The Connection between Pancreatitis and DiabetesMonday, September 15, 2014
As a diabetes educator and author, I have been asked many times about the connection between pancreatitis and diabetes. I thought I would share the answer with all of my readers. First we need to define pancreatitis. I will also tell you about the most common forms and tell you about the connection with diabetes.
The Definition of Pancreatitis
When a word ends with “itis”, it is a suffix used to let us know that there is inflammation. (1) So…. pancreatitis is an inflammation of the pancreas. There are two common kinds of pancreatitis, acute and chronic.
Acute pancreatitis- The definition of “acute” is a condition that comes on suddenly and is severe. (2) Acute pancreatitis is therefore an inflammation and swelling in the pancreas that comes on suddenly! (3)
The pancreas is a unique organ that has many functions. People with diabetes usually are taught that the beta cells in the islets of Langerhans of the pancreas makes the hormone insulin. They are also taught that the pancreas makes other hormones like glucagon. The job that the pancreas has in making hormones and controlling blood glucose is referred to as pancreatic endocrine functions. Hormones are released by the pancreas and go directly into the blood stream. They travel through the body to get to the sites needed.
The pancreas which is located behind the stomach and very near to the small intestine also has what we call exocrine functions. Enzymes are produced as needed to help with the digestion of fats, proteins and carbohydrates. These enzymes are not released into the blood but they travel through a series of ducts that end in the small intestines where they usually become active. (3, 4) In acute pancreatitis, there is a problem when these enzymes are prematurely activated inside of the pancreas. They actually start to digest pancreatic tissue. This is very painful and causes the pancreas to swell and potentially bleed which can damage the pancreas. (3)
What can cause Acute Pancreatitis?
There are many possible causes of acute pancreatitis (AP). The most common cause is a history of alcoholic binge drinking. (5) It is thought that as much as 70% of people with acute pancreatitis have been habitual consumers of alcohol. They might drink approximately 5-8 drinks per day for up to 5 years. (3)
Another condition called biliary colic can also cause AP. (5) Biliary colic results from the blockage of the duct that drains the gallbladder by gallstones. This may cause cramping that resolves if the stone passes into the small intestine. (6) When gallstones are passed from the gallbladder, they travel down into the bile ducts which can block the pancreatic duct. (3) When the pancreatic duct is blocked, the enzymes cannot drain into the intestines.
Other less common illnesses that may cause acute pancreatitis are autoimmune problems, high triglyceride levels, cystic fibrosis and use of medications like estrogens, steroids and thiazides. For a more complete list of conditions that are associated with acute pancreatitis, visit the MedlinePlus page on Acute Pancreatitis.
Diabetes and Acute Pancreatitis
A recent review of the literature (2014) and meta-analysis was carried out at the University of Auckland in New Zealand. The researchers looked at 24 prospective studies with a total of 1,102 patients that had experienced AP. After experiencing AP, a total of 37% of the individuals developed pre-diabetes or diabetes. Sixteen percent of the people that developed diabetes needed insulin after experiencing AP. It was shown that a diagnosis of AP will increase the risk of diabetes in individuals by more than “twofold” over 5 years. The researchers conclude that studies need to take place to see how this risk can be lowered. (7)
People with type 2 diabetes that take incretin mimeties or DPP-4 inhibitors should have a discussion with their medical professionals about their chance of developing acute pancreatitis due to their medication.
Incretin mimeties include:
- Exenatide (Byetta)
- Liragltide (Victoza)
- Albiglutide (Tanzeum)
- Lixisenatide (Lyxumia)
The DPP-4 inhibitors include:
- Alogliptin (Nesina)
- Linagliptin (Tradjenta)
- Saxagliptin (Onglyza)
- Sitagliptin (Januvia and Janumet
- Vildagliptin (available outside of the United States)
It has been noted that cases of AP are on record for both animals and people using both of these classifications of medications. Research needs to be done to see if the AP is caused by the use of these medications. The FDA has required a warning for people using Incretin based medications. There is a possibility of developing AP. (8) It is suggested to avoid these medications with an AP history. Read more about the debate on the possibility of pancreatitis and incretin based therapies.
Symptoms of Acute Pancreatitis
If you are experiencing AP, you may have the following symptoms:
- Pain emanating from your left or middle upper abdomen. This pain may intensify shortly after eating or drinking. This is true especially with foods high in fat. The pain may be intense and last a few days. It may be stronger when laying down on your back.
- Nausea and Vomiting
- Gastrointestinal symptoms such as bowel movements that are grayish (clay colored), indigestion, gas, hiccups and swelling (3)
Report immediately to your doctor if you think you may be experiencing AP Your doctor will most likely need to draw blood to look at various parameters such as enzyme levels to help with a diagnoses and you may need an abdominal CT, MRI or ultrasound. Treatment most likely will involve hospitalization and receiving IV fluids. You may need to stop all food and beverage by mouth and take pain medications. (3) When individuals obtain treatment for the cause of the AP, they may avoid attacks in the future. This may involve:
- Treating gallstones (or removing the gallbladder)
- Unblocking the pancreatic duct
- Surgery for removing part of a damaged pancreas
- Avoiding alcohol
- Stopping smoking
- Going on a low fat meal plan
- Treating high triglycerides (3)
Acute pancreatitis can be life threatening when other body organs are impaired, if part of the pancreas dies or when the condition causes bleeding in the pancreas. Chronic pancreatitis can develop with repeat bouts of AP. (3)
Chronic Pancreatitis (CP) is inflammation to the pancreas that usually cannot be reversed. An exception to this is auto-immune pancreatitis which affects a small portion of the population. Auto-immune chronic pancreatic is potentially reversible with the use of steroids. (10)
Chronic Pancreatitis usually develops after acute pancreatitis or in people that drink excessive alcohol. The difference between AP and CP is that scar tissue develops in the pancreas in CP. (9) Pain may be intense and the person may suffer from ongoing gastrointestinal symptoms. Diabetes may develop. A person with CP must stop drinking alcohol and smoking. Therapy may include taking pancreatic enzymes with meals and if diabetes develops, injecting insulin. Following a low fat diet may also be recommended. (11) Diabetes develops in about half of the people with chronic pancreatitis due to destruction of the insulin producing cells in the pancreas. (12) For a detailed information on Chronic Pancreatitis visit patients.co.uk or nhs.uk.
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