Pankreopriv

Pankreopriv is the medical name for a lack of pancreatic tissue. Mostly the term is used in connection with a special form of diabetes, the so-called pancreatic diabetes mellitus . The proportion of pancreatic diabetics among diabetes patients is approx. 8%.

If the pancreas fails completely or partially in its function (> 90% parenchyma loss), it may a. to an absolute insulin deficiency and consequently to a diabetic metabolic situation. Due to the exocrine pancreatic insufficiency associated with the destruction of the pancreatic tissue , maldigestion with steatorrhea , emaciation, protein deficiency edema or ascites can also occur.

Other common names for pancreatic diabetes mellitus are type 3c diabetes according to the WHO classification of 1999, which lists eight categories under “Other specific diabetes types”, or secondary diabetes due to a disease of the pancreas.

Diseases of the pancreas that lead to the loss / destruction of pancreatic tissue can include:

Inflammation of the pancreas ( pancreatitis ), often caused by gallstones or alcohol abuse
Pancreatic cancer that requires partial or complete removal of the pancreas ( pancreatectomy )
Cystic fibrosis
Hemochromatosis

There are the following recommendations for the
therapy of pancreatogenic diabetes mellitus: The therapy of pancreatogenic diabetes aims to normalize blood sugar, avoid complications and set the HbA1c value to approx. 7%. The therapy consists of alcohol abstinence and individual nutritional therapy. If possible, the patient should have six low-fat, mostly vegetable, low- fiber meals. All meals should be substituted with digestive enzymes ( pancreatins , fungal enzymes ), the substitution should take place during the meal.

The patient should take a rigorous self-monitoring of blood glucose to avoid putting themselves at risk from hypoglycaemia . He should generally not take oral anti-diabetic drugs . An intensified insulin therapy is optimal. If this is not possible, three injections of short-acting insulin and one injection of an evening intermediate insulin are advisable.

In patients with chronic pancreatitis, intensive interdisciplinary therapy should be carried out if possible. The prognosis of these patients can be improved if pancreatologists, addiction doctors, pain therapists, and endocrinologists work together.

Individual evidence

↑ Philip D. Hardt, Annette Hauenschild, Jens Nalop, Axel M. Marzeion, Clemens Jaeger, Joachim Teichmann, Reinhard G. Bretzel, Manfred Hollenhorst, Hans U. Kloer: High prevalence of exocrine pancreatic insufficiency in diabetes mellitus: A multicenter study screening fecal elastase 1 concentrations in 1,021 diabetic patients. In: Pancreatology. Vol. 3, No. 5, 2003, pp. 395-402, doi : 10.1159 / 000073655 .
^ World Health Organization Department of Noncommunicable Disease Surveillance: Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications. In: WHO / NCD / NCS / 99.2. 1999, accessed on April 20, 2017 (PDF; 1.8 MB, English).
↑ Maximilian Galonska, Ines Hartje, R. Büchsel: Pancreatic diseases and diabetes mellitus. In: Journal of Clinical Endocrinology and Metabolism. Vol. 5, No. 3, 2012, pp. 26–30, ( digital version (PDF; 1.9 MB) ).

[1] Philip D. Hardt, Annette Hauenschild, Jens Nalop, Axel M. Marzeion, Clemens Jaeger, Joachim Teichmann, Reinhard G. Bretzel, Manfred Hollenhorst, Hans U. Kloer: High prevalence of exocrine pancreatic insufficiency in diabetes mellitus: A multicenter study screening fecal elastase 1 concentrations in 1,021 diabetic patients. In: Pancreatology. Vol. 3, No. 5, 2003, pp. 395-402, doi : 10.1159 / 000073655 .

[2] World Health Organization Department of Noncommunicable Disease Surveillance: Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications. In: WHO / NCD / NCS / 99.2. 1999, accessed on April 20, 2017 (PDF; 1.8 MB, English).

[3] Maximilian Galonska, Ines Hartje, R. Büchsel: Pancreatic diseases and diabetes mellitus. In: Journal of Clinical Endocrinology and Metabolism. Vol. 5, No. 3, 2012, pp. 26–30, ( digital version (PDF; 1.9 MB) ).