When we think of ‘diabetes’, we often think of type 1 and 2 diabetes. However, there is ‘hidden diabetes’ that is not widely known around the world. That’s pancreatic diabetes. Many patients are diagnosed with pancreatic disease before being diagnosed with diabetes. Pancreatic diabetes mellitus is considered one of the most closely managed diabetes mellitus because it has a greater range of blood sugar fluctuations than type 1 and 2 diabetes, can lead to serious complications, and has a higher risk of death. Find out the mechanism of occurrence of pancreatic diabetes and how to deal with it.
Pancreatic diabetes mellitus is different from type 1 and 2 diabetes in the pathogenesis. Type 1 diabetes is an autoimmune disease that destroys the beta cells of the pancreas, the ‘insulin production factory’. On the other hand, pancreatic diabetes mellitus occurs when there is a disease in the pancreas or when more than 75% of the pancreas is removed by resection and the pancreas function itself decreases. The most common cause is chronic pancreatitis, and pancreatic ductal cell carcinoma, hemochromatosis, and a history of pancreatic surgery may also be the cause. Professor Jeonghwan Park of the Department of Endocrinology and Metabolism at Hanyang University Hospital said, “According to some studies, the incidence of pancreatic diabetes accounts for 0.5% to 10% of all diabetic patients. As a result, there are many cases where diabetes onset following the age of 50 is mistakenly diagnosed as ‘adult diabetes’, that is, type 2 diabetes.”
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Hyperglycemia and hypoglycemia are frequent, accompanied by complications
Pancreatic diabetes is called the most dangerous type of diabetes because of its fatal symptoms. Pancreatic diabetes mellitus is characterized by repeated fluctuations in hyperglycemia and hypoglycemia. This is caused by the destruction of all cells, including alpha cells, beta cells, and pancreatic polypeptide cells, in the pancreas due to pancreatic disease or loss by pancreatic resection. Professor Kiyoung Lee of the Department of Endocrinology and Metabolism at Gachon University Gil Hospital said, “In the original pancreas, when hypoglycemia occurs, alpha cells release glucagon into the blood to raise blood sugar, and beta cells produce insulin to induce the blood to absorb glucose. This is the reason why people with diabetes mellitus experience sudden fluctuations in blood sugar levels.” When the causative disease of pancreatic diabetes is chronic alcoholic pancreatitis, diabetic neuropathy is also characteristic. This is because alcohol has damaged nerves due to prolonged drinking.
In fact, a study in Korea showed in May that the clinical results of pancreatic diabetes were worse than those of type 2 diabetes. According to ‘Diabetes Care’, an authoritative journal in the field of diabetes, Professor Han Seung-jin’s team at the Department of Endocrinology and Metabolism at Ajou University Hospital found 3629 patients with pancreatic diabetes who were diagnosed with diabetes following being diagnosed with pancreatic disease among 157,523 patients diagnosed with diabetes for the first time between 2012 and 2017. Patients (2.3%) and 153,894 patients with type 2 diabetes were compared and analyzed. As a result, the rate of receiving insulin treatment 5 years following diagnosis was 38% higher in the pancreatic diabetes group than in the type 2 diabetes group. As complications, hypoglycemia (85%), diabetic neuropathy (38%), nephropathy (38%), and ophthalmopathy (10%) were also higher, respectively. Mortality was also 74% higher. Professor Han Seung-jin, who led the study, emphasized, “If you are diagnosed with a pancreatic disease such as chronic or acute pancreatitis or pancreatic cancer, you need to manage it to prevent pancreatic diabetes from occurring. .
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Suspicion when blood sugar is not controlled over the age of 50
There are situations in which you may suspect pancreatic diabetes. The first is when a healthy adult over the age of 50 has sudden uncontrolled blood sugar levels and high blood sugar levels. Professor Cheon Young-guk of the Department of Gastroenterology at Konkuk University Hospital said, “In medicine, this is defined as newly onset DM. emphasized. In a study of a group of people over 50 years of age with newly developed diabetes, pancreatic cancer was found in 3 to 5%, and even a significant number of them had advanced pancreatic cancer.
The second is when you have been receiving treatment for type 2 diabetes for a long time and you have lost weight and have abdominal pain without knowing the cause. It is possible that the cause of diabetes was a pancreatic disease such as pancreatic cancer, or that pancreatic cancer was induced in some patients with long-standing diabetes. Professor Cheon Young-guk said, “If you have diabetes, but suddenly your blood sugar is not controlled and symptoms such as weight loss occur, it is better to get a pancreatic cancer test.” It would be safe to get tested and track down.”
Pancreatic diabetes mellitus is caused by a lack of insulin secretion, so insulin injection treatment is usually performed. At the same time, lifestyle changes are important. In order not to raise blood sugar rapidly, you should eat a balanced diet of mixed grains such as brown rice and vegetables rich in dietary fiber. In pancreatic diabetes mellitus, a fatty, high-fat diet should be avoided because the polypeptide cells that break down and absorb nutrients in the pancreas are broken, making it difficult to break down and absorb fat. In the case of type 2 diabetes patients, when symptoms of hypoglycemia appear, as an emergency measure, eat monosaccharide foods such as candy, juice, and yogurt to raise blood sugar. However, if a patient with pancreatic diabetes eats these foods during the hypoglycemic stage, the blood sugar spikes rapidly and may move into the hyperglycemic stage. Eat a meal before exercise to prevent hypoglycemia, and if low blood sugar occurs, foods with a high fat content, such as ice cream, milk, and chocolate, raise blood sugar more slowly than candy, juice, or yogurt to prevent hyperglycemia as much as possible.
Jeong Simkyo (jeong.simkyo@joongang.co.kr)
