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Query: UMLS:C0011849 (diabetes)
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The prevalence of diabetes due to chronic pancreatitis would appear to be increasing. In western countries this is associated with the known increase in alcohol consumption and AIP. Malnutrition may be etiologic in tropical areas. The incidence of diabetes in chronic pancreatitis is dependent on a number of factors. It is more common in alcohol-induced pancreatitis, rarely occurs after the first attack but tends to increase with time and rises markedly in calcific pancreatitis. Abnormal glucose tolerance occurred in 91% of patients with calcific pancreatitis and 70% of patients with noncalific AIP in our follow up of five to 12 years. This stresses the importance of serial regular glucose tolerance tests in these patients (Table I). The insulin-reserve is severely depleted in most patients who do not yet demonstrate abnormal glucose tolerance, indicating that pancreatitis regularly affects the islets and that nearly all patients are potential diabetics. The beta cells appear to respond better to oral glucose, glucagon or secretin than to i.v. glucose suggesting a selective glucose receptor loss or block to hyperglycemia in chronic pancreatitis. The alpha cells seem to be more resistant to the effects of chronic pancreatitis but true hypoglucagonemia was found in 16% of patients. In addition, stimulated growth hormone secretion may be deficient in pancreatic diabetes. These last two factors, among others, may be responsible for the protracted and even fatal hypoglycemia to which some patients with AIP on insulin therapy are liable. The danger of drug-induced hypoglycemia, coupled with the infrequency of vasculopathy, retinopathy and nephropathy in pancreatic diabetes has induced us to keep these patients hyperglycemic and glycosuric rather than in a sugar-free state, as long as symptoms are contained. Recurrent abdominal pain, marked weight loss and associated steatorrhea often raise special problems in the management of the pancreatic diabetic.
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PMID:Clinical and hormonal aspects of pancreatic diabetes. 80 21

A total of 201 patients with chronic pancreatitis were treated surgically between 1964 and 1975. In 116 cases (57,7%) resection was done at operation: 44 partial and 18 total duodenopancreatectomies, 37 partial and 17 subtotal left pancreatic resections. The mortality rate of the operation was 12.9%. The late mortality was 9.4% based on an average observation period of 2 7/12 years. Three quarters of the patients became completely asymptomatic. Preoperative diabetes was observed in 21% rising to 38% postoperatively. Satisfactory long-term results were mainly seen after partial duodeno-pancreatectomy and subtotal left resection. However, continued alcohol abuse limits the success rate.
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PMID:[Results of resection treatment of chronic pancreatitis (author's transl)]. 83 84

Very frequently in acute and chronic pancreatitis, the surgical treatment is indispensable. The disease itself is accompanied by metabolic disturbances, protein deficiency, hepatic lesion, by diabetes and malabsorption syndrome. Following the laboratory parameters we were able to perform partial or total hyperalimentation, correction of acid-base dis-equilibrium and to obtain the positive nitrogen balance, and in this way keep the patients in optimal conditions pre- and postoperatively.
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PMID:[Metabolic disorders and current treatment of the surgical patient with pancreatitis]. 85 52

Fifty-nine patients with chronic pancreatitis were studied in retrospect. The incidence of overt diabetes was high, 36/59. Half of the diabetics were insulin-dependent, and among these labile diabetes with hyperglycemia and high amounts of glucose in the urine was not uncommon. Hypoglycemic episodes were noted in 14 of the 18 insulin-treated patients, and in 3 patients severe hypoglycemia was believed to be the cause of death. Mechanisms leading to such disastrous hypoglycemia are discussed, and a hypothesis regarding lack of glucagon as the cause of severe hypoglycemic attacks was experimentally tested by measuring pancreatic glucagon in plasma in two patients with pancreatic diabetes and severe brain damage following hypoglycemic coma. Low basal glucagon values were found, and the normal rise upon insulin-induced hypoglycemia was not seen. From these results it may be justified to suggest, firstly that glucagon should be used in the management of severe hypoglycemia in chronic pancreatitis, and secondly that a certain degree of hyperglycemia should be allowed in the treatment of diabetes in these patients.
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PMID:Diabetes and hypoglycemia in chronic pancreatitis. 86 1

Because of the differently selected groups of patients due to a narrow indication for pancreatic surgery, a direct comparison of the results of conservative and surgical therapy is not possible. A follow-up survey of 348 patients with proven chronic pancreatitis showed that patients suffering from uncomplicated pancreatitis should be treated conservatively as long as possible, for 70% (77 out of 109) will improve. In 2/3 of our patients with chronic pancreatitis, surgical treatment became necessary. As to the recurrence of pancreatitis and the lethality, resecting techniques were more successful (72%: 107 out of 148) than the non-resecting ones (61%: out of 91). The cooperation of the patient is crucial for the prognostic outcome regardless of the kind of treatment; especially the elimination of alcohol intake is essential. The most important accompanying or/and succeeding disease is diabetes mellitus, which impairs the long term prognosis especially because of the hazard of postoperative irreversible hypoglycemia. Optimal treatment of patients with chronic pancreatitis can only be accomplished on an individual basis and on the basis of a close cooperation of internists and surgeons.
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PMID:[Chronic pancreatitis--conservative versus surgical treatment under prognostic aspects]. 90 64

The aim of the present investigation was to determine in patients with idiopathic haemochromatosis whether diabetes is of the primary type or secondary to pancreatic injury due to iron deposition. For this purpose, plasma glucagon concentrations were determined following arginine infusion or an oral glucose load in eight patients with diabetes and idiopathic haemochromatosis. The enhanced glucagon response to arginine and the nonsuppressibility of glucagon secretion by oral glucose found in these patients were similar to the results found in the same tests performed in our previous series of patients with "idiopathic" diabetes and at variance with those reported by others in patients with chronic pancreatitis.
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PMID:Glucagon secretion in diabetic patients with idiopathic haemochromatosis. 90 75

Exocrine pancreatic function was studied in 20 juvenile-onset diabetics, seven maturity-onset diabetics, and five patients with diabetes secondary to chronic pancreatitis. The results were compared with 13 non-diabetic controls. The outputs of bicarbonate, trypsin, and amylase were reduced in the diabetic patients in response to intravenous secretin and CCK-PZ. In the juvenile-onset group, exocrine pancreatic secretory capacity was reduced in 80% of the patients, and the severity of the reduction was related to the duration of the diabetes. The reduction in pancreatic secretory capacity must be taken into consideration when interpreting pancreatic exocrine function in patients with diabetes.
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PMID:Exocrine pancreatic function in juvenile-onset diabetes mellitus. 97 8

Chronic pancreatitis has to be treated in the first line by medical means. Dietary procedures, absolute abstinence from alcohol, compensation of malabsorption and treatment of diabetes will do in most cases. Surgery is indicated in cases resistent to this form of therapy of when complications arise (cysts, persistent jaundice, portal hypertension). The patient has to be given high caloric parenteral nutrition preoperatively. Pancreato-jejunostomy with an Y shaped loop and surgical removal of various amounts of pancreatic tissue are the only efficient surgical procedures. In cases of dilatation of the pancreatic duct drainage has to be performed. Results of surgery are satisfactory in 2/3 of cases.
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PMID:[Medical and surgical management of chronic pancreatitis (author's transl)]. 100 87

Of one hundred and forty-nine patients (101 male and 48 female) 4-67 years of age, 117 were alcoholics and underwent pancreatectomy because of episodic or continuous abdominal pain or complications or chronic pancreatitis. Nineteen patients underwent pancreaticoduodenectomy, seventy-seven 80-95% distal resection, anf fifty-three 40-80% distal pancreatic resection. There were 3 operative death and 30 late deaths 6 months to 11 years post pancreatectomy. Twenty-one patients were lost to followup, 1 to 11 years post pancreatectomy. Ninety-five patients are known to be alive, 4 of whom are institutionalized. Indications for pancreatectomy in addition to abdominal pain include recurrent or multiple pseudocysts, failure to relieve pain after decompression of a pseudocyst, pseudoaneurysm of the visceral arteries associated with a pseudocyst, recurrent attacks of pancreatitis unrelived by non-resective operations, duodenal stenosis and left side portal hypertension. The choice between pancreaticoduodenectomy or distal resection of 40-80% or 80-95% of the pancreas should be based on the principle site of inflammation whether proximal or distal in the gland, the size of the common bile duct, the ability to rule out carcinoma, and the anticipated deficits in exocrine and endocrine function. The risk of diabetes is very significant after 80-95% distal resection and of steatorrhea after pancreaticoduodenectomy. When the disease process can be encompassed by 40-80% distal pancreatectomy this is the procedure of choice.
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PMID:Pancreatectomy for chronic pancreatitis. 101 87

New tests and test methods aid in the diagnosis of pancreatic disorders. Pancreatic carcinoma, especially, may have an improved prognosis with earlier detection as a result of refinements in arteriography, cytology, pancreatic radioisotopic scanning, and endoscopic retrograde cholangiopancreatography. Acute pancreatitis results most commonly from alcoholism, biliary tract disease, and trauma. Management is directed primarily at decreasing pancreatic exocrine secretion. Surgery is usually best avoided in the acute phase. Chronic pancreatitis is most often a result of recurrent attacks of acute pancreatitis. Diabetes and malassimilation become manifest as pancreatic destruction progresses. Management consists of replacement of pancreatic enzymes and diet supplements. Once chronic pancreatitis is established, surgery can only be directed at complications of the disease. Pancreatic ascites is usually associated with a break in the pancreatic ductal system. Ascites caused by trauma responds well to surgical intervention, but the alcoholic type is less amenable to treatment.
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PMID:Pancreatic disease. 107 54


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