Is Diabetes Caused by Surgery Different?
I had 60 percent of my pancreas removed because of a kidney cancer. I was left with insulin-dependent diabetes. Is surgically induced diabetes treated like other types? Judy A. Emery, Salisbury, Massachusetts
Paris Roach, MD, responds:
What to Know
Diabetes due to pancreatectomy—the surgical removal of the entire pancreas—is similar to type 1 diabetes, in which the immune system destroys the insulin-producing beta cells of the pancreas. While type 1 is characterized by complete loss of insulin production, the loss of pancreatic function is more extensive with total pancreatectomy. Not only is insulin absent, but the glucose-balancing hormone glucagon goes away as well, the pancreas being its only source. In addition, digestive enzymes previously produced by the pancreas have to be taken in pill form with meals.
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Glucagon’s action is opposite that of insulin. It acts to raise blood glucose and in a way “balances” insulin’s action of lowering blood glucose. So, you might assume that the treatment of diabetes due to pancreatectomy would be associated with an increased risk of hypoglycemia (low blood glucose) compared with type 1 diabetes, in which glucagon is present, although sometimes at lower levels. However, a Mayo Clinic review of 137 patients followed for an average of two to three years after pancreatectomies found that the incidence of hypoglycemia, including severe hypoglycemia (requiring someone else’s help to treat), and diabetic ketoacidosis was roughly equal between pancreatectomy and typical type 1 populations. Mild, self-treated hypoglycemia is not uncommon in either group, but severe hypoglycemia is generally infrequent. Some pancreatectomy patients have nutritional and gastrointestinal issues that may complicate diabetes management.
Most people who undergo partial pancreatectomy do not develop diabetes. Exceptions include people with diseases such as pancreatitis or a family history of diabetes. Because you had a partial pancreatectomy, your body still may produce some insulin. While not enough to prevent diabetes, it may make your blood glucose levels a bit easier to manage.
Management of both type 1 diabetes and diabetes due to pancreatectomy is a balancing act between too much and too little insulin. Being vigilant in self-management and working with your care team can help you set reasonable glucose targets while minimizing your risk of hypoglycemia.