The Connection Between EPI and Diabetes
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More than 25 million Americans have diabetes, and if you’re one of the millions living with the condition, you understand the crucial role your pancreas plays in producing insulin and preventing diabetes complications. But you might not know about exocrine pancreatic insufficiency, a condition that by some estimates could affect as many as half of people with insulin-dependent diabetes, as well as many of those with non-insulin-dependent diabetes.
The pancreas has two basic functions. The first is to make insulin and other hormones as part of what's called its endocrine function. The cells that make insulin (islet cells) exist in the pancreas alongside those that carry out the second function of the pancreas, called the exocrine function, which is the production of enzymes that help with digestion.
When you have exocrine pancreatic insufficiency, either your pancreas isn’t able to make needed digestive enzymes or important ducts in it are blocked, meaning that the enzymes can’t get to your digestive tract to break down food. A blockage in your pancreas can cause partial digestion of the pancreatic tissue itself, which in turn can damage the cells that produce insulin.
There’s more to the link between diabetes and exocrine pancreatic insufficiency than proximity, but researchers aren’t exactly sure what it is — although it sounds a lot like the riddle of the chicken and the egg. “Diabetes can be caused by exocrine disease, and exocrine pancreatic insufficiency can be caused by diabetes," explains Philip D. Hardt, a physician and researcher with the University Hospital of Giessen and Marburg in Giessen, Germany, and author of a review on this topic published inExperimental Diabetes Research."Both are possible.”
Diabetes and Pancreatic Insufficiency: Possible Connections
Theories about the relationship between exocrine pancreatic insufficiency and diabetes include:
- Diabetes damages pancreatic tissue.Autopsies of people who had diabetes have shown greater-than-normal amounts of inflammation and damage to pancreatic tissue, suggesting that having diabetes could increase the risk for exocrine pancreatic insufficiency. “People with diabetes have a much greater risk for acute pancreatitis compared to those without diabetes,” says endocrinologist Rita Kalyani, MD, an assistant professor of medicine at Johns Hopkins University in Baltimore.
- Pancreatitis causes diabetes.People who have a bout of acute pancreatitis appear to be at an increased risk for diabetes later on, Dr. Kalyani says, and people with chronic pancreatitis can also have diabetes. Pancreatitis and diabetes are both inflammatory conditions. Other pancreas diseases, such as cystic fibrosis, are also associated with diabetes.
- Both share autoimmune links.In about 1 percent of people, autoimmune dysfunction could cause the development of both pancreatitis and diabetes. This area of research is still being explored.
- Complications of diabetes may lead to exocrine pancreatic insufficiency.Diabetic neuropathy, a serious complication of diabetes involving nerve damage, may interfere with the signaling of pancreatic cells and neurons that carry out exocrine functions.
Research into all these connections needs to be expanded, Dr. Hardt says.
Signs and Symptoms of Exocrine Pancreatic Insufficiency
If you have diabetes, these are the signs and symptoms of exocrine pancreatic insufficiency to be aware of:
- Abdominal pain that can either be mild or severe
- Diarrhea or fatty, oily stools — a sign that pancreatic enzymes aren’t getting to your digestive tract to break down fats in the food you eat
- Weight loss
- Nausea or vomiting
- “Brittle” (labile or unstable) diabetes — some people with type 1 diabetes find that their blood sugar is extremely hard to control, possibly because the body is digesting carbohydrates poorly, or a damaged or inflamed pancreas is undermining their best efforts, Kalyani says.
Although the most common signs of pancreatic insufficiency are usually severe diarrhea and weight loss, these problems can have other causes as well. In fact, many people with diabetes complain of general stomach problems that don’t necessarily indicate an emergency health situation. Kalyani cautions that if these are new symptoms for you, you should see your doctor promptly or seek medical attention at a walk-in clinic.
Video: Rx Sugar Epi 1 h : How to Control Blood Sugar | Diabetes Cure |HINDI| शुगर (मधुमेह) | Dr.Education
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