T3cDM

Question 1

what is T3cDM?

Answer 1

secondary to exocrine pancreatic disease (e.g. chronic pancreatitis, pancreatic cancer, cystic fibrosis, hemochromatosis, or after pancreatic surgery)

Question 2

what is the aetiology of T3cDM?

Answer 2

• chronic pancreatitis
• partial/total pancreatectomy
• pancreatic cancer
• CF
• haemochromatosis
• trauma

Question 3

what are the symptoms of T3cDM?

Answer 3

• endocrine (e.g. polyuria, polydipsia, blurred vision)
• hypoglycaemia (e.g. sweating, tremors, dizziness)
• exocrine (e.g. steatorrhea, bloating, flatulence, vitamin A, D, E, and K deficiencies)

*hypoglycaemia is due to loss of glucagon (α-cells)

Question 4

what are the investigations for T3cDM?

Answer 4

• capillary blood glucose (e.g. BM)
• HbA1C
• c-peptide
• faecal elastase-1
• vitamin A, D, E, K
• ? US/CT

Question 5

what is the management of T3cDM?

Answer 5

• insulin (e.g. basal-bolus)
• ? metformin/DPP-4i
• PERT (e.g. creon)
• vitamin/mineral replacement (e.g. A, D, E, K, calcium, magnesium, zinc, B12, folate)