17/08/2025
Type 3c Diabetes(Pancreatogenic Diabetes):—
This diabetes can be due to -1)Acute or chronic pancreatitis.
Chronic pancreatitis accounts for around 75% of cases of type 3c diabetes.
2)Other causes include pancreatic cancer,pancreatic surgery,trauma to pancreas,cystic fibrosis and haemochromatosis.
Type 3c diabetes often occurs quite early from diagnosis of pancreatic cancer.
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Why it is important to accurately identify type 3c diabetes?
1-Patients with type 3c diabetes are nearly twice as likely to have sub-optimal glycemic management and
2-They are at increased risk of hypoglycaemia.
Hypoglycaemia in these patients can be quite longer lasting.This is because of loss of GLUCAGON production from the alpha cells in the pancreas.So this lack of glucagon blunts the response to hypoglycaemia in these patients.
Additionally people living with type 3c diabetes are much more likely to need INSULIN within 5 years of diagnosis of their diabetes.
Specific features that may point towards type 3c diabetes or pancreatic exocrine insufficiency include-diarrhoea & steatorrhoea(fatty,frothy,foul smelling stool that floats), abdominal discomfort,flatulance and bloating,weight loss,fatigue and erratic blood glucose management.
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Useful tests —-
1)Fecal elastase 1 level in stool-Low level of f***l elastase 1 are suggestive of pancreatic exocrine insufficiency.
2) plasma C-Peptide levels are generally low.
3)pancreatic antibodies are absent.
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Management:-
Appropriate management of malabsorption with pancreatic enzyme replacement therapy.
Type 3c diabetes does carry an increased risk of osteopenia & osteoporosis due to possible VIT D malabsorption.So Vit D supplementation should also be considered.
Type 3c diabetes itself sadly carries an increased risk of PANCREATIC CANCER.So we should remain clinically vigilant to this .
Incretin based therapies should be avoided.These agents are thought to be associated with pancreatitis and potentially worsening of gastrointestinal symptoms with these therapies.
We can use Metformin.Metformin have possible protective effect against pancreatic cancer.
Sulfonylureas such as glipizide are less effective due to declining beta cell function in type 3c diabetes and their increased risk of hypoglycaemia.
SGLT2 inhibitors can be considered although there is an increased risk of diabetic ketoacidosis(insulin deficiency in type 3c diabetes).
Ultimately INSULIN is required for most patients with type 3c diabetes to deal with this INSULIN DEFICIENCY.HbA1c is markedly elevated in these type of patien
