Diabetes arising from pancreatic exocrine problems

The pancreas serves the dual function of being both an endocrine (hormone secreting) and exocrine (digestive enzyme producing) organ, and the interdependency of pancreatic endocrine and exocrine function is increasingly recognised. When pancreatic exocrine disease leads to diabetes mellitus the latter is termed pancreatogenic (or type 3c) diabetes mellitus, a distinct entity from type 1 or type 2 diabetes.¹

Pancreatogenic diabetes is frequently misclassified (often as type 2 diabetes) which can lead to suboptimal management. It is therefore important for the primary care practitioner to be alert to the possibility of type 3c diabetes. Treatment of both the diabetes and the pancreatic exocrine insufficiency (PEI), which leads to malabsorption, are necessary. Diabetes from pancreatic damage can be problematic to control with wide swings from hyperglycaemia to hypoglycaemia – so called ‘brittle diabetes’ – due to the nature of the hormone deficiency.