From the Guidelines
Diabetes and pancreatitis are closely interconnected conditions that can significantly impact morbidity, mortality, and quality of life, requiring careful management to mitigate these risks. The relationship between diabetes and pancreatitis is bidirectional, with diabetes increasing the risk of developing acute pancreatitis and pancreatitis potentially leading to diabetes due to inflammation damaging insulin-producing cells 1.
Key Considerations
- People with diabetes are at an approximately twofold higher risk of developing acute pancreatitis 1.
- Conversely, prediabetes and/or diabetes may develop in approximately one-third of patients after an episode of acute pancreatitis 1.
- The use of incretin-based therapies for diabetes has been associated with a potential increased risk of pancreatitis, although results are mixed and causality has not been established 1.
Management Approach
For patients with both diabetes and pancreatitis, blood sugar management is crucial, typically requiring insulin therapy rather than oral medications. Initial insulin regimens often start with basal insulin at 0.2-0.3 units/kg/day, with additional mealtime insulin at 0.1-0.2 units/kg/day divided between meals 1. During acute pancreatitis, more aggressive insulin therapy may be needed with frequent monitoring every 2-4 hours.
Additional Recommendations
- Pain management should avoid high-dose opioids which can worsen outcomes.
- Nutritional support is essential, starting with clear liquids and advancing as tolerated, while maintaining adequate hydration.
- Alcohol avoidance is critical as it can worsen both conditions.
- Regular monitoring of pancreatic enzymes (amylase, lipase) and HbA1c levels helps track disease progression 1.
This approach addresses both the inflammatory process of pancreatitis and the metabolic demands of diabetes, recognizing that the pancreas serves both digestive and endocrine functions, and prioritizes minimizing morbidity, mortality, and improving quality of life 1.
From the Research
Diabetes and Pancreatitis: An Overview
- Diabetes mellitus, particularly type 2, has been associated with an increased risk of acute pancreatitis [ 2, 3 ].
- Metformin, a commonly used medication for type 2 diabetes, can increase the risk of lactic acidosis, especially in patients with risk factors for acute kidney injury [ 4, 5 ].
- The use of insulin in patients with acute pancreatitis may be associated with an increased risk of progression to recurrent acute pancreatitis or chronic pancreatitis, regardless of diabetes status [ 6 ].
Lactic Acidosis and Metformin
- Lactic acidosis is a rare but potentially life-threatening complication of metformin use, with a mortality rate of approximately 50% [ 4, 5 ].
- Patients with diabetes mellitus taking metformin are at increased risk of developing lactic acidosis, especially those with risk factors for acute kidney injury [ 4, 5 ].
Diagnosing Acute Pancreatitis in Diabetes Mellitus
- Patients with diabetes mellitus are at increased risk of acute pancreatitis, and diagnosis can be challenging due to elevated serum lipase and amylase levels in the absence of acute pancreatitis [ 3 ].
- Hypertriglyceridaemic pancreatitis, which can occur in individuals with diabetes mellitus, may be associated with falsely normal lipase and amylase levels due to laboratory interference [ 3 ].