Living with diabetes blog

Diabetes after pancreatectomy: A unique challenge

By Nancy Klobassa Davidson, R.N. and Peggy Moreland, R.N. October 24, 2013

I came across an article about the first total pancreatectomy (removal of the pancreas), which was performed at Saint Marys Hospital in Rochester, Minn., on July 14, 1942. The patient didn't have diabetes, but after the removal of her pancreas, she did. This individual was able to live an additional 29 years without her pancreas and died in 1971 at the age of 79. Yes, you can live without a pancreas, but it does involve a lifetime of managing type 1diabetes and daily pancreatic enzyme replacement.

The decision to do a total pancreatectomy is often made when no other surgical or medical options are available. When your pancreas is removed, you instantly have type 1 diabetes. Some reasons total pancreatectomies may be done include trauma, unmanageable pain from pancreas inflammation (pancreatitis), certain types of cancer or tumors, and a family history of pancreatic cancer. "Pancreatogenic diabetes" is a new term used for individuals who get diabetes after removal of all or part of the pancreas.

Only a very small number of people have the pancreas removed proactively. These people have an inherited type of pancreatic cancer and have seen several family members develop pancreatic cancer and die. I'm no expert on gene mutation; the only reason I bring this up is to inform you that there are individuals out there dealing with this and developing type 1diabetes immediately after surgery.

I've worked with people before and after total pancreatectomies, and I feel that they're faced with more challenges then a typical person with a new diagnosis of type 1 diabetes. In some ways, they can prepare ahead of time, but knowing it and living it are two different things.

From my observations, it seems that people who have pancreatogenic diabetes struggle with more variable (up and down) blood glucose levels. One reason is the lack of glucagon, a hormone excreted by the pancreas that raises blood glucose, giving warning and preventing hypoglycemia or low blood glucose. People without a pancreas must monitor the blood glucose closely to avoid hyperglycemia and hypoglycemia.

It's also important that those without a pancreas have a glucagon kit available and family members or friends who are trained to give them a glucagon injection during times when they experience a low blood glucose and are unable able to identify it or treat themselves or become unconscious.

My hat is off to individuals who live and manage pancreatogenic diabetes. If you're interested in finding out more about this type of diabetes, try the following websites.

www.mywhipple.org
www.amensupport.org
http://hagemanfoundation.org

Have a good week.

Regards,

Nancy

Oct. 24, 2013