Diabetes Can Be Controlled in Patients After Pancreas Removal
Removing the entire pancreas in patients with cancer or precancerous cysts in part of the organ does not result in unmanageable diabetes — as many physicians previously believed, research at Mayo Clinic in Florida has found. The study, published online Sunday in the journal HPB Surgery, evaluates how well patients who had their entire pancreas removed could control their resulting diabetes. The pancreas produces insulin to remove sugar from the blood, so when the organ is gone, insulin must be replaced, usually through an external pump or with injections.
The researchers examined control of insulin over several years in 14 patients whose entire pancreas was removed. They compared their findings with 100 people with type 1 diabetes, and must use insulin replacement. They found both groups had little difficulty controlling their blood sugar, and no complications resulted.
The findings should reassure physicians and surgeons that removing the entire pancreas is reasonably safe and effective, says senior investigator Michael B. Wallace, M.D., chair of the Division of Gastroenterology & Hepatology at Mayo Clinic in Florida.
“What has confounded surgery for pancreatic cancers and precancerous cysts for a long time is the notion that if the entire organ is removed, patients will have great difficulty in controlling the resulting diabetes,” Dr. Wallace says. “Most surgeons try to leave as much of the pancreas as possible”.
“What we have shown here is that, due to wonderful recent improvements in insulin therapy, patients without a pancreas can control their blood sugar as effectively as type 1 diabetes patients can,” he says.
Diabetes that is not well controlled can lead to many health complications. Diabetes can affect the eyes, heart, nerves and kidneys if blood-sugar levels are not kept in check. Given the seriousness of diabetes, it is always best to speak with a physician about the right treatment plan. Some patients may be able to control diabetes with dietary changes, while others may need medications and/or insulin.
Type 1 Diabetes
After a meal, the body breaks down the food into glucose to be used for energy. The hormone insulin must be present for the cells to use the glucose. If this process is not working correctly, blood-sugar levels can get too high and diabetes can develop. Type 1 diabetes occurs when the body’s immune system attacks and destroys the insulin-producing cells of the pancreas. To survive, Type 1 diabetics need multiple insulin injections throughout the day or the use of a pump that continuously injects insulin into the body. However, a healthy diet is still important to fully control blood-sugar levels.
Pre-diabetes
Pre-diabetes, or insulin resistance, is diagnosed when blood-sugar levels are starting to get high but are not high enough to be diagnosed as diabetes. At this stage, a combination of diet and exercise may be all that is needed. The National Diabetes Information Clearinghouse suggests exercising for 30 minutes on most days of the week. Losing just 5 to 7 percent of body weight and eating a diet low in fat and cholesterol may prevent or delay Type 2 diabetes by nearly 60 to 70 percent. It is important to use a combination of diet and exercise. A healthy diet will prevent spikes and fluctuations in blood-sugar levels, and exercise will help the body use insulin more efficiently.
Type 2 Diabetes
Type 2 diabetes, which accounts for about 90 to 95 percent of all diabetes cases, is diagnosed when the pancreas does not make enough insulin, or the cells cannot use it properly. Controlling diet plays a large role in managing Type 2 diabetes; however, exercise must also be part of the plan. The Cleveland Clinic recommends relearning what an actual serving size is, especially when it comes to carbohydrates, as carbohydrates affect blood-sugar levels the most. A general guideline is to eat no more than 60 to 75 g of carbs at each meal, and some diabetics may need to go lower. Since each case is unique, it is important to test after every meal to see how the body is responding. Regular self-testing and testing at checkups are the only ways to know if your diet and exercise plan is enough to control your diabetes, or if medication is necessary.
Although this study was small, Dr. Wallace says the findings are mirrored in the experiences of patients treated at Mayo Clinic in Florida with total pancreas removal.
Even though the approach of preserving as much of the pancreas as possible benefits most patients, leaving part of the pancreas in some patients may put them at risk of developing hard-to-detect cancer in the remaining organ, he says.
Similarly, patients who have a potentially precancerous cystic condition known as intraductal papillary mucinous neoplasm in part of the pancreas can develop the same cysts in the part of the pancreas that remains after partial removal, he says. Removing the entire pancreas eliminates the possibility of recurrence in the residual pancreas.
Many who progress to diabetes could have prevented it by maintaining a lower and not necessarily even a near-ideal body weight. For those who are overweight or obese with or without diabetes, an emphasis on good nutrition and physical activity is still a good investment. Obesity without diabetes increases the risk of heart disease and orthopedic injury, and is a risk factor for diseases including breast, prostate, colon and pancreas cancers.
I have to say that maintaining a normal body weight is difficult in today’s society. Over the past 50 years, our society has increased its reliance on high-calorie fast foods. Also, food serving sizes have increased dramatically. As caloric intake has increased, the average person is walking less and getting less exercise as part of his or her normal daily routine. In the U.S., such things as suburban living without sidewalks and the phenomenon of the couch potato have created a “built environment” that is conducive to obesity.
In the early 1970s, 12 percent of American men and 17 percent of American women were obese. By 2006, 34 percent of men and 36 percent of women were obese. An additional 20 percent are overweight, but not so heavy as to be considered obese. Yes, more than half of American adults are overweight or obese. Among American children ages 6 to 11 years, 4 percent were obese in the early 1970s and 17 percent were obese in 2006. Interestingly, weight gain is a problem in Asia, Africa and Europe, though trends are not as dramatic as in the U.S.
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Dr. Otis Brawley
Chief Medical Officer,
American Cancer Society
“Most surgeons today make difficult decisions about how much of the pancreas to remove in a patient, but that process may become a little more straightforward now that we have demonstrated patients do well when their entire pancreas is removed,” Dr. Wallace says.
The study was funded by Mayo Clinic.
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About Mayo Clinic
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