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Type 3c Diabetes

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leather_ferret

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Hi folks,

Looking for information on Type 3c Diabetes aka Pancreatitis diabetes. This is a little known form of brittle Diabetes characterised by rapid and large Hi/Lo & Lo/Hi swings in BGLs.

Chronic pancreatitis, apart from one of the most painful things that can ever, ever happen to you, basically kills off the pancreas over a period leading to no insulin production at all. Fine and dandy and on the face of it treatable in the same way as Type 1

Now for the awkward part. As the pancreas self-digests and dies off, it kills off not just the Beta cells that produce insulin, but also the alpha cells that produce Glucagon, the enzyme that instructs the Liver to convert Glucogen into Glucose when blood sugars are low.

So with the insulin/blood sugar uptake, and the Glucagon/'Liver glucose top up' mechanisms stuffed there are bound to be additional problems in control.

I just can't seem to find any reliable info on the web.

Anyone out there with this problem or knowledge of it please ??

be good and be lucky

Dave
 
Hi Ken,

thanks for the links. I was seeking the full text in the first link but could only find the abstract.

Some heavy reading to do methinks. Trouble is with Medical papers, you keep having to go and look things up and get sidetracked all the time. All grist to the mill, but it can take ages to unravel what the paper is trying to say. Well worth it though and good intellectual exercise.

Cheers

Dave
 
Dave.
I am not sure what is happening with the first link, it shows the whole text including charts etc and references to studies. I don't see an abstract when I click on it. It is in pdf format.

Bit of a puzzle ?

You are dead right about the medical papers, I burn much 'midnight oil' reading and digesting stuff !
'Perk' of the job........ :roll:

Cheers
Ken
 
Eh Up Ken,

slight misunderstanding .... prior to posting here I had been looking all over for the full paper ... you kindly provided it

As a side issue, I have long had the understanding that the endocrine pancreas is massively 'over-engineered' and has a great deal of spare capacity so diabetes arising from cell loss, usually tends to come when a lot of the pancreas has calcified of atrophied. A friend was told (by a Doctor) that ' most of the islet cells are in the tail of the pancreas' I have always understood them to be widely distributed, but with significantly higher concentration in the tail area. I wonder if you might be able to point me towards reliable information on the distribution of Islet cells please.

Cheers

Dave
 
Dave.
I too always understood that they were distributed throughout the Pancreas so am not too sure. I think you probably need to talk to an Endocrinologist about this one. I only have limited resources here.

Here are a couple of links which give some explanations:

http://en.wikipedia.org/wiki/Islets_of_Langerhans

http://www.wisegeek.com/what-are-the-is ... erhans.htm

Extract:
A healthy human pancreas contains approximately one million of these cells, but their total weight is only 1 to 1.5 grams (0.03 to 0.05 ounces), or about 1% of the weight of the pancreas. The rest of the pancreas serves to produce enzymes that aid in the digestion of food, while the islets of Langerhans produce hormones that help to regulate levels of sugar, also called glucose, in the blood.

Distributed throughout the pancreas, the islets of Langerhans are made up of at least five specific types of cells. The beta cells are the most prevalent, making up about 65 to 80% of the total islets. Beta cells are responsible for making the hormones insulin and amylin.

There are many more links, but basically all say much the same, I didn't find anything which showed them as being concentrated in any particular area. Maybe some anatomical text book might provide an answer. I have always believed them to be scattered randomly throughout the Pancreas, so if you find out differentl.....give me a shout with a link or some information.

Ken
 
I
Our study has shown that the islet concentration of
the tail is significantly greater than the concentration in
the head and body. The uncinate did not differ significatly
from the tail, head or body
Click to expand...
.
Islet concentration in the head, body, tail and uncinate process of the pancreas.
Wittingen J, Frey CF.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1355988/pdf/annsurg00242-0034.pdfThis paper dates from 1974 but I was referred there by a more recent text
Islets of Langerhans Cellular structure and Physiology Gustafsson and Islam
http://sciencestage.com/uploads/text/1TOnqaR0heaSLSGXCySO.pdf
 
Hi Ken,

Thanks for the links.

Hi Phoenix,

Thanks for the link to that paper, It is one among hundreds I lost when the hard drive died.

Interesting that this appears to be just about the only paper available and that it took till 1974 for someone to question and research the 'received wisdom' about the concentration of islets in the tail.

paper intro reads:-

The paper intro says
"one consideration in planning operations for the traumatized or inflamed pancreas would be to preserve as many islets as possible. It has been stated that the concentration of islets is greater in the tail than in the head of the pancreas. We could find no documentation for this opinion in the medical literature."

As the paper looked at only 9 organs and the range in results was very large, I would guess that the results are statistically not that reliable.
Given the stated importance in making decisions about the best type of pancreas surgery with islet preservation in mind, I am surprised not to be able to locate more extensive and up-to-date research on this subject. With the growing application of Islet cell transplant, the research must have been done to establish best practice for cell recovery for transplanting.

Thanks again Guys

Dave
 
Dave.
Not sure if you know about the Islet Cell Transplantation which is still experimental but has had some success. It appears that the cells are actually transplanted into the Liver, not the Pancreas and it works from there.....again quite a strange thing but apparently it has worked for some T1's.

The use of the immunosuppressant drugs meant this lowers the immune system's ability to cope if you have other complications.....nothing is simple really.

Here is the link about it.
http://en.wikipedia.org/wiki/Islet_cell_transplantation

I do hope you find what you are looking for. Keep us informed.

Ken
 
Hi Ken,

Islet transplantation is a radical new approach and remarkable that someone would even think of trying it. Taking a lump of pancreas removing the 'flesh' by enzyme action, harvesting the Islet cells and and placing them in the liver (and elsewhere). Once there, the cells manage to establish their own individual blood supplies and learn to communicate with each other and produce insulin. Pretty unlikely stuff and amazing to me, but it really does work for some folks.
In the past, results have been a bit hit and miss and benefits often fairly short lived, but they are improving with experience so maybe as the science and practice becomes proven, the NHS might be a bit more amenable to stumping up for the very hefty costs and make this treatment more widely available in the UK.

cheers

Dave
 

Hi @leather_ferret, great first thread! Could I just point out the type 3C is not just caused by pancreatitis. Mine was caused by the necrosis/atrophy/calcification due to a rare (but becoming more common) autoimmune disease! Also many 'pancreatitis diabetics' are type 2, dependant on the extent of the damage to the pancreas and whether the alpha cells are damaged/destroyed. Sue xx
 

I have no idea of the physiological answer but my last MRI before my pancreas died completely showed less than 2mm of organ left, and at that point I was still producing insulin!!! Sue xxx
 
@cugila, unfortunately islet transplantation is not an option for most type 3Cs (see article link in post above) Sue xx
 

I'm igG4 hyper defiency. My pancreatic disease is sclerosing cholagiopancreatrophy with bile duct involvement but generally it's now classed as a severe case of autoimmune pancreatitis t1 but I'm not a typical AIP1. Sue xx
 
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@leather_ferret @cugila @Galja it would be really useful to know if you are diagnosed type 3c, or whether it's been flagged as a possibility or you are just exploring. I realise that on a thread like this I do tend to presume that everyone is a diagnosed 3c and start rambling about the (to me) obvious stuff like pre 3c indicators, associated issues etc etc! @ Martin_1967 am I right to presume you are diagnosed 3c? Thanks
 
I had pancreatitis as a type 2 and was hospitalised with DKA and came out as 'basically same as type 1' told by consultant but on paper as type 3.
 
Hello all! Happy Christmas!!

I have diabetes as a result of chronic panc.

Does that mean It will be "brittle".

As it happens I have terrible trouble controlling my BS.

Sean
 
Hi Sean, type 3c people are not necessarily brittle but it does mean you can have unexpected hypos/hypers, the worst I find is when you have a low and you are eating to bring it back and eating and eating and you manage to get to 4.0 but if you move it will drop, diabetes of any type is the fun illness that likes to surprise
 
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