[Exocrine and endocrine pancreatic disorders in chronic pancreatitis]

A many-year prospective follow-up of patients with chronic pancreatitis has shown that the development of carbohydrate metabolism disorders in such patients is always preceded by exo-secretory pancreatic insufficiency of varying severity. Considerable enzyme-secretory pancreatic insufficiency is much more often in patients with secondary diabetes than in those with chronic pancreatitis without diabetes. Insulinemia and blood C-peptide level are regularly reduced in chronic pancreatitis with secondary diabetes but are normal in the patients with less manifest disturbances of carbohydrate metabolism, detectable by the double glucose tolerance test. Blood glucagon is increased in both groups of patients, but more so in those with secondary diabetes. A high direct correlation of the beta-cell activity and the pancreatic enzymes debit are characteristic of patients suffering from chronic pancreatitis with secondary diabetes, as well as a negative correlation, equally high, between the blood glucagon level and the pancreatic enzymes debit in the duodenal contents.