Our buddy the pancreas - endocrine vs exocrine functions

[StillMamamia]

Does anyone know if, in Type 1 Diabetes, the exocrine functions of the pancreas are also compromised? If so, which? What can we do about it?
Are there tests for this?
Thanks.

[LantusFiend]

Exocrine function is generally just enough impaired to make it hard to test for other pancreatic disease
It is worth noting that the endocrine functions other than production of insulin do tend to be affected. That's why symlin is on the market; we aren't making amylin.






Here's an abstract you might find interesting:


Follow-up of exocrine pancreatic function in type-1 diabetes mellitus.
Creutzfeldt W, Gleichmann D, Otto J, St?ckmann F, Maisonneuve P, Lankisch PG.

Department of Internal Medicine, Division of Gastroenterology and Metabolism, University of G?ttingen, G?ttingen, Germany.

Comment in:

Digestion. 2005;72(2-3):69-70.

In a previous study, mild to moderate exocrine pancreatic insufficiency, as measured by the secretin-pancreozymin test, was found in 23 (43%) of 53 patients with type-1 diabetes mellitus. Of these 53 patients, 20 (7 of whom initially had an abnormal secretin-pancreozymin test) were available for a follow-up examination 11 years later. Of the 7 patients with abnormal exocrine pancreatic function at the first test, 5 remained abnormal and 2 became normal, whereas of the 13 patients with initially normal pancreatic function the test result remained normal in 11 patients and became abnormal in 2. In these 2 groups the test result did not differ significantly between both tests. However, exocrine pancreatic function had returned to normal or had become abnormal in 2 patients, respectively, at the second test. In the 3 patients with exocrine pancreatic insufficiency at the first and second tests, the lipase level had not fallen below 10% or less than the normal level at which steatorrhea occurs and therapy is required. There was no significant correlation between the duration of the diabetes and the test results for both time points of investigation. The data suggest that mild to moderate exocrine pancreatic insufficiency found in type-1 diabetes is due to an early event in the course of the diabetes and does not progress. Therefore, this finding is of minor clinical importance and expensive pancreatic enzyme substitution will not be required. Copyright (c) 2005 S. Karger AG, Basel.

[fredntan2]

can anyone translate?

[StillMamamia]

I think it means YDMV.

My scholarly English to human English translator is broken.

[LantusFiend]

Yes.

The islet cells are just 2% of the pancreas. The beta cells, which produce insulin, are only 85% of the islet cells. For a person to be diagnosed with type 1 diabetes, their beta cells must be mostly or totally nonfunctional.

That leaves another 99% of the pancreas that may or may not be damaged. So, what's happening with the rest of the pancreas?

And the answer to that is that YDMV.
In type 1 diabetes, there is usually damage to the rest of the islet cell, not just the beta cells, and the beta cells don't just stop making insulin.

So the body stops making insulin (or at least stops making enough).
It makes way less (or sometimes none at all) of cpeptide, which is produced with insulin.
It makes less amylin, which is also produced alongside insulin. Amylin is available as the medication symlin.
That's the definites.

Then the rest of the islet cells:
In most newly dxd type 1s, the alpha cells, which make glucagon, function pretty normally.
By the end of the first year on insulin, most type 1s are producing too much glucagon right after meals, and too little the rest of the time; about 90% have some abnormal glucagon profile. This varies a lot. It contributes to mealtime spikes too.

Unlike the hormones I just discussed, lipase and amylase are produced in the pancreas outside of the islet cells.
Lipase production is below normal in about half of type 1 diabetics, but not VERY abnormal, and it doesn't get worse with time. A few studies (that I haven't quoted) have shown that most type 1 adults, but not type 2 adults, do not produce extra lipase in response to meals, which is not normal. I don't know that that means anything at all.
I've read even fewer studies on amylase production in type 1 diabetics.



So maybe that still doesn't translate. Here's as simple as I can get: When a person has no pancreatic function at all, usually because they were born without a pancreas, had it removed due to cancer, or have cystic fibrosis, then they need to take insulin and they need to take enzyme pills with everything they eat. The pancreatic enzymes help with digestion of food, and without them, you'd die. Unlike with insulin, taking too much doesn't have fatal side effects.
Most diabetics' pancreases are making enough pancreatic enzymes to digest their food; the only thing the pancreas is BADLY forgetting is our insulin.

Hope this made sense.


Edit: Yes, you can get your cpeptide, amylin, glucagon, amylase, and lipase levels measured. Amylase and lipase are usually only measured to see if a person has pancreatitis; cpeptide is usually measured because it corresponds to how much insulin a person is making; amylin is measured in people thinking about going on symlin, and I don't know of any reason other than research that glucagon levels are measured.

[StillMamamia]

Thank you Jonah. That made perfect sense.

[fredntan2]

thanks
that helps

[SarahsMum]

Hi

I know this thread is quite old but thought Id add my knowledge.

My daughter was born without a Pancreas, so we have both no Endocrine Function and no Exocrine Function.

Basically the exocrine function of the pancreas is alot of hormones and digestive enzymes.

the hormones themselves are also produced by other organs so not an issue, however the lack of Digestive Enzymes is a very big issue.

We use Creon to replace her enzymes. They come on capsule form and depending on the level of pancreatic insufficiency depends on how many you need to take.

Probably the biggest problem is getting the right dosage. If you underestimate, you cant absorb the nutrients ?(including carbs), if your not absorbing carbs, you have nothing to sustain your blood sugars above hypo level and you will also suffer extremely painful stomach cramping and the runs.

Also you can overdose on Creon and it can be highly dangerous. The enzymes allow our intestines to absorb the foods, but take too much enzyme and your dile ducts can collapse causing a bowel obstruction, which can only be resolved with surgery. Previous bowel surgery increases the risk of bowel obstructions from enzyme replacement therapy

Finally - The biggest thing to look out for exocrine insufficiancy is offensive smelling stools and also they will look "fatty/oily", a quick test on how much fat is in your stool will tell if you have malabsorbtion

Hope that helps

[StillMamamia]

Thank you Karina. My goodness, you have a lot to deal with. How is Sarah doing??

[SarahsMum]

Just thought id add the most important of the Enzymes is Lipase, Amylase and Protease. Out Pancreas make hundreds of enzymes but these 3 are critical for digestion of food.

The main problem is there lifespan once taken

Once a person has taken the Creon - the medication only lasts for 20 mins.

So you take capsules ( or in our case we empty the capsules into a teaspoon of apple puree. The apple protects the grannules against the stomach acids) and you then only have 20 mins to finish your meal/snack.

It is based purely on fat content though, we tend to look at foods with very little fat content. As Sarah has no pancreatic function she need 1 capsule of creon per 2 grams of fat. The recommended safe dose is 10,000 units of lipase per kg/per day. Sarah's capsules contain 5000 units of lipase each.

So Sarah having no function at all and is 7kgs, so the safe level for her is 70,000 units per day.

Currently to be able to absorb her food and with us being extremely careful of the fat content of the foods she is eating is on 24 capsules per day which is 120,000 units of Lipase, well above the safe level.

Just another isolating things we deal with. Our Drs have no guide, they havnt treated a child with her condition before, there is no precedent, they are guided purely by case studies.