Pancreas and diabetes

Pancreas is an organ which is situated just behind the stomach in the upper abdominal region. It has two functions:

• Exocrine function: To secrete digestive enzymes which are carried through the ducts into the stomach for digestion process
• Endocrine function: To secrete insulin and glucagon directly into the blood to maintain normal blood sugar level. Any failure in endocrine function is responsible for diabetes

Diabetes is the result of a deficiency of insulin, a hormone found in the endocrine tissue of the pancreas. Every cell in the body needs glucose for energy and insulin helps in the glucose absorption at cellular level. If the pancreas doesn’t make enough insulin, glucose builds up in the bloodstream, leaving the cells starved for energy.

In Type 1 diabetes there is absolutely no production of insulin, therefore injecting insulin is the only treatment. In people with Type 2 diabetes, the pancreas produces insulin but the body is not able to use it. Muscle, fat, and liver cells do not respond to the produced insulin appropriately. This condition is known as insulin resistance.

People with insulin resistance need more insulin to help glucose enter the cells. The pancreas tries to keep up with the increased demand for insulin but eventually fails to produce enough. This causes excess glucose to build up in the bloodstream. Over time, the effects of repeated high blood sugar levels will damage beta cells (which produce insulin), further reducing the ability of the pancreas to produce insulin.
Causes of pancreas damage

Any form of extensive pancreatic damage may result in diabetes. Some of the common causes of pancreatic damage are listed below

1. Surgical excision of the pancreas (usually for a pancreatic tumour)

2. Acute and chronic pancreatitis

3. Cancer of the pancreas

4. Any inherited disorder affecting the pancreas (e.g. cystic fibrosis etc.)

Treatment options

Traditional treatment of diabetes includes the regulated use of insulin and/or oral medication, in addition to proper diet and exercise. There are also three advanced procedures that can potentially help in managing diabetes better:

1. Pancreatic islet transplant

2. Pancreas transplant

3. Artificial pancreas – which is the continuous blood glucose monitor with insulin pump and computerised algorithm

In pancreatic islet transplantation, islets are taken from the pancreas of a deceased organ donor. The islets are purified, processed, and transferred into another person. Once implanted, the beta cells in these islets begin to make and release insulin. This transplantation may help people with Type 1 diabetes live without daily injections of insulin.

A transplant of the pancreas is usually reserved for those with serious complications. Pancreas transplants are most often done when a patient also receives a new kidney. The pancreas transplant adds a further risk in this situation but offers significant advantage.

Artificial pancreas is an equipment consisting of insulin infusion pump, a glucometer, a computer which calculates the dose of insulin and controls rate of infusion of insulin by the pump. Artificial pancreas is still in an experimental phase.

Incorporating lifestyle changes can help reduce the risk of both diabetes and pancreatitis. Since pancreas is important for the management of insulin in the body, consulting the doctor in case of any complication is essential.

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