Chronic Pancreatitis Leading to Pancreatogenic Diabetes Presenting in Diabetic Ketoacidosis: A Rare Entity

Abstract

Diabetes mellitus type 3c (DM3c) is an uncommon cause of diabetes due to pancreatic pathology. Its prevalence reaches about 5-10% among all diabetics in the Western world, largely due to chronic pancreatitis. DM3c occurs due to the destruction of the endocrine islet cells. Glucagon and insulin levels are both decreased due to the destruction of alpha and beta cells, respectively. This makes the development of diabetic ketoacidosis (DKA) a rare process in patients with DM3c because of the destruction of glucagon, which facilitates ketone production. We report a case of DM3c presenting with DKA. The patient presented with a history of chronic pancreatitis and was on pancreatic enzyme replacement therapy. Prior records revealed that HbA1c levels were normal. Prior computed tomography evidence revealed diffuse pancreatic calcifications. The patient was admitted for DKA, presenting with hyperglycemia, blood glucose of 703 mg/dL, bicarbonate of 16 mmol/L, ketones in the urine and acetone in the blood. The patient’s anion gap corrected for albumin was 27. The patient was admitted to the medical intensive care unit where he was treated with intravenous (IV) insulin and IV hydration. Once the anion gap closed, the patient was transitioned to long-acting insulin. HbA1c level on admission was elevated, autoimmune causes of diabetes were sent and were negative, ruling out late onset type 1 diabetes. This shows that although it is a rare phenomenon, diabetics with DM3c can present in DKA.

Diabetic Ketoacidosis: A Rare Complication of Type 3c Diabetes

“…The role of PERT in this group of patients is inevitable. PERT improves incretin secretion, insulin secretion, and glucose intolerance [4][5][6]. It also aids in the absorption of fat-soluble vitamins A, D, E, and K [6,12].…”

Antioxidant, anti-inflammatory, and anti-fibrotic properties of olive leaf extract protect against L-arginine induced chronic pancreatitis in the adult male albino rat

“…This indicates insulin resistance reflected by increased homeostatic model assessment of insulin resistance (HOMA-IR) index [ 1 ]. The CP has a serious negative impact on the social and psychological health [ 5 ]. Further, the risk of pancreatic cancer in CP patients increased almost eightfold [ 6 ].…”

The impact of acid-base disorders in patients with chronic pancreatitis comorbid with type 2 diabetes on long-term quality of life and possible improvement with small volume infusion therapy

“…Subclinical disorders of acid-base balance, according to the latest scientific data, have the following consequences for the patient [10]: directly affect the development of chronic pain syndrome, which is difficult to stop [11], worsen the effectiveness of the therapy involved, lead to chronicity of pathological processes [12], affect quality of life in the long-term period, provoke more frequent development of CP complications in comorbidity with T2DM [13].…”