Pancreatogenic diabetes mellitus is an endocrine disease that occurs against the background of a primary lesion of the pancreas of various genesis (more often, chronic pancreatitis). It is manifested by dyspeptic disorders (heartburn, diarrhea, periodic epigastric pain) and the gradual development of hyperglycemia. Diagnosis is based on the study of the glycemic profile, blood test, ultrasound, MRI of the pancreas. Treatment includes a diet with a reduced fat content and “fast” carbohydrates, the appointment of enzyme and sugar-lowering drugs, abstinence from alcohol and tobacco smoking. After radical operations, insulin replacement therapy is prescribed.
Meaning
Pancreatogenic diabetes mellitus (type 3 diabetes mellitus) is a secondary glucose metabolism disorder that develops as a consequence of damage to the pancreatic endocrine apparatus (pancreas). The disease occurs in 10-90% of patients with chronic pancreatitis. Such variability of data is associated with the difficulty of predicting the development of endocrine dysfunction of the pancreas and the difficulty of differential diagnosis of pathology. After acute pancreatitis, the risk of type 3 diabetes mellitus is 15%. The disease affects more often men who excessively consume alcohol, fatty foods.
Causes
The disease develops with a violation of the endocrine and exocrine function of the pancreas. There are the following causes of damage to the insular apparatus of the gland:
- Chronic inflammation of the pancreas. Frequent exacerbations of pancreatitis increase the risk of developing diabetes. Chronic inflammation causes gradual destruction and sclerosis of the islets of Langerhans.
- Operations on the pancreas. The frequency of postoperative diabetes varies from 10% to 50% depending on the volume of surgery. Most often, the disease develops after total pancreatectomy, pancreatoduodenal resection, longitudinal pancreatojunostomy, resection of the caudal part of the pancreas.
- Other diseases of the pancreas. Pancreatic cancer, pancreatic necrosis cause a violation of endocrine function with the formation of persistent hyperglycemia.
There are risk factors that provoke the occurrence of pancreatogenic diabetes in patients with pancreatic dysfunction. These include:
- Alcohol abuse. Systematic consumption of alcoholic beverages increases the risk of pancreatitis of alcoholic origin several times with the formation of transient or persistent hyperglycemia.
- Eating disorders. Excessive consumption of foods rich in fats, easily digestible carbohydrates contributes to the development of obesity, hyperlipidemia and impaired glucose tolerance (prediabetes).
- Prolonged use of medications (corticosteroids) is often accompanied by the occurrence of hyperglycemia.
Pathogenesis
The endocrine function of the pancreas is the release of insulin and glucagon into the blood. Hormones are produced by the islets of Langerhans located in the tail of the gland. Prolonged external influences (alcohol, medications), frequent attacks of exacerbation of pancreatitis, surgical intervention on the gland leads to a violation of the insular function. The progression of chronic inflammation of the gland causes destruction and sclerosis of the insular apparatus. During the period of exacerbation of inflammation, pancreatic edema is formed, the content of trypsin in the blood increases, which has an inhibitory effect on insulin secretion. As a result of damage to the endocrine apparatus of the gland, transient at first, and then persistent hyperglycemia occurs, diabetes mellitus is formed.
Symptoms
Pancreatogenic diabetes mellitus occurs more often in persons of lean or normal build with increased excitability of the nervous system. The defeat of the pancreas is accompanied by dyspeptic phenomena (diarrhea, nausea, heartburn, flatulence). Painful sensations with exacerbation of inflammation of the gland are localized in the epigastric zone and have different intensity. The formation 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 make its debut with the manifestation of acute pancreatitis. Postoperative hyperglycemia is formed simultaneously and requires correction with insulin.
Pancreatogenic diabetes occurs in a mild form with a moderate increase in blood glucose and frequent attacks of hypoglycemia. Patients are satisfactorily adapted to hyperglycemia up to 11 mmol/l. A further increase in blood glucose causes symptoms of diabetes (thirst, polyuria, dry skin). Pancreatogenic diabetes responds well to treatment with diet therapy and hypoglycemic drugs. The course of the disease is accompanied by frequent infectious and skin diseases.
Complications
Ketoacidosis and ketonuria rarely occur in patients with type 3 diabetes. Patients with pancreatogenic diabetes are characterized by frequent short-term attacks of hypoglycemia, which are accompanied by a feeling of hunger, cold sweat, pallor of the skin, excessive excitement, tremor. A further drop in blood glucose levels causes clouding or loss of consciousness, the development of seizures and hypoglycemic coma. With a prolonged course of pancreatogenic diabetes, complications form from other systems and organs (diabetic neuropathy, nephropathy, retinopathy, angiopathy), hypovitaminosis A, E, impaired metabolism of magnesium, copper and zinc.
Diagnostics
Diagnosis of pancreatogenic diabetes mellitus is difficult. This is due to the prolonged absence of symptoms of diabetes, the difficulty of recognizing inflammatory diseases of the pancreas. With the development of the disease, the symptoms of pancreatic lesion are often ignored, prescribing only hypoglycemic therapy. Diagnosis of carbohydrate metabolism disorders is carried out in the following areas:
- Consultation of an endocrinologist. An important role is played by a thorough study of the history of the disease and the connection of diabetes with chronic pancreatitis, pancreatic surgery, alcoholism, metabolic disorders, taking steroid medications.
- Monitoring of glycemia. It involves determining the concentration of glucose on an empty stomach and 2 hours after eating. With type 3 diabetes, the fasting glucose level will be within the normal range, and after eating it will be increased.
- Evaluation of the pancreatic function. It is carried out using a biochemical analysis to determine the activity of diastase, amylase, trypsin and lipase in the blood. Blood test are indicative: with pancreatogenic diabetes, traces of glucose and acetone in the urine are usually absent.
- Instrumental visualization methods. Abdominal ultrasound, MRI of the pancreas allow us to assess the size, echogenicity, structure of the pancreas, the presence of additional formations and inclusions.
In endocrinology, differential diagnosis of the disease is carried out with type 1 and type 2 diabetes mellitus. Type 1 diabetes is characterized by a sharp and aggressive onset of the disease at a young age and pronounced symptoms of hyperglycemia. Antibodies to pancreatic beta cells are detected in the blood test. The distinctive features of 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, as well as surgical interventions on the organ.
Treatment
For the best result, it is necessary to carry out joint treatment of chronic pancreatitis and diabetes mellitus. It is required to permanently abandon the use of alcoholic beverages and tobacco smoking, adjust nutrition and lifestyle. Complex therapy has the following directions:
- Diet. The diet for pancreatogenic diabetes includes correction of protein deficiency, hypovitaminosis, electrolyte disorders. Patients are recommended to limit the consumption of “fast” carbohydrates (pastries, bread, sweets, cakes), fried, spicy and fatty foods. The main diet consists of proteins (lean meats and fish), complex carbohydrates (cereals), vegetables. Food should be taken in small portions 5-6 times a day. It is recommended to exclude fresh apples, legumes, rich meat broths, sauces and mayonnaise.
- Compensation of pancreatic enzyme deficiency. Medicines containing the enzymes amylase, protease, lipase in different proportions are used. The drugs help to improve the digestive process, eliminate protein-energy deficiency.
- Taking hypoglycemic drugs. To normalize carbohydrate metabolism, the appointment of drugs based on sulfonylurea gives a good result.
- Postoperative replacement therapy. After surgical interventions on the pancreas with complete or partial resection of the tail of the gland, fractional administration of insulin is indicated no more than 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, it is necessary to switch to the appointment of oral hypoglycemic drugs.
- Autotransplantation of islet cells. It is carried out in specialized endocrinological medical centers. After successful transplantation, patients undergo pancreatotomy or pancreatic resection.
Prognosis and prevention
With complex treatment of pancreatic lesions and correction of hyperglycemia, the prognosis of the disease 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 operations on the gland, the prognosis will depend on the intervention and the rehabilitation period. The course of the disease is aggravated by obesity, alcoholism, abuse of fatty, sweet and spicy foods. To prevent pancreatogenic diabetes mellitus, it is necessary to lead a healthy lifestyle, give up alcohol, and in the presence of pancreatitis, undergo a timely examination by a gastroenterologist.