Bert's Update Re: Diabetes

[Guest guest]

Bert,

You wrote, " My blood sugar issues have grown worse. I believe some of my

transplanted

cells have hibernated or died and it may even be possible that I have begun

to develop resistance to insulin so that I have a blend of type I and type II

diabetes. "

I am sorry to hear that you have developed diabetes. You are definitely

right that this is not normal diabetes. My Endocrinologist says pancreatitis

induced diabetes is not Type 1 or Type 2; he calls it Type 11/2 or Type 3. He

says that the utilization of glucose is not only complicated by the endocrine

system, but the exocrine system of digestion, makes stabilization even more

difficult. It is hard to know how much food you actually absorb, even if you

have your carb to insulin ratio down. I understand the problem of going from 40

to 300 in a second's notice. There is also the problem of hypoglycemia

unawareness.

Since pancreatitis is a progressive disease, there are varying stages of

diabetes in persons with pancreatitis. Many may only have a mild stage for a

long time. By nature of this disease, it will progress, however, so effort

should be made to do what we can to avoid long-term complications. I see a

diabetes eye specialist. When the Neuro-Opthalmologist spoke at the symposium

one

year, he explained that they could often identify signs of renal disease and

cardiac disease long before the nephrologist or cardiologist. Early diagnosis

and intervention is the key to ensure optimum outcome.

If you have diabetes or even " early " diabetes, I recommend joining the

American Diabetes Association. They have a monthly magazine called Diabetes

Forecast that provides excellent information. In this month's magazine they

explain, in lay person's language, what an AiC really measures, what the blood

sugar

should be one, two, and three hours after you eat, and how giving Humalog

before, during, or after you eat depending on the glycemic index of the food

will avoid post meal highs or lows. It was fascinating! [if you visit the ADA

site or that for the American Heart Association or American Cancer Society,

you will see the goals that the Pancreatitis Association is seeking - I know we

dream big. You will also see the wide variety of volunteer opportunities

there, which could be implemented within the PAI.]

I know that most of the persons that have undergone the TP/ICT have

developed diabetes. This may dim support of the TP/ICT. There have been a few

cases,

however, that have successfully transplanted an adequate number of islet

cells. Those persons have had one thing in common, it seems; the TP/ICT was

done

as soon as the diagnosis of pancreatitis was obtained. The key appears to be

to remove the pancreas before all of the islet cells are damaged. There are

other reasons to have the TP/ICT so this is not always possible, this is just

the ideal. Often it is important to get the diseased pancreas out before the

disease spreads to the surrounding organs. Salvaging as many islet cells as

possible is a bonus, which previously was not possible. An early TP/ICT will

increase the probability that neurogenic pain from damage to the spinal

nerves innervating the pancreas will not occur. Of course, one last thought on

this issue is that with or without the TP/ICT if a person has pancreatitis,

diabetes will likely develop. The TP/ICT, as with any pancreatic surgery,

remains

an individual decision, as the prognosis depends on the cause of the

pancreatitis and primary area of involvement, i.e. tail, body, or head.

Karyn E. , RN

Executive Director, PAI

_www.pancassociation.org_ (http://www.pancassociation.org/)