Pancreatogenic (Type 3c) Diabetes Revealed by Diabetic Ketoacidosis

Pancreatogenic diabetes also known as type 3c diabetes mellitus (DM) is a distinct entity often overlooked and misdiagnosed as type 2 diabetes. It results from exocrine pancreatic dysfunction involving both insulin and glucagon deficiencies due to damage to pancreatic beta and alpha cells. This case highlights a 46-year-old male presenting with diabetic ketoacidosis (DKA), a rare but severe complication of type 3c DM. The patient exhibited symptoms of dehydration, metabolic acidosis, and positive urinary ketones, with imaging revealing chronic calcific pancreatitis. The diagnosis was confirmed using established criteria, and management involved intensive insulin therapy for glycemic control and pancreatic enzyme replacement therapy (PERT) to address exocrine insufficiency. Additionally, lifestyle modifications including alcohol and smoking cessation and a tailored high-protein, fat-restricted diet were implemented. A basal-bolus insulin regimen was introduced for long-term control, with regular follow-ups to monitor metabolic and pancreatic health. This report underscores the importance of accurate diagnosis and a multidisciplinary approach to optimize outcomes in type 3c DM.