New-Onset Pancreatogenic Diabetes After Near-Total Pancreatectomy for Treatment of an Insulinoma (FS17-04-19)

Abstract

ObjectivesAn insulinoma is an insulin-secreting neuroendocrine tumor of the pancreas. This rare tumor induces severe hypoglycemia and is often resolved through total or near-total pancreatectomy (TP). With the removal of the pancreas, patients lose their insulin and glucagon function, thus inducing a Type 1 diabetic state with complete dependence on insulin replacement therapy. This diabetes type is known as Type 3c or pancreatogenic diabetes. MethodsThe patient was a 58-year-old female that presented with severe hypoglycemia (fasting blood glucose (FBG) 20–30 mg/dL). She was diagnosed with an insulinoma and underwent a near-TP. After surgery, she was diagnosed with new-onset Type 1 Diabetes Mellitus (T1DM) with FBG 137–207 mg/dL. The nutrition diagnosis was food- and nutrition-related knowledge deficit related to lack of exposure to information as evidenced by new diagnosis of insulin dependent diabetes secondary to near-TP. She began insulin therapy along with education on diabetes management using dietary approaches. She will be monitored for malabsorption from pancreatic insufficiency. An interdisciplinary approach was used for treatment including a registered dietitian, endocrinologist, diabetes educator, and primary care physician. ResultsThe literature on pancreatogenic diabetes treatment is scarce. Current American Diabetes Association standards of care do not set specific glycemic targets for Type 3c. Cases are treated as T1DM due to the reliance on exogenous insulin, yet there are some differences owing to the insufficiency of digestive enzymes and glucagon unique to Type 3c (e.g., patients may be more vulnerable to hypoglycemia). A multidisciplinary approach to bridge the patient’s knowledge gap was used for disease management. ConclusionsAn insulinoma induces severe hypoglycemia, while its treatment induces diabetes. In the absence of evidence-based guidelines, the clinical course and treatment is similar to that of T1DM due to the dependence on exogenous insulin. Thus, a multidisciplinary approach with focus on dietary strategies to manage glucose was used treat the disease. More research on the differences between Type 3c and T1DM and its subsequent treatment is necessary to minimize risk of chronic micro- and macro-vascular complications and hypoglycemia. Funding SourcesNA.