From the Guidelines
Uncontrolled diabetes and pancreatitis require immediate attention, with a focus on stabilizing blood glucose levels and treating the pancreatitis, as the relationship between the two conditions is bidirectional and can exacerbate each other. The management of these conditions is complex and requires a comprehensive approach.
Key Considerations
- For acute pancreatitis with diabetes, insulin therapy is typically necessary, often as an intravenous infusion in hospital settings, transitioning to subcutaneous insulin as the condition improves 1.
- Oral diabetes medications are usually temporarily discontinued during acute episodes.
- For chronic pancreatitis with diabetes, insulin therapy is often required as pancreatic damage affects both digestive enzyme and insulin production 1.
- Metformin may be used in milder cases if kidney function is normal.
- Blood glucose monitoring should be frequent, aiming for levels between 140-180 mg/dL during acute illness.
- Nutritional support is crucial, typically starting with clear liquids and advancing as tolerated, while maintaining adequate hydration.
- Pain management should avoid NSAIDs which can worsen kidney function.
- Pancreatic enzyme supplements may be needed for proper nutrient absorption in chronic cases.
Underlying Pathophysiology
The connection between diabetes and pancreatitis exists because pancreatitis damages the insulin-producing cells, worsening diabetes control, while poorly controlled diabetes increases inflammation and can trigger or worsen pancreatitis 1.
Specific Considerations for Chronic Pancreatitis
- Patients with chronic pancreatitis are at risk of malnutrition and should be screened and supplemented accordingly 1.
- Osteoporosis and increased fracture risk should be acknowledged in patients with chronic pancreatitis, and preventive measures should be considered.
- Type 3c (pancreatogenic) diabetes is a complication of chronic pancreatitis, characterized by decreased glucagon secretion and an increased risk of hypoglycaemia 1.
- Diabetes control is further complicated by poor diet, malabsorption, and (for some) alcoholism, and therefore those with type 3c diabetes have clinical characteristics and therapeutic goals that are different from that of type 1 and type 2 diabetes patients.
From the Research
Uncontrolled Diabetes and Pancreatitis
- Uncontrolled diabetes can be a complication of acute pancreatitis, as stated in the study 2, which discusses the epidemiology, pathophysiology, and management considerations of diabetes following acute pancreatitis.
- The pathophysiology of acute pancreatitis-related diabetes is poorly understood and is probably multifactorial, according to the study 2.
- Acute pancreatitis can cause substantial morbidity and significant mortality, especially in cases of severe disease with persistent organ failure, as mentioned in the study 3.
- The initial management of acute pancreatitis is crucial and involves goal-directed moderate fluid resuscitation, analgesia, and enteral nutrition, as stated in the study 4.
- Patients with severe acute pancreatitis may require intensive respiratory and cardiovascular management, interventional treatment, blood purification therapy, and nutritional support, as recommended in the study 5.
- Enteral feeding is superior to parenteral nutrition for patients with severe acute pancreatitis, according to the study 5.
- Prophylactic antibiotic administration is recommended to prevent infectious complications in patients with severe acute pancreatitis, as stated in the study 5.
- The study 3 highlights the importance of proactive management to prevent or reduce the risk of recurrence and progression to chronic pancreatitis, which can increase the risk of pancreas cancer.
- Nurses should have a good understanding of the physiology surrounding acute pancreatitis and the significance of close and careful monitoring of patients with this condition, as mentioned in the study 6.