Several pancreatic diseases, in addition to trauma of the pancreas, can destroy much of the gland, resulting in an absence of insulin much like T1DM. One important difference of diabetes caused by diseases of the pancreas, however, is that the cells that make glucagon (which raises blood glucose when it's too low) are destroyed along with the cells that make insulin, so the drive to make more glucose is diminished. The following sections discuss some of the more prominent examples of destructive diseases of the pancreas.
The pancreas has cells that make digestive enzymes as well as insulin and other hormones. The digestive enzymes are carried to the intestine in a tube called the pancreatic duct, but if they leak into the tissue of the pancreas, they can digest and destroy the pancreas itself. This is what sometimes happens when the pancreatic duct becomes blocked by a gallstone or when a person drinks large quantities of alcohol.
The resulting inflammation of the pancreas is very painful and makes the patient extremely sick with the following symptoms:
^ Fever ^ Nausea ^ Rapid pulse ^ Severe abdominal pain ^ Swollen and tender abdomen ^ Vomiting
If the patient can't consume any more alcohol or the gallstone passes or is removed, the symptoms subside; however, if the patient has repeated bouts of this same condition or the pancreatitis becomes chronic, a form of diabetes results from the absence of insulin. Treatment is with insulin and avoidance of alcohol. The patient is usually very responsive to insulin, and the diabetes isn't hard to treat, although hypoglycemia may occur.
The occurrence of hyperthyroidism or hypothy-roidism (insufficient thyroid hormone) along with T1DM is greater than expected by chance. Many autoimmune diseases occur together in the same person. In particular, celiac disease (intolerance to gluten in wheat and other grains) is found in up to 5
percent of children with T1DM and causes anemia, abdominal discomfort, and diarrhea. Uptake of all foods is decreased in celiac disease, and that includes glucose, leading to more hypoglycemia in these patients.
As if children with cystic fibrosis (CF) didn't have enough to worry about, as they grow older, about 50 percent of them develop diabetes by age 30. Cystic fibrosis is associated with the following afflictions:
1 Frequent lung infections 1 Liver disease 1 Obstruction of the intestine
1 Reduced function of the part of the pancreas making digestive enzymes (see the previous section for more about these enzymes)
CF is an inherited disease that causes the secretion of thick, sticky mucous that clogs the lungs, leading to infection. The mucous also blocks the ducts carrying digestive enzymes, leading to decreased digestion of food in the intestine, increased digestion of the pancreas, and loss of insulin.
The life expectancy of patients with CF used to be very short, and there was little concern about the development of diabetes. With modern methods of CF management, however, many more patients are living to develop diabetes. They're subject to complications similar to those associated with autoimmune T1DM and must be screened for eye disease (see Chapter 5), high blood pressure, and kidney disease in the same way. For example, a study of 38 CF patients in Diabetes Care in December 2006 pointed out that the prevalence of eye disease in CF-associated diabetes is similar to autoimmune T1DM of the same duration, about 27 percent of patients. One great difference between autoimmune T1DM and diabetes caused by CF, however, is the absence of coronary artery disease in the latter form because the intestine has trouble absorbing fats.
Treatment for CF may involve lung transplantation. After the transplant, patients receive a drug called cyclosporine to block rejection of the lung. Cyclosporin is known to cause kidney damage, especially in combination with T1DM.
The diabetes associated with CF is treated with insulin and a more liberal diet than is typical for someone with T1DM because of the high calorie requirements in CF.
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What Is The Gluten Free Diet And What You Need To Know Before You Try It. You may have heard the term gluten free, and you may even have a general idea as to what it means to eat a gluten free diet. Most people believe this type of diet is a curse for those who simply cannot tolerate the protein known as gluten, as they will never be able to eat any food that contains wheat, rye, barley, malts, or triticale.