Diabetes and Pancreatic Disease

Insulin helps glucose (sugar) move from your blood into your cells, where it can be used for energy. When the pancreas is damaged or its function is affected by pancreatic disease, the body may not produce enough insulin or may have difficulty regulating blood sugar. This can lead to diabetes.

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All types of diabetes involve problems with how the body makes or uses insulin, but the underlying causes are different.

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Type 1 Diabetes

In type 1 diabetes, the immune system mistakenly attacks and permanently damages the insulin-producing beta cells in the pancreas. As a result, the pancreas produces little or no insulin. Type 1 diabetes is considered an autoimmune disease, but we don’t know what causes it to start.  It is thought that both genetic and environmental factors play a role.

• Accounts for approximately 5–10% of diabetes cases
• Can develop at any age, including childhood and adulthood
• The autoimmune markers of type 1 diabetes can be identified before blood sugars become abnormal
• Cannot be prevented by diet or lifestyle; some ability to delay need for insulin therapy using medication to suppress the immune system if type 1 diabetes is diagnosed before blood sugars are high
• Currently cannot be cured and requires insulin therapy‍

Type 2 Diabetes

Type 2 diabetes usually begins with insulin resistance, meaning the body's cells do not respond to insulin effectively. The pancreas may initially produce enough insulin, but over time the pancreas does not produce enough to keep blood sugar within a healthy range. Factors that can contribute to type 2 diabetes include:

• Overweight or obesity
• Physical inactivity
• Dietary patterns
• Family history and genetics
• Age and other environmental or health factors

Type 3c diabetes

Type 3c diabetes, also known as pancreatogenic diabetes, occurs when diabetes develops because of damage to or loss of pancreatic tissue. Unlike type 1 diabetes, which occurs when the immune system attacks insulin-producing cells, or type 2 diabetes, which is primarily associated with insulin resistance, type 3c diabetes is associated with pancreatic disease or damage. It is important to note that type 3c diabetes, although a distinct diagnosis, can share some features with type 1 and type 2 diabetes. Type 3c diabetes may develop after:

• Chronic pancreatitis
• Repeated episodes of acute pancreatitis
• Pancreatic surgery
• Pancreatic cancer
• Cystic fibrosis
• Other conditions that damage or affect the pancreas

Diabetes and Pancreatitis.

Both acute and chronic pancreatitis increase the risk of diabetes. Some people develop pre-diabetes or diabetes after an episode of acute pancreatitis. This risk is probably higher for people who have a severe episode of acute pancreatitis, or multiple episodes of acute pancreatitis, because their islets are more damaged. Chronic pancreatitis can cause permanent damage to the pancreas, and the risk of diabetes increases as pancreatic damage progresses. The relationship also works both ways: people with diabetes may have a higher risk of pancreatitis, depending on other factors such as high triglycerides, certain medications, and other health conditions.

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Some people with diabetes have few or no symptoms. When symptoms occur, they may include:

• Increased thirst
• Frequent urination
• Increased hunger
• Fatigue
• Blurred vision
• Unexplained weight loss
• Cuts or wounds that heal slowly
• Tingling, pain, or numbness in the hands or feet

Diabetes is diagnosed using blood tests that measure your blood sugar levels or average blood sugar levels over time. Your healthcare provider may use one or more tests to diagnose diabetes. If you do not have symptoms, an abnormal result is usually confirmed with repeat testing.

• A1C: 6.5% or higher
• Fasting plasma glucose: 126 mg/dL or higher
• 2-hour oral glucose tolerance test: 200 mg/dL or higher
• Random plasma glucose: 200 mg/dL or higher when accompanied by symptoms of diabetes

What do these tests measure?

• A1C: Estimates your average blood sugar over the past 2–3 months. Fasting is not required.  
• Fasting plasma glucose: Measures your blood sugar after fasting for at least 8 hours.  
• Oral glucose tolerance test: Measures your blood sugar 2 hours after drinking a glucose-containing beverage.  
• Random plasma glucose: Measures your blood sugar at any time of day. A level of 200 mg/dL or higher, along with symptoms of diabetes, may indicate diabetes.

What Is Prediabetes?

Prediabetes occurs when blood sugar levels are higher than normal but not yet in the diabetes range. Pre-diabetes is a sign thatyou are at higher risk for developing type 2 diabetes and heart disease.

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Prediabetes is sometimes described as impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), depending on the blood glucose test used.

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Prediabetes has no obvious symptoms, so you may have it without knowing. If you have prediabetes, your healthcare provider can recommend steps to reduce your risk of developing type 2 diabetes and determine how often you should be retested

Type 1 Diabetes

• Cannot be prevented by diet or lifestyle; some ability to delay need for insulin therapy using medication to suppress the immune system if type 1 diabetes is diagnosed before blood sugars are high
• Currently cannot be cured and requires insulin therapy

Type 2 Diabetes

Treatment may include healthy eating, physical activity, and weight management when appropriate. Although sometimes weight loss is sufficient, most individuals will eventually need medications, sometimes including insulin.

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Type 3c Diabetes

Treatment may include:

• Regular blood glucose monitoring
• Continuous glucose monitoring (CGM)Nutrition support, including working with a dietitian knowledgeable in pancreatitis and diabetes, when available
• Diabetes medications when appropriate
• Insulin therapy when needed

After Pancreatic Surgery.

Removing part or all of the pancreas can reduce the body's ability to produce insulin. The risk of diabetes depends on how much pancreatic tissue is removed and the health of the remaining pancreas. People who have had a total pancreatectomy will need lifelong insulin therapy because the body can no longer produce insulin. Diabetes management after a total pancreatectomy can be more complex because the pancreas also no longer produces glucagon, which normally helps prevent blood sugar from dropping too low.

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If you have both diabetes and EPI, your healthcare team may include a gastroenterologist or pancreatologist, endocrinologist, dietitian, diabetes educator, and other specialists who can help coordinate your care.

Managing both pancreatic disease and diabetes can feel overwhelming, but you do not have to manage them alone.

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Keeping your healthcare providers informed about changes in your symptoms, blood sugar, weight, nutrition, digestion, and medications can help your care team identify problems early and adjust your treatment when needed.

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Because pancreatic disease can affect both digestion and blood sugar regulation, coordinated care may be especially helpful for people living with both pancreatic disease and diabetes.