Type 1 Diabetes And Pancreas: What’s The Connection?

The pancreas is a vital organ of the body's digestive and hormonal systems. It is located behind the stomach and feeds digestive enzymes into the intestine and hormones into the blood.

Dysfunction of the pancreas causes type 1 diabetes as the immune system attacks the cells that make insulin, the hormone that manages blood sugar levels. However, the pancreas and type 1 diabetes also affect each other in other ways.

Diabetes can damage the pancreas, causing pancreatitis. There are different kinds of pancreatitis, and they may lead to different symptoms and complications in type 1 diabetes.

This article will cover all of these, as well as a few common causes of pancreatitis and ways to treat and prevent it when you have type 1 diabetes.

How does type 1 diabetes affect the pancreas?

The pancreas is the main cause of type 1 diabetes symptoms as when it becomes damaged, it is unable to produce insulin. This causes high blood sugar, which can, in turn, cause inflammation that may affect the pancreas.

So, either damaging or improving the state of one affects the other. For someone with both pancreatitis and diabetes, this means that by managing their diabetes, they will reduce the severity of their pancreatitis. Similarly, by reducing the inflammation of their pancreas, they will improve their diabetes symptoms.

It's important to note that this doesn’t mean that having diabetes will always lead to pancreatitis or that pancreatitis will always cause diabetes.

Can pancreatitis cause diabetes, or can diabetes cause pancreatitis?

Diabetes can cause pancreatitis by increasing blood sugar, which leads to inflammation that may increase the risk of developing pancreatitis.¹

Some observational studies have seen that type 2 diabetics seem to have a two to three times greater risk of developing acute pancreatitis, but that might be because the two conditions share risk factors like:

• Gallstones

• High blood triglycerides

• Autoimmune disorders

• Medications

• Alcohol use

• Smoking

An analysis of the results of eight different studies showed that people with diabetes are at an increased risk of developing acute pancreatitis,² but it was not clear if they had an increased risk of chronic, gallstone-related, or gallstone-unrelated pancreatitis.

Pancreatitis can also cause type 3c diabetes,³ a form of diabetes caused specifically by damage to the pancreas, as inflammation affects the pancreas's insulin-producing cells.

This prevents the pancreas from producing insulin (like type 1 diabetes) or enzymes for digestion.

Patients with type 3c diabetes experience the same problems with regulating blood sugar as type 1 diabetics but also struggle to digest food like people with cystic fibrosis.

In some cases, acute or chronic pancreatitis can lead to type 3c diabetes as the damage to the pancreas becomes permanent, leading to scarring.

Pancreatitis 

Pancreatitis refers to inflammation of the pancreas, which can lead to permanent damage and scarring and prevent the pancreas from functioning normally.

It is commonly caused by gallstones, high blood lipids, high calcium levels, and excessive alcohol use. There are many different kinds of pancreatitis that someone can develop, some more serious than others.

Acute pancreatitis

Acute pancreatitis is when the pancreas becomes inflamed over a short period, and it is often caused by gallstones. It is much more common in adults than children but can happen at any age.

People with acute pancreatitis often feel better within a week and have no further problems. For others, acute pancreatitis can be severe and leave them with complications like severe tissue damage to the heart, lung, or kidneys, bleeding, cysts, and infection.

Symptoms of acute pancreatitis include:

• Sudden drastic stomach pain

• Nausea

• Vomiting

• Diarrhea

• Fever

It can be caused by several factors, including binge drinking of alcohol, infections, gallstones, or autoimmune diseases.

The cause of acute pancreatitis in some people is unknown.

Chronic pancreatitis

Chronic pancreatitis happens when the pancreas has been seriously damaged and can no longer work properly. This usually develops between the ages of 30 and 40, and most people with chronic pancreatitis have suffered from one or more attacks of acute pancreatitis earlier in their lives.

Symptoms of chronic pancreatitis commonly include frequent experiences of abdominal pain that may last several hours or days without there being an obvious trigger. Most symptoms of chronic pancreatitis are similar to those of acute pancreatitis but can also include diarrhea and weight loss.

Some people also experience nausea and vomiting. Chronic pancreatitis is usually caused by chronic alcohol abuse but can also be due to cystic fibrosis, high blood cholesterol, and fats. However, the cause of chronic pancreatitis is unknown in some cases.⁴

Hereditary pancreatitis

Hereditary pancreatitis is a rare genetic condition that leads to repeated attacks of pancreatitis. This is usually diagnosed in people younger than 20 but may also begin later in life.

Symptoms of hereditary pancreatitis are similar to other kinds of pancreatitis, including:

• Abdominal pain

• Nausea

• Vomiting

Hereditary pancreatitis is essentially chronic pancreatitis with a genetic cause.

Does type 1 diabetes increase the risk of pancreatitis?

Studies show that people with diabetes are at an increased risk of developing acute pancreatitis.

Some diabetes medications,⁵ like exenatide and sitagliptin, were previously thought to increase the risk of pancreatitis, but this no longer seems likely as these studies were unable to correctly estimate the risk due to confounding factors like varying patient compliance. In addition, several studies have suggested the opposite.

However, other diabetes medications, like Januvia and Byetta, have been found to be linked to an increased risk of pancreatitis.⁶

Signs and symptoms of pancreatitis in type 1 diabetics

Symptoms of acute pancreatitis include:

• Intense pain in the upper abdomen

• Nausea

• Vomiting

• Diarrhea

• Fever

Symptoms of chronic pancreatitis include:

• Regularly occurring pain in the upper abdomen

• Feeling bloated and gassy

• Abnormally bad-smelling stools

• Unexplained weight loss

• Jaundice

Common causes of pancreatitis in type 1 diabetics

Alcohol consumption

Excessive and regular alcohol use⁷ is thought to cause 17% to 25% of all cases of acute pancreatitis and 40% to 70% of all cases of chronic pancreatitis globally.

This usually involves more than five years of heavy drinking, but there have been rare instances of pancreatitis caused by a single binge-drinking event.

Alcohol can also make the pain worse in people with pancreatitis, and it’s generally recommended that people who are worried about their pancreas avoid alcohol as it can be damaging to the organ.

Gallstones

Gallstones form in the gallbladder and can sometimes block the duct that opens into the intestine.

Since this duct is shared by the pancreas and gallbladder, if the blockage isn’t cleared, it can cause a fluid buildup that travels back to the gallbladder and pancreas. This can be extremely painful but is also life-threatening and requires hospitalization.

Possible complications of pancreatitis in type 1 diabetics

Type 3c diabetes

Type 3c diabetes develops because of damage to the pancreas, which prevents it from producing insulin (as is the case in type 1 diabetes) and enzymes for digestion.

Patients experience the same problems with regulating blood sugar as type 1 diabetics but struggle to digest food like patients with cystic fibrosis. In some cases, acute or chronic pancreatitis can lead to type 3c diabetes as the damage to the pancreas starts to become permanent.

If you were already diabetic, pancreatitis would make management of your blood sugar harder and begin to affect digestion. That’s why it is so important to seek medical support if you notice symptoms of pancreatitis so that these can be managed quickly and further complications can be prevented.

How is pancreatitis treated in type 1 diabetics?

Pancreatitis treatment requires hospitalization and may involve using an oxygen mask, which would allow the blood to carry more oxygen to the tissues, especially those that are being damaged. Patients may also be put on a drip to prevent them from dehydrating.

In very serious cases where the damage has progressed a lot, it may be necessary to have treatment in a high dependency or intensive care unit.

A doctor would likely treat the symptoms of pancreatitis in this way but would probably also address the cause of pancreatitis, whatever that may be, and try to reduce inflammation.

Chronic pancreatitis treatment may be more long-term, and patients may be prescribed pain-relieving medicines to improve comfort and digestive enzymes to prevent malnutrition.

Depending on the cause, surgical intervention may be necessary.

Managing pancreatitis in type 1 diabetics

Type 1 diabetics would usually be managed in the same way as other patients with pancreatitis, but more insulin may be required as part of their treatment on account of their low insulin production before developing pancreatitis.

This would commonly involve some or all of the following and may also involve other management techniques, depending on the kind of pancreatitis and the specific cause.

Fasting and short-term intravenous feeding

Patients with pancreatitis may be told to refrain from eating for a few days to give the pancreas a break and be put on a drip to keep hydrated. If they are unable to eat for five to seven days⁸ or begin to show signs of malnourishment, they may be given a feeding tube to deliver nutrients directly to the stomach or small intestine.

If this is not possible, they may be given intravenous nutrition. This is not as effective as a feeding tube but is better than nothing when a feeding tube can’t be used.

Fluid therapy

Acute pancreatitis can cause dehydration due to low fluid consumption and vomiting. It can also cause a leakage of fluid from the blood vessels around the organ, worsening dehydration and decreasing blood pressure.

To counter this, patients may be given high amounts of fluid via a drip to prevent the tissue from being under-perfused (poor blood circulation through organs).

Several studies have shown that early fluid therapy is beneficial⁹ in the treatment of acute pancreatitis, and it is recommended in most instances. By keeping up fluids and blood pressure, blood can continue to circulate and provide nutrients to the tissues.

Pain management with narcotics (severe pain)

If the pain is severe or becomes unbearable, patients may be prescribed narcotics like morphine or codeine.

The narcotic used and the dose given will depend on the context, but they are usually only used when pain is moderate to severe, in addition to weaker pain medicines.

These drugs are unlikely to be prescribed for use out of the hospital, as they can be addictive.

Non-steroidal anti-inflammatory drugs (milder cases)

Milder pain might be treated with non-steroidal, anti-inflammatory drugs such as aspirin or ibuprofen. If the pain becomes more moderate to severe, these are likely to be used in addition to the narcotics already mentioned.

Non-steroidal anti-inflammatories are more likely to be prescribed for use outside of the clinical setting as well. Pain medications are usually prescribed in this way according to the WHO pain management ladder.¹⁰

Prevention of pancreatitis in type 1 diabetics

There are a few major risk factors for developing pancreatitis, including:

• Having gallstones

• Being overweight

• Regularly overindulging in alcohol

• Smoking

• Sudden weight loss

By managing these risk factors, people with type 1 diabetes can reduce their risk of developing pancreatitis and any associated complications.

Limit alcohol consumption

Alcohol has been found to cause up to one-quarter of all cases of acute pancreatitis and around two-thirds of all cases of chronic pancreatitis globally.

This usually involves years of heavy drinking, but occasionally pancreatitis is caused by a single binge-drinking event.

Eat a heart-healthy diet

The pancreas makes the enzymes that help you digest food. To reduce the risk of pancreatitis and pain caused by chronic pancreatitis, a diet low in saturated and trans fats can be helpful. This is because these kinds of fats lead to more digestive enzymes being released than needed, which may damage the pancreas.

Reducing cholesterol through diet reduces the risk of developing gallstones. It can also be helpful in reducing refined carbohydrates, as these cause the pancreas to release more insulin.

A heart-healthy diet encompasses all the goals of a diet for pancreatitis,¹¹ with the bonus of being easy on the heart.

Exercise regularly and lose excess weight

Regular low-intensity exercise,¹² such as walking, is thought to be beneficial for preventing pancreas-associated metabolic disorders, as it helps the pancreas to work more efficiently and therefore improves its functioning.

Obesity has been shown to increase the risk of developing gallstones and high blood cholesterol and may increase the incidence of acute pancreatitis.¹³

Exercising regularly and losing excess weight will reduce blood cholesterol and fat levels, thereby reducing the risk of developing gallstones and pancreatitis.

Skip crash diets

As tempting as it may be to try and lose weight quickly to lower the risk that your excess weight causes to the pancreas, this isn’t the best idea. Losing weight too quickly can cause blood cholesterol levels to increase.¹⁴

An increase in cholesterol increases the risk of gallstones and, therefore, pancreatitis. Crash diets are not the best idea for people with diabetes either, as they make controlling blood sugar levels more challenging.

It’s best to try and lose weight in a way that is sustainable long term, which generally means that it’s going to take a little longer, but it will also stay off.

Don’t smoke

Studies have shown that adults who smoke cigarettes are one and a half times more likely to develop pancreatitis¹⁵ than adults who don’t smoke.

To reduce the risk of developing pancreatitis, it would be best to stop smoking altogether. There are several resources available to people trying to give up smoking.

Ask for help from your nearest clinic, and they will point you in the right direction. You might also consider joining a local support group.

When to visit a doctor

If you have any reason to believe that you might be suffering from an attack of pancreatitis and you are at an increased risk of damaging your pancreas, there’s no harm in going to see your doctor. The outcomes of pancreatitis are better if treatment can be started earlier on.

However, if you are experiencing severe abdominal pain that lasts over 20 minutes, difficulty breathing, an accelerated pulse, fever and chills, weight loss, jaundice, or any new or deteriorating symptoms of pancreatitis, go to the hospital for emergency care as soon as possible.

The lowdown

Diabetes and the pancreas are closely related, and either of these can affect the other. Having diabetes does not automatically mean that you will develop pancreatitis, but your risk may be increased.

It’s important to look out for the signs and symptoms of pancreatitis and try to limit the risk of developing pancreatitis by managing diet and lifestyle factors. If you are concerned that you may be developing pancreatitis, see your doctor, as there are several treatment options. The earlier you get treatment, the better the outlook.