November is Diabetes Awareness Month, a time when communities around the world bring attention to diabetes and its impact on millions of lives.
According to Abbot Laboratories, in South Africa, 7 per cent of adults aged 21 to 79 have type 1 diabetes. A large proportion of these remains undiagnosed. The global prevalence of adult diabetes has nearly doubled and is rising more rapidly in middle and low-income countries. Globally, about 1.5 million people have died as a direct result of diabetes in 2012.
Did you know that there is an important link between diabetes and the functioning of the pancreas?
Professor Jose Ramos, head of HPB Surgery, Wits University Donald Gordon Medical Centre, explained that the pancreas has two main functions. “It makes enzymes, which help digest proteins, fats, and carbohydrates before they can be absorbed in the intestine, and it makes hormones, the most important of which is insulin, which control how the body uses and stores sugar (glucose), its main source of energy.”
The link between the pancreas and diabetes
“Because the pancreas is the organ that produces insulin, it plays a major role in regulating blood glucose levels,” explained Prof. Ramos. “Type 1 diabetes occurs when the pancreas does not make enough or any insulin. Type 2 diabetes develops when the body cannot use insulin correctly.”
Insulin helps the body use the carbohydrates in food for energy. It transports glucose from the blood into the body’s cells. Glucose then provides the cells with the energy they need to function. If there is too little insulin in the body, cells can no longer take up glucose from the blood. As a result, levels of glucose in the blood rise, a condition known as having high blood sugar or hyperglycaemia. Hyperglycaemia is responsible for most of the symptoms and complications of diabetes. Type 1 and type 2 diabetes both involve the pancreas.
Diabetes is characterised by high blood sugar. “This results from insufficient insulin production or function, which can be one effect of problems with the pancreas,” Prof. Ramos continued. “People with diabetes experience high or low blood sugar levels at different times, depending on what they eat, how much they exercise, and whether they take insulin or diabetes medication.”
Type 3c diabetes, also known as pancreatogenic diabetes, is not as well-known compared to type 1 and type 2 diabetes. It develops when the pancreas becomes inflamed, or part of it is removed and eventually stops producing insulin.
The pancreas and PEI
According to Prof. Ramos, pancreatic exocrine insufficiency (PEI) is when the pancreatic functions start to falter and there are not enough exocrine enzymes produced or released to digest food properly. As a result, the body struggles to absorb a lot of vital nutrients such as certain vitamins that rely on fat absorption. “This usually happens when there is damage to the pancreas or part of the gland is removed, with a reduction in enzyme production, or as a blockage of the ducts that transfer the enzymes into the intestines. This can lead to several symptoms and complications,” he said. “Some people with diabetes (mainly type 3c) may also have PEI.”
It is unknown exactly what causes certain cases of PEI, but it may occur in people with insulin-dependent diabetes. Among other theories such as it being caused by a virus, PEI may be as a result of an autoimmune disease attacking the pancreas, just as type 1 diabetes is. In 2003, a study of over 1 000 diabetic patients found that insulin-dependent diabetics were more likely to produce abnormally low levels of exocrine pancreatic enzymes, resulting in PEI.
Between 25 per cent and 50 per cent of insulin-dependent diabetics were found to have developed pancreatic exocrine insufficiency (PEI), but this may not cause noticeable symptoms according to Prof Ramos.
Furthermore, another study published in 2011 found that obese women produced less elastase, one of the exocrine enzymes. A person’s development of type 2 diabetes may be related to obesity, and so they could well suffer from a form of PEI.
“Pancreatic enzyme replacement therapy (PERT) works by replacing the pancreatic enzymes normally made by a healthy pancreas – lipase, protease, and amylase,” he explained. “Your pancreas normally produces enzymes every time you eat, so PERT needs to replace those enzymes every time you eat.”
An inability to digest fat and proteins can lead to malnutrition. “Malnutrition can be avoided with PERT, which involves taking the digestive enzymes you need in the form of a capsule to assist the digestion of fat, carbohydrates and proteins. PERT can also help to reduce fatty diarrhoea, referred to as steatorrhoea, which contributes significantly to poor quality of life for patients. Diabetes is common due to damage to the pancreas and must be properly controlled to maintain health and well-being.”
Consult your physician if you want to know more diabetes and its link to the pancreas.
Related Article:
How to reduce your chances of developing diabetes this #DiabetesAwarenessMonth
