Diabetes and Pancreas Disease

A direct connection exists between the pancreas and diabetes. The pancreas is an organ deep in your abdomen behind your stomach. It’s an important part of your digestive system.  The pancreas produces enzymes and hormones that help you digest food. One of these hormones, insulin, is necessary to regulate glucose. Glucose refers to sugars in your body. Every cell in your body needs glucose for energy. Think of insulin as a lock to the cell. Insulin must open the cell to allow it to use glucose for energy. If your pancreas doesn’t make enough insulin or your body doesn’t use it effectively, glucose builds up in your bloodstream, leaving your cells starved for energy. When glucose builds up in your bloodstream, this is known as hyperglycemia. The symptoms of hyperglycemia include thirst, nausea, and shortness of breath.  Hyperglycemia can quickly become life-threatening.

The Diabetes-Pancreatitis Connection

Inflammation of the pancreas is called pancreatitis. When inflammation comes on suddenly and lasts for a few days, it’s called acute pancreatitis. When it happens over many years, it’s called chronic pancreatitis.

Some people may require hospitalization for pancreatitis, which can become life-threatening. But in many cases, doctors can treat the condition with medication.

Chronic inflammation of the pancreas can damage the cells that produce insulin. This can lead to diabetes.

Pancreatitis source and type 2 diabetes share some of the same risk factors. Observational studies indicate that people with type 2 diabetes may have a two to threefold increased risk of acute pancreatitis.

Other possible causes of pancreatitis include:

  •  gallstones
  •  high triglyceride levels
  •  high calcium levels
  •  excessive alcohol use

The Diabetes-Pancreatic Cancer Connection

Diabetes can increase your risk of pancreatic cancer if you’ve had diabetes for more than 5 years.

Diabetes can also be a symptom of pancreatic cancer, especially if you develop type 2 diabetes after age 50.

If your diabetes has been well-controlled, but you suddenly can’t control your blood sugar, it may be an early sign of pancreatic cancer.

In people with type 2 diabetes and pancreatic cancer, it’s difficult to know whether one caused the other. The diseases share certain risk factors, including:

  •  poor diet
  •  physical inactivity
  •  obesity
  •  aging

Pancreatic cancer may not cause symptoms in the early stages. People typically receive the diagnosis when the condition is in an advanced stage.

It begins with mutations of pancreatic cells. While doctors can’t always determine the cause of pancreatic cancer, contributing factors may include genetics and smoking.


Having diabetes doesn’t mean you’ll develop other problems with your pancreas. Also, being diagnosed with pancreatitis or pancreatic cancer doesn’t mean you’ll develop diabetes.  Because your pancreas is essential for managing insulin, you may want to talk with a doctor about the connection. You can also incorporate lifestyle changes to reduce your risk of diabetes or pancreatitis, such as:

  •  Maintain a healthy, well-balanced diet.
  •  Reduce your intake of simple carbohydrates.
  •  If you drink alcohol, reduce your intake.
  •  Exercise regularly.
  •  Talk with a doctor about the best ways to maintain a healthy weight.
  •  If you have diabetes, follow your doctor’s prescribed treatment plan.

Types of Diabetes

There are several types of diabetes and understanding the differences between them is important in understanding a diagnosis. Each type of diabetes involves the pancreas not functioning properly. How the pancreas doesn’t function properly differs depending on the type.  No matter what type of diabetes you have, ongoing monitoring of blood glucose levels is essential so you can take the appropriate action.

Type 1 Diabetes

In type 1 diabetes the immune system attacks the beta cell that produces insulin in your pancreas. The attack causes permanent damage and leaves your pancreas unable to produce insulin.  The exact cause of the attack by the immune system is unclear, but genetic and environmental factors may play a role.  You’re more likely to develop type 1 diabetes if you have a family history of the disease. About 5 to 10% of people with diabetes have type 1. People with type 1 diabetes typically receive the diagnosis during childhood or early adulthood. Because the exact cause is unclear, type 1 diabetes isn’t preventable nor is it curable. Anyone with type 1 diabetes needs insulin therapy because their pancreas doesn’t function.

Type 2 Diabetes

Type 2 diabetes starts with insulin resistance. This means your body no longer uses insulin well, so your blood glucose levels can become too high or too low.  Type 2 diabetes can also mean that your pancreas produces insulin but not enough. Most of the time, type 2 diabetes develops due to a combination of insulin deficiency and ineffective use of use of insulin.

This type of diabetes may also have a genetic or environmental cause. Other factors contributing to type 2 diabetes include:

  • a poor diet
  • a lack of exercise
  • obesity

Treatment for type 2 diabetes generally includes changes to your diet and exercise routines. Medications can also help you keep type 2 diabetes under control.  Some drugs help reduce the amount of glucose in your blood and make your body more responsive to insulin. Others stimulate the pancreas to produce more insulin. In some cases, the pancreas eventually stops producing insulin, so insulin therapy becomes necessary.

Type 3 Diabetes

Type 3c diabetes is not as commonly discussed as type 1 or type 2 diabetes however, it is the form of diabetes that regularly affects people suffering from other forms of pancreas disease, including chronic pancreatitis, acute recurrent pancreatitis, and pancreatic cancer.

Type 3c diabetes, also referred to as secondary diabetes, is a form of diabetes that develops when the pancreas has been damaged or removed (partially or in full) resulting in a decreased number (or elimination of) the beta cells that produce insulin in the pancreas. When a person has pancreatitis or pancreatic cancer and the organ is being repeatedly inflamed, damage to the cells of the pancreas can occur. The damage of islet cells prevents them from secreting insulin as it must in order to process carbs and regulate blood sugar.

While it has a very different origin from type 1 diabetes (which is an autoimmune disease where the body attacks beta cells), the treatment of type 3c diabetes is most similar to type 1 diabetes. Patients with type 3c diabetes typically have to monitor their blood sugar using finger pricks or a continuous glucose monitor (CGM) and administer their own insulin via syringes, pens, or an insulin pump. Like type 1 diabetes, people with type 3 diabetes usually also count their carbs in order to dose their insulin properly.

To summarize: type 3c diabetes is caused by repeated damage or removal of the pancreas. The damage/ removal eliminates the beta cells that produce insulin in the pancreas. Despite its differing origin, the treatment of type 3c diabetes is similar to type 1.

Life of a Diabetic 

25-80% of people with chronic pancreatitis will develop diabetes when their islet cells are not producing insulin. The specific diabetes is called type 3c diabetes, otherwise known as pancreatogenic diabetes.

We follow Cecilia Petricone to learn more about a day in the life of a diabetic, post -TPIAT.

How does pancreatitis cause type 3c diabetes?

Over time in chronic pancreatitis the pancreas loses the ability to produce enough insulin, and thus to control blood sugar. The ability to release enzymes to help digest food also declines in parallel. Scientists don’t yet understand how this happens, but some preliminary research exists. It’s possible that the inflammation from the pancreatitis damages the part of the pancreas that releases insulin, or that the inflammation directly prevents the release of insulin. In the later stages of the pancreatitis, the scarring of the pancreas destroys the insulin-producing parts of the pancreas. It is also possible that the body becomes less able to use insulin to regulate blood sugar – called “insulin resistance” – due to chronic pancreatitis over time.

Other causes of diabetes in people with pancreatitis

Rarely, new diabetes in people aged over 50 years turns out to be due to pancreatic cancer. This risk is highest in the first 2-3 years after diagnosis of diabetes. Weight loss at the time of diabetes diagnosis is also more likely in people eventually diagnosed with pancreatic cancer (59%) versus type 2 diabetes (30%). Among all people with new-onset diabetes aged older than 50 (not solely people with pancreatitis), the risk of pancreatic cancer can range from 1% to 13.5%. Nevertheless, the vast majority of people who are diagnosed with new-onset diabetes at those ages solely have diabetes. It should also be noted that individuals with pancreatitis are still able to get type 1 or type 2 diabetes, independently of their pancreatitis.


There are several ways to diagnose diabetes. Each way usually needs to be repeated on a second day to diagnose diabetes. Testing should be carried out in a healthcare setting (such as your doctor’s office or a lab). If your doctor determines that your blood glucose (blood sugar) level is very high, or if you have classic symptoms of high blood glucose in addition to one positive test, your doctor may not require a second test to diagnose diabetes.


The A1C test measures your average blood glucose for the past two to three months. The advantages of being diagnosed this way are that you don’t have to fast or drink anything.

  • Diabetes is diagnosed at an A1C of greater than or equal to 6.5
Result A1C
Normal…………………… less than 5.7%
Prediabetes…………. 5.7% to 6.4%
Diabetes………………… 6.5% or higher


Fasting Plasma Glucose (FPG)

This test checks your fasting blood glucose levels. Fasting means after not having anything to eat or drink (except water) for at least 8 hours before the test. This test is usually done first thing in the morning, before breakfast.

  • Diabetes is diagnosed at fasting blood glucose of greater than or equal to 126 mg/dl
Result Fasting Plasma Glucose (FPG)
Normal………………….. less than 100 mg/dl
Prediabetes………… 100 mg/dl to 125 mg/dl
Diabetes……………….. 126 mg/dl or higher

Oral Glucose Tolerance Test (OGTT)

The OGTT is a two-hour test that checks your blood glucose levels before and two hours after you drink a special sweet drink. It tells the doctor how your body processes sugar.

  • Diabetes is diagnosed at two-hour blood glucose of greater than or equal to 200 mg/dl
Result Oral Glucose Tolerance Test (OGTT)
Normal…………………. less than 140 mg/dl
Prediabetes……….. 140 to 199 mg/dl
Diabetes………………. 200 mg/dl or higher


Random (also called Casual) Plasma Glucose Test

This test is a blood check at any time of the day when you have severe diabetes symptoms.

  • Diabetes is diagnosed at blood glucose of greater than or equal to 200 mg/dl

What is Prediabetes?

Before people develop type 2 diabetes, they almost always have prediabetes—blood glucose levels that are higher than normal but not yet high enough to be diagnosed as diabetes.

Doctors sometimes refer to prediabetes as impaired glucose tolerance (IGT) or impaired fasting glucose (IFG), depending on what test was used when it was detected. This condition puts you at a higher risk for developing type 2 diabetes and cardiovascular disease.


There are no clear symptoms of prediabetes, so you may have it and not know it. Common symptoms of diabetes include:

  • Urinating often
  • Feeling very thirsty
  • Feeling very hungry—even though you are eating
  • Extreme fatigue
  • Blurry vision
  • Cuts/bruises that are slow to heal
  • Weight loss—even though you are eating more (type 1)
  • Tingling, pain, or numbness in the hands/feet (type 2)

Early detection and treatment of diabetes can decrease the risk of developing the complications of diabetes.

Although there are many similarities between type 1 and type 2 diabetes, the cause of each is very different. And the treatment is usually quite different, too. Some people, especially adults who are newly diagnosed with type 1 diabetes, may have symptoms similar to type 2 diabetes and this overlap between types can be confusing.

The American Diabetes Association offers a Risk Test to find out if you are at increased risk for having type 2 diabetes.

Some people with prediabetes may have some of the symptoms of diabetes or even problems from diabetes already. You usually find out that you have prediabetes when being tested for diabetes.

If you have prediabetes, you should be checked for type 2 diabetes every one to two years.

Results indicating prediabetes are:

  • An A1C of 5.7–6.4%
  • Fasting blood glucose of 100–125 mg/dl
  • An OGTT two-hour blood glucose of 140–199 mg/dl

Preventing Type 2 Diabetes

You will not develop type 2 diabetes automatically if you have prediabetes. For some people with prediabetes, early treatment can actually return blood glucose levels to the normal range.

Research shows that you can lower your risk for type 2 diabetes by 58% by:

  • Losing 7% of your body weight (or 15 pounds if you weigh 200 pounds)
  • Exercising moderately (such as brisk walking) 30 minutes a day, five days a week

Don’t worry if you can’t get to your ideal body weight. Losing even 10 to 15 pounds can make a huge difference.


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