Evaluation of Pancreatic Exocrine Function Using Pure Pancreatic Juice in Noninsulin-dependent Diabetes Mellitus

Abstract

To investigate the pancreatic exocrine function in noninsulin-dependent diabetes mellitus (type 2 DM), we evaluated the pure pancreatic juice obtained by endoscopic cannulation of the main pancreatic duct in 13 healthy control subjects and 22 patients with type 2 DM who had no evidence of pancreatic disease. Samples of pancreatic juices were collected in six fractions for 30 minutes at 5-minute intervals after an intravenous bolus injection of secretin (0.25 CU/kg) and cholecystokinin-8 (CCK) (40 ng/kg). The responses of plasma glucose, insulin, and C-peptide to intravenous administration of glucose (50%, 40 mL) were measured. The levels of plasma insulin and C-peptide levels in type 2 DM were the same as in healthy controls in the basal state but did not further increase in response to an intravenous glucose. This suggested that patients with type 2 DM had insulin secretion defect rather than insulin deficiency. Pancreatic secretions including volume, bicarbonate, and protein output in response to stimulation with secretin, and CCK were significantly reduced when compared to the healthy controls. We conclude that patients with type 2 DM exhibit impairment of pancreatic exocrine secretion and that this impairment might not be related to insulin deficiency. Therefore, we recommended that careful evaluation for exocrine pancreatic function in type 2 diabetics who have any clinically suspicious symptoms of pancreatic insufficiency.

Serum amylase activity disorders in the course of experimental diabetes in rabbits

“…Clinical investigations and experimental laboratory research supported by morphological and ultrastructural observations indicate a close relation between pancreatic exo-and endocrine parts (Okabayashi et al, 1988;Aughsteen and Kataoka, 1993;Meral et al, 2001) Insulin and glucagon actions have been investigated in great detail and clinical studies in diabetic patients show that the impairment of pancreatic exocrine functions is due to insulin deficiency and relative glucagon predominance (Adeghate, 1999;Taniyama et al, 1999;Hardt et al, 2000;Lernmark, 2000;Harding et al, 2001). Reports regarding the influence of insulin deficiency on the pancreatic exocrine function describe distinctive changes in composition and quality of pancreatic juice as well as its decreased production (Okabayashi et al, 1988;Aughsteen and Kataoka, 1993;Kim et al, 2000). Interestingly, the relation between insulin and glucagon concentrations in extracellular fluid and their antagonistic actions also seem to play a key role in pancreatic exocrine function disorders.…”

Assessment of the Secondary Metabolite Patulin and Lycium Barbarum Fruit on INS-1 Rat Pancreatic Β-Cells

“…This reducing of insulin caused by patulin in G I affect on pancreatic function resulting in changes in the composition and quality of pancreatic juice as well as its decreased production leading to accumulation of glucose in the blood and this agreed with the increasing in serum glucose showed in Fig.5. [32].…”

The Physiology and Pathophysiology of Pancreatic Ductal Secretion

“…Many animal and human studies have demonstrated reduced pancreatic exocrine secretion (including total secretory volume pancreatic enzyme activity and HCO 3 − concentration) in both insulin-dependent and non-insulin-dependent diabetes mellitus, but the clinical relevance of these findings remains uncertain. 338,339 Secretin-stimulated pancreatic secretion including volume and HCO 3 − output was decreased in patients with insulindependent 340,341 and non-insulin-dependent diabetes mellitus 342 when compared with control subjects. The prevalence of exocrine insufficiency (which is usually mild to moderate, without clinical signs of exocrine pancreatic insufficiency) is somewhat lower in non-insulin-dependent (30%-50%) versus insulin-dependent (50%) diabetes mellitus, 339 although in certain subgroups of patients, this rate may be much higher.…”