smoking, and neglect of diet.

To prevent type 3c diabetes, it is important to consult a doctor for symptoms of pancreatitis and undergo a comprehensive examination by an endocrinologist. At least once a year (even with the usual tests and well-being) preventive courses of drugs to improve the pancreas are taken. The diet is prescribed permanently.

Pancreatogenic diabetes mellitus occurs due to inflammation of the pancreas, leading to sharp fluctuations in blood sugar. Be sure to follow a diet, use enzymes and tablets to lower sugar, and refuse alcohol.

Diabetic pancreatitis: everything you need to know

Chronic pancreatitis is an inflammatory phenomenon that develops in the pancreas, which leads to irreversible transformations in cells and tissues. In the case of a severe course of the disease, a significant portion of the pancreatic tissue is replaced. 

In this case, the glandular tissue degenerates into connective and adipose tissue. Internal and external secretion is disturbed in the body. At the level of external secretory deficiency, the development of enzyme deficiency occurs, and at the level within the secretory deficiency, glucose tolerance, and, as a consequence, diabetes mellitus.

 This type is called pancreatogenic, that is, formed on the background of inflammation of the pancreas. It is chronic pancreatitis that causes diabetes mellitus (DM). Undoubtedly, diabetes can occur as an independent disease, so patients with type 1 or type 2 diabetes may develop classic pancreatitis.

Pancreatitis and diabetes

Scientists have not yet reached a unanimous opinion on the details of pathogenesis. However, it is not news that the gradual destruction and sclerosis of the islet apparatus lead to diabetes as a reaction to inflammatory phenomena in neighboring cells that produce digestive enzymes.

The pancreas has the property of mixed secretion. Its first function is the production of enzymes and the release of the digestive tract to digest food, the second function is the production of insulin - a hormone whose regulation regulates glucose levels. 

The prolonged course of pancreatitis may be jeopardized by the fact that in addition to the pancreas, which is responsible for digestion (enzyme apparatus), it will affect the islet zone, which is in the form of the islet of Langerhans.

Other endocrine diseases often act as triggers. Clinically, secondary diabetes mellitus is similar to type 1 diabetes but differs in the lack of autoantibody gland tissue damage.

• Itsenko-Cushing's disease stimulates the release of hormones from the adrenal cortex. Excess cortisol reduces glucose uptake into tissues, which increases its level in the blood.
• Pheochromocytoma - a tumor with hormonal activity. The tumor can randomly throw high doses of catecholamines into the bloodstream, which, as mentioned, increases blood sugar. With acromegaly, high levels of growth hormone have an insulin-like effect. This is accompanied by the fact that the production of insulin by the pancreas and betta is weakened - the cells gradually atrophy.
• Glucagonoma produces the counter-hormone glucagon. With increased secretion, there is an imbalance of the endocrine system responsible for carbohydrate metabolism, and diabetes reappears.
• Hemochromatosis contributes to the increased accumulation of iron in the pancreas, which leads to its damage, including damage to beta cells.
• Wilson-Konovalov disease is accompanied by excessive accumulation of copper in the liver, which violates the deposition of glucose in it and, as a result, leads to diabetes.

Cohn's syndrome is associated with a disorder of potassium metabolism. Liver hepatocytes cannot do without the help of a potassium pump, using glucose. Symptomatic hyperglycemia also occurs in this case.

In addition to endocrine diseases, which in one way or another increase glucose, pancreatic lesions are also possible. These include complications of post-pancrectomy, pancreatic cancer, and somatostatinoma. The pancreas, in addition, can be a target when dangerous toxins (pesticides, glucocorticosteroids) are exposed to the body. The development of hyperglycemia and diabetes similarly takes place.

Pancreatogenic diabetes: causes and symptoms

The leading link in the pathogenesis of pancreatogenic diabetes is progressive sclerosis and destruction of the islet apparatus (not every betta cell, but a certain percentage of them). Some scientists do not rule out autoimmune causes of the disease.

Pancreatogenic diabetes develops, which is different from type 1 or type 2 diabetes:

• With insulin therapy, hypoglycemic episodes are more common.
• Insulin deficiency causes more frequent cases of ketoacidosis.
• Pancreatogenic diabetes is easier to correct with a low-carb diet.
• More effective in treating diabetes pills.

Class 2 diabetes mellitus develops on the background of complete or partial insular insufficiency. 

Insulin deficiency develops as a result of insulin resistance, which in turn appears as a hypercaloric diet with a predominance of low molecular weight carbohydrates.

 Unlike type 2 diabetes, pancreatogenic diabetes develops as a result of direct damage to beta cells by enzymes.

Pancreatitis in diabetes mellitus (the second disease developed independently, and the first is the background) looks different: inflammation of the pancreas is chronic, there are no exacerbations, and the sluggish type of course prevails.

The highest risk group is people who suffer from alcoholism. More than 50% of patients begin to develop pancreatitis of alcoholic origin. The risk include gastroduodenal ulcers, and people prone to protein deficiency.

The disease is accompanied by three main phenomena: diabetes, pain, and impaired digestive function. Clinically and pathogenetically, the disease can be described as follows:

• First, there is a change in the process of exacerbation and remission of the disease. In this case, the pain occurs with pain of varying intensity or localization. The period lasts 10 years.
• Dyspeptic phenomena come to the fore: diarrhea, heartburn, decreased appetite, and bloating. Hypoglycemic episodes soon join (carbohydrate metabolism is disturbed). Hypoglycemia occurs due to an increase in insulin levels in the blood due to the stimulation of beta cells by aggressive pancreatic enzymes.
• During a diffuse lesion of the pancreas, cells and tissues continue to break down, and impaired glucose tolerance is soon formed. Then the sugar on the voice is within normal limits, but after a meal or the glucose tolerance test is higher than normal.
• When hyperglycemia increases and decompensation of carbohydrate metabolism reaches a peak, diabetes develops. Diabetes debuts in 30 patients with long-term chronic pancreatitis, which is 2 times more likely than diabetes due to other causes.

Herbal diet for pancreatitis and diabetes

Despite the wide variety of antidiabetic drugs and drugs to treat pancreatitis, diet therapy is the basis for the treatment of diabetes, especially in combination with pancreatitis.

 A unique diet is shown for each disease, so the diet for pancreatitis and diabetes is rigorous. It is strictly forbidden to eat fried, spicy, fatty foods, and alcohol.

 The following products are not recommended: meat soups, apples, and cabbage. Protein foods should not exceed 200 grams per day.

Raw vegetables and fruits are in principle the basis of any person’s diet, as the genome of a rational person has been adapted to foods of plant origin over many millions of years of evolution.

 Proteins of animal origin will stimulate the production of aggressive digestive enzymes in the patient, which will inadequately affect the already damaged gland and the course of the disease. Therefore, plant foods are recommended for diabetics and patients with pancreatitis if:

1. There is no worsening of pancreatitis.
2. These are not the first two years of pancreatitis.
3. Fruits of soft consistency.
4. Peeling removed (coarse fibers cause bloating).
5. We consume fruits and vegetables in small meals.

Diabetes mellitus does not develop in all patients with pancreatitis. Damage to the pancreas leads to diabetes in 30% of cases. Pancreatitis and diabetes "hold" because one and the same organ is affected - the pancreas.

Therapy requires a careful approach to determine whether these conditions occur independently or are interconnected. 

Enzyme preparations are prescribed to treat the digestive dysfunctions of the gland, while antidiabetic medications, such as insulin or tablets, are used to manage the underlying disease.