Can cause diabetes pancreatitis

Pancreatitis and diabetes

Diseases of the exocrine pancreas (tissue parts of the pancreas that are involved in the digestive functions) are the cause of diabetes mellitus in less than 1%.

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Diseases of the exocrine pancreas (tissue parts of the pancreas that are involved in the digestive functions) are the cause of diabetes mellitus in less than 1%.
Acute pancreatitis is associated with transient hyperglycemia in 50-70% of cases, but only becomes permanent diabetes in up to 15% of cases. Chronic pancreatitis leads to decreased glucose tolerance or diabetes in 40-50% of cases.
Insulin therapy is usually indicated for pancreatitis-related diabetes.
Acute metabolic imbalances in the form of ketoacidoses are rare - this is attributed to a lack of glucagon effect. Hypoglycemia is common for the same reason. Diabetic complications occur in a similar pattern to type 2 diabetes mellitus, but macrovascular complications are less common.

In addition to acute and chronic pancreatitis, which are most commonly caused by alcohol abuse or gallstones, there are rarer forms of pancreatitis that can lead to diabetes. Hereditary and secondary hemochromatosis (iron storage disease) should be mentioned here, which can lead to diabetes in up to 25% of cases. Cystic fibrosis also leads to diabetes in 25% and to reduced glucose tolerance in 50%. In tropical and subtropical zones, calcifying pancreatitis is known, which leads to diabetes in 90% of cases, but is responsible for only about 1% of diabetes in these tropical zones.

Acute pancreatitis
Acute pancreatitis leads to a temporary increase in blood glucose levels in 50-70% of cases. This is mainly attributed to increased glucagon levels and less to decreased insulin production. In fact, insulin production can even be increased in this condition. Blood glucose values> 200 mg / dl within the first 24 hours are a bad prognostic sign. The hyperglycaemia usually resolves within a few days to a few weeks without the need for insulin treatment. Diabetes (with persistent disturbance of the glucose metabolism) occurs in 15% of the cases and usually has to be treated with insulin, since insulin-producing cells have now been destroyed. Differences with different origins are not described, the extent of tissue destruction is considered to be decisive.

Chronic pancreatitis
Decreased glucose tolerance occurs in 40-50% of cases in chronic pancreatitis. The cause is a reduction in beta cell activity as a result of the absence of growth stimuli from the exocrine pancreatic tissue, which are necessary to maintain the insulin-producing cells.

As a rule, it takes a few years for the onset of diabetes; the maximum prevalence is reached after 20 years. At least 50% of these diabetics must be treated with insulin. Ketoacidosis rarely occurs, which is attributed to a reduced effect of the islet hormone glucagon. The generally low proportion of adipose tissue in these patients as a source of triglycerides for the formation of ketone bodies is discussed as a further reason for the low frequency of ketoacidosis. There are no known differences in terms of development with regard to the development of diabetes; the decisive factor is the extent of tissue destruction.

Chronic diabetic complications
Contrary to previous belief, it has been found that retinopathy, nephropathy and neuropathy occur in this secondary form of diabetes with a similar frequency and severity as in type 2 diabetes. The risk of macrovascular complications (large blood vessels) is lower, probably because the patients are on average younger and slimmer than type 2 diabetics.

Dr. med. Achim Hübinger, German Diabetes Clinic of the German Diabetes Center at Heinrich Heine University Düsseldorf, Leibniz Center for Diabetes Research

Status: June 2005