Diabetes

Your Pancreas Isn't Dead!

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If you’re like me and live with diabetes, you may have heard a joke or two about being the proud owner of a useless pancreas. Or that you're now part of the #deadpancreasgang (they even have stickers!). 

We like to keep things fun around here! 😄

Your Pancreas Is Not Dead

But in all seriousness, if you have diabetes, your pancreas is not actually dead!
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The pancreas is an incredibly complex organ that is both an endocrine and exocrine gland.

On the endocrine side, beta cells secrete insulin, alpha cells secrete glucagon, and I, L, & K cells (and more!) secrete important metabolic hormones like GLP-1, GIP, and CCK into our bloodstream. ⁣⁣⁣
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On the exocrine side, duct cells secrete bicarbonate to neutralize stomach acid, and acinar cells secrete enzymes for digesting fat, proteins, and carbohydrates into our intestine. ⁣⁣⁣
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Without functioning beta cells, the regulation of the other endocrine hormones can get wonky, but they usually still work. There is some evidence that alpha cells atrophy without feedback from beta cells, causing poor glucagon response to hypoglycemia, but that’s for another rabbit hole, another time.
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Importantly, without beta cells, the exocrine system usually keeps working just fine, aiding in digestion so your body can break down and absorb the macronutrients you eat.

When this doesn’t work, it’s called exocrine pancreatic insufficiency (EPI), and causes abdominal discomfort, bloating, loose and greasy stools, and in severe cases, weight loss and symptoms of vitamin deficiencies. ⁣⁣⁣

But It Could Be a Little Wonky

⁣⁣⁣EPI is usually caused by things like chronic pancreatitis, cystic fibrosis & other rare genetic diseases, and small bowel pathologies (e.g. celiac disease), but it is actually also not uncommon in diabetes.

One literature review estimated that anywhere from 25-74% of us with type 1 diabetes have EPI, while roughly 28–54% of those living with type 2 diabetes have it.

While EPI in diabetes is associated with longer disease duration and higher insulin requirements, no one is sure why this is.

It could be lack of insulin/wonky regulation of other endocrine hormones failing to stimulate the exocrine cells, autoimmunity, or (since it’s associated with disease duration) diabetic neuropathy, since pancreatic exocrine function (PEF) is also under neural control. ⁣⁣⁣
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The moral of the story is that your pancreas is (probably) not dead at all! And that beta cell function is only a tiny sliver of what our otherwise hard-working pancreas does for most of us every single day.

It’s very much alive! And still getting things done in there. So maybe, we call it the “Wonky Pancreas Gang.” 🤟 Welcome to the club!

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JH
Jordan Hoese, MD, MPH
Jul 18, 2019

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