The principles of the treatment of pancreatic diabetes

Abstract

In pancreatic diabetes the whole of the Langerhans islets are damaged, which means that both the beta-cells and the alpha-cells are damaged. Unpredictable oscillations of blood glucose level are common due to malabsorption and maldigestion and one may count with explicit proneness to hypoglycaemia. The defence against hypoglycaemia also diminishes due to the damage of glucagon secretion, which is often aggravated by alcohol consumption. If normoglycaemia in pancreas diabetes cannot be achieved with appropriate diet, insulin treatment is necessary. Oral antidiabetic agents are not expedient. The best metabolic state can be achieved at the expense of the least amount of hypoglycaemia by giving the necessary minimum portions of insulin in an intensive, conservative insulin therapy. There is not enough experience with insulin analogs in pancreatic diabetes, but it seems expedient to use long-acting insulin analogs. The treatment of pancreas diabetes is a teamwork in which everybody has a decisive role, the gastroenterologist, the diabetologist, the dietitian and the diabetes nurse as well.