Pancreatitis and Diabetes: What You Need To Know
Key takeaways:
- Pancreatitis, whether acute or chronic, is a serious condition caused by inflammation of the pancreas. Recognizing the symptoms can help with early diagnosis.
- The main causes of pancreatitis are gallstone disease, excessive alcohol use, and high triglyceride levels, but there are also genetic, viral, and medication-related factors that can lead to the condition.
- Adopting lifestyle changes can significantly lower your risk of developing pancreatitis and help prevent lesser-known consequences, such as a specific type of diabetes caused by pancreatitis.
Pancreatitis is inflammation of the pancreas, an organ that helps with digestion and produces insulin, which helps regulate blood sugar. The inflammation can be acute, meaning it appears suddenly and lasts a short time, or a long-term chronic condition that worsens over time.
High levels of triglycerides, a type of fat found in the blood, can cause both acute and chronic pancreatitis and are also a risk factor for diabetes. To prevent serious complications from pancreatitis, it’s important to understand the different causes and symptoms.
Symptoms of pancreatitis
The main symptom of both acute and chronic pancreatitis is pain in the upper abdomen that may spread to the back. While the pain in acute pancreatitis can start suddenly and become worse after eating, people with chronic pancreatitis may not have pain at all. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) lists the following symptoms to be aware of that may indicate a problem with your pancreas:
- Fever and/or chills
- Diarrhea
- Nausea and/or vomiting
- Weight loss
- Greasy, foul-smelling stools
- Fast heartbeat
- Shortness of breath
- Jaundice, or a yellowish color of the skin or whites of the eyes
If you are experiencing any of the above, it is important that you seek care from a health professional promptly. The diagnosis of pancreatitis is usually made through blood tests that show the levels of pancreatic enzymes, as well as a CT scan or MRI.
Causes of pancreatitis
Approximately 2.75 million people in the world are affected by pancreatitis, according to data from the 2021 Global Burden of Disease Study. The main causes of pancreatitis are gallstone disease, alcohol consumption, and high levels of triglycerides.
High triglycerides
Triglycerides come from foods like butter and oils and are also naturally produced by the liver. After you eat, your body converts any calories it doesn’t need right away into triglycerides, which are stored in fat cells for future energy use.
While a certain level of triglycerides is essential to our health, elevated levels of these fats in the blood are linked to many health conditions, such as heart disease, type 2 diabetes, and liver disease. One of the most immediate and serious risks of elevated triglyceride levels is pancreatitis.
While it’s not fully understood how high triglycerides cause pancreatitis, research suggests that the process of breaking down triglycerides in the pancreas creates high levels of free fatty acids, which can damage the pancreas and cause a lack of blood flow. Less blood flow creates an acidic environment, which makes the pancreas start "digesting" itself.
Triglycerides are measured through a blood test. Here are some ranges to be familiar with:
- Healthy range for adults: Below 150 mg/dL
- Healthy range for children and teenagers: Below 90 mg/dL
- Borderline high: Between 150 and 199 mg/dL
- High: Between 200 and 499 mg/dL
The risk of developing acute pancreatitis increases significantly with triglyceride levels over 500 mg/dL; the higher the level of triglycerides, the more severe the pancreatitis tends to be. Monitoring triglyceride levels is crucial to catch problems before they develop into something more serious, especially since having high triglycerides itself doesn’t always cause symptoms.
Alcohol use and smoking
Heavy alcohol consumption is the single most common cause of chronic pancreatitis and the second most common cause of acute pancreatitis in North America and Europe. Heavy drinking is defined as five or more drinks per day (or 15 or more per week) in men, and four or more per day (or eight or more per week) in women. Interestingly, studies have found that there is a spike in the rates of acute pancreatitis during national holidays, when binge drinking (defined as five or more alcoholic drinks per session) is more frequent.
Smoking is also a risk factor for acute and chronic pancreatitis, especially in heavy drinkers. Studies have shown that smoking damage to the pancreas appears to be reversible, so quitting smoking and keeping alcohol consumption low (less than two drinks per day for men and less than one drink per day for women) could help to significantly lower the chances of developing pancreatitis.
Gallstone disease
The number one cause of acute pancreatitis is gallstone disease, which is responsible for about half of all cases. Gallstones, which are frequently formed from cholesterol, are solid particles that can block the flow of bile in the gallbladder, causing pain and infection. When the stones get stuck in the common bile duct, enzymes can’t properly drain from the pancreas. As pressure builds up behind the blockage, these enzymes get activated and begin digesting the pancreas itself, leading to gallstone pancreatitis.
Other less common causes
Genetic conditions, such as hereditary pancreatitis, cystic fibrosis, and familial chylomicronemia syndrome (FCS), can also cause pancreatitis. FCS, for example, is an inherited disorder caused by genetic mutations that prevent enzymes from breaking down fat-carrying particles in the blood. This leads to extremely high levels of triglycerides that can cause recurrent attacks of acute pancreatitis. The FDA recently approved the first medication for FCS, Tryngolza (olezarsen).
Some viral infections, including mumps, measles, hepatitis, HIV, and even COVID-19, can trigger pancreatitis as well, which is why it’s important to stay up-to-date on your vaccinations.
Certain medications can also increase the risk of developing pancreatitis, such as some antibiotics, steroids, and blood pressure therapies.
Because people with obesity are more likely to take blood pressure medication and have gallstone disease and/or high triglycerides, this population also has an increased risk of developing pancreatitis.
Is there a link between pancreatitis and diabetes?
Pancreatitis can damage insulin-producing cells in the pancreas, which can lead to pancreatic diabetes (also termed pancreatogenic diabetes or type 3c diabetes, according to the American Diabetes Association). This involves both the destruction or removal of normal pancreatic tissue and a loss of insulin secretion.
Unlike type 1 diabetes, where the damage is caused by an attack of the immune system, or type 2 diabetes, where the body doesn’t respond to insulin and produces insufficient amounts of insulin, pancreatic diabetes involves direct damage to the organ itself.
Pancreatic diabetes is often misdiagnosed as either type 1 or type 2 diabetes. Although the relationship between chronic pancreatitis and diabetes is well-established, more research needs to be done on diabetes that follows acute pancreatitis.
Dr. Walter Park, a pancreatologist at Stanford’s Department of Gastroenterology and Hepatology, said that although there is no clear test for pancreatic diabetes yet, the condition is suspected in people who have had pancreatitis and have low C-peptide levels (an indicator your body is producing less insulin) in the absence of autoantibodies associated with type 1 diabetes.
“We are validating many of the observations, which I think will change the standard of care shortly to check for diabetes and impaired glucose metabolism after acute pancreatitis,” Park said.
Because pancreatitis can damage insulin-producing cells, people with pancreatic diabetes may be treated similarly to those with type 1 diabetes. However, as Park noted, some individuals also develop insulin resistance after pancreatitis, so the treatment approach for pancreatic diabetes is still being worked out.
Research also suggests that pancreatic diabetes may be the most common complication after both acute and chronic pancreatitis, emphasizing the need for further research on prevention, screening, and management of this condition.
While diabetes can be caused by pancreatitis, the reverse may also be true – studies have shown that as fasting glucose levels rise, the risk for developing acute pancreatitis increases. The same is true for pancreatic cancer – researchers have found that people with prediabetes have a 40% higher risk of developing pancreatic cancer than those without prediabetes.
How to prevent pancreatitis
Acute and chronic pancreatitis can be caused by many different factors, with high triglycerides, excessive alcohol consumption, and gallstones topping the list. Since high triglycerides are often associated with increased blood glucose levels, it is crucial to monitor both of these with your healthcare provider.
Important lifestyle changes you can take to help reduce your chances of developing this serious condition include:
- Staying active
- Eating a balanced diet
- Limiting high-fat foods
- Avoiding smoking
- Limiting alcohol intake
- Keeping blood sugar levels within range
The link between pancreatitis and diabetes is complex, and ongoing research efforts are focused on improving screening strategies to ensure earlier diagnoses and better outcomes.
Learn more about diabetes and pancreatic health here: