Diabetes in pancreatitis, pancreatectomy and other pancreatic diseases

Pancreatogenic diabetes is classified by the American Diabetes Association as a form of type 3 diabetes mellitus (T3cDM) secondary to acquired diseases of the exocrine pancreas. It is a clinically relevant condition, representing 5-10% of all diabetic cases in the Western population. It develops in about 50% of patients with chronic pancreatitis, in 80% of pancreatic cancer cases, in 70% of patients submitted to subtotal pancreatectomy and in over 7% of hemochromatosis cases. Patients typically develop symptoms associated with hyperglycemia, but they have a distinctly increased risk of hypoglycemia and glycemic instability. Hypoglycemic episodes associated with insulin or sulfonylurea therapy are more frequent and tend to be more severe and to last longer. Hypoglycemia is the consequence of impaired counterregulation and glucose recovery due to deficient glucagon secretion, blunted catecholamine response and subsequent impaired activation of hepatic glucose production. In terms of the therapeutic approach, maintenance of plasma glucose levels slightly above the normal range may be necessary to avoid frequent hypoglycemic reactions and to improve the quality of life. © 2014 S. Karger AG, Basel