Pancreatogenic Type 3c Diabetes - Underestimated, Underappreciated and Poorly Managed

Oct 5, 2026

Uploaded by dabgoudw

Pancreatogenic type 3c diabetes refers to diabetes caused by pancreatic disease, including pancreatitis, cystic fibrosis, and pancreatic cancer. Diagnosis is difficult, and management is challenging due to metabolic instability after pancreatic tissue damage, with glucose swings from hypoglycemia to hyperglycemia and potential progression to brittle diabetes. A review outlines disease characteristics, diagnostic approach, complications, and management, supported by two clinical cases highlighting malnutrition, vitamin deficiencies, pancreatic exocrine insufficiency, and ongoing care needs.

LanguageEnglish

CategoryHealthcare

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Pages8

Reading Time20 min

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Nutrition Issues in Gastroenterology, Series #163

Pancreatogenic Type 3c Diabetes

Clinical Case 1

Clinical Case 2

Introduction

Prevalence of T3cDM

NUTRITION ISSUES IN GASTROENTEROLOGY, SERIES \#163 Carol Rees Parrish, M.S. , R. D. , Series Editor Pancreatogenic Type 3c Diabetes: Underestimated, Underappreciated and Poorly Managed Type 3c diabetes, also known as pancreatogenic diabetes, refers to diabetes resulting from pancreatic disease, including pancreatitis, cystic fibrosis and pancreatic cancer. It is difficult to diagnose, and for many, management is challenging due to erratic swings from hypoglycemia to hyperglycemia caused by metabolic abnormalities due to pancreatic tissue damage. This review aims to describe the disease along with its characteristics, diagnosis, complications, and management. CLINICAL CASE 1 A42 year old male with an eight-year history of alcohol-induced chronic pancreatitis was admitted from the ER. His current weight was 61Kg as opposed to his usual weight of 67Kg; his appearance was cachectic. He reported abdominal pain, intermittent diarrhea/steatorrhea along with periods of constipation, cramping, flatulence and poor appetite. He was not compliant with prescribed pancreatic enzyme replacement therapy (PERT), was still abusing alcohol, and was a heavy smoker for many years. He took opiates for relief of chronic, constant abdominal pain. His dietary intake was minimal over the past week and poor for several years. He was admitted and re-educated Sinead N. Duggan RD PhD, Research Fellow, 1.29 Department of Surgery. Professor Kevin C. Conlon MD, Professor of Surgery, 1.36 Department of Surgery, Trinity Centre for Health Sciences,Tallaght Hospital, Trinity College Dublin, Tallaght, Ireland regarding adequate dietary intake, prescribed oral nutritional supplements, and counselled on adequate and appropriate usage of PERT. Blood work revealed low levels of serum vitamins (25 OHD, vitamin E and vitamin A), normal fasting glucose and HbA1c. He was discharged after 3 days once he was established on adequate oral diet, micronutrient supplementation, PERT, and his pain medication had been adjusted. He was readmitted three weeks later with dehydration, fatigue, excess thirst and blurred vision. Fasting glucose was measured and was elevated at 250 mg/dl (13.9 mmol/L), therefore new diabetes mellitus (DM) was diagnosed. A referral was made to the endocrinology service for further evaluation. CLINICAL CASE 2 A 37 year old female with a five-year history of type 2 diabetes mellitus (T2DM) presented to the gastroenterology outpatient clinic complaining of a 6 14 PRACTICAL GASTROENTEROLOGY • MAY 2017 Pancreatogenic Type 3c Diabetes: Underestimated, Underappreciated and Poorly Managed NUTRITION ISSUES IN GASTROENTEROLOGY, SERIES \#163 month history of diarrhea (3-4 times per day), flatulence and bloating. She had taken anti-diarrheal medication with limited effect. She reported that the diarrhea tended to occur post-prandially, and was worse with larger,‘richer’ meals. She reported that she could see visible oil in the toilet pan after defecating, requiring several flushes. She also had a history of three episodes of hypertriglyceridemia-induced acute pancreatitis. On one occasion the acute pancreatitis had been deemed‘severe’ and she was hospitalized for several weeks, including one week in the critical care unit requiring enteral feeding. She was 88Kg (BMI 30.4 Kg/M2) . Given her history of acute pancreatitis, and the oily nature of her stools, pancreatic exocrine insufficiency (PEI) was suspected and a fecal elastase-1 test ordered. Results showed faecal elastase-1 of 95µg /g (indicating severe PEI) . She was referred to a pancreatologist for further workup and pancreatic imaging. INTRODUCTION According to the American Diabetes Association (ADA), there are four DM subgroups. Most are familiar with type 1 diabetes (T1DM), an immunemediated condition associated with beta-cell destruction leading to absolute insulin deficiency. T2DM is well recognized as a spectrum involving varying degrees of peripheral insulin resistance and

FAQs

What is type 3c (pancreatogenic) diabetes and what causes it?

Type 3c diabetes is diabetes resulting from pancreatic disease, including pancreatitis, cystic fibrosis, and pancreatic cancer. It is tied to damage affecting the exocrine pancreas.

Why is type 3c diabetes difficult to diagnose and manage?

Diagnosis is difficult because patients can show fluctuating metabolic patterns driven by pancreatic tissue damage. Management is challenging due to severe glucose swings between hypoglycemia and hyperglycemia, influenced by malnutrition and nutrient absorption changes.

How do the clinical cases illustrate nutritional and metabolic complications?

In Case 1, malnutrition and low serum vitamins are present, followed by new diabetes after dehydration and elevated fasting glucose. In Case 2, chronic diarrhea with steatorrhea leads to suspicion of pancreatic exocrine insufficiency, supported by low fecal elastase-1 and referral for pancreatic imaging and workup.

Oct 5, 2026

Uploaded by dabgoudw