Diabetes, unfortunately, goes hand in hand with stomach problems, for many alternative reasons. Type 1 diabetes has a well known connection to celiac disease, and each types increase the incidence of thyroid conditions that could cause digestive problems. Gastroparesis, a variety of very uncomfortable partial stomach paralysis, is a frequent complication of long-term diabetes. A few of the very best type 2 diabetes medications, including metformin and semaglutide (Ozempic), are widely known for his or her unpleasant gastrointestinal effects.
In the event you’ve been fighting belly issues, and none of those conditions above appear to fit, here’s one other condition to think about: exocrine pancreatic insufficiency (EPI). Though EPI is just not commonly related to diabetes, a brand new study suggests that it’s much more prevalent in individuals with diabetes than most endocrinologists and doctors realize.
What’s Exocrine Pancreatic Insufficiency (EPI)?
Based on On a regular basis Health, EPI is a condition during which the pancreas doesn’t secrete enough digestive enzymes, which causes food to go through your system without being fully digested. This leads to uncomfortable symptoms like diarrhea, oily stools, and lack of appetite. EPI could cause malnutrition and could be very bad in your health.
EPI is notoriously difficult to discover, leading often to “misdiagnosis and suboptimal treatment,” in keeping with a 2019 review. The issue is that its symptoms overlap with those of many other common conditions, and the tests available for EPI are “generally difficult to perform, inaccurate, or non-specific.” It could possibly take patients years to properly discover the reason for their troubles. A machine learning model has estimated that just one in twelve individuals with EPI has actually been diagnosed with the condition.
EPI is most strongly related to conditions which are known to wreck the pancreas, corresponding to cystic fibrosis and chronic pancreatitis. Yet even in patients with these conditions and the signature symptoms of EPI, “diagnostic testing is never performed.”
How Often Do Individuals with Diabetes Develop EPI?
Diabetes, in fact, can also be a disease of the pancreas. In type 1 diabetes, the body launches an auto-immune attack on the pancreatic Beta cells, which might completely eliminate the flexibility to secrete the vital hormone insulin. In type 2 diabetes, insulin resistance causes the identical pancreatic cells to overwork and eventually fail. It’s unknown exactly how diabetes might cause exocrine pancreatic insufficiency, or vice versa, but each are possible.
A brand new study argues that these mysteriously related two conditions coexist more often than almost anyone realizes. The paper is the work of a patient advocate with type 1 diabetes named Dana Lewis. Lewis is well-known throughout the small but highly influential community of “loopers” — she led the event of the world’s first open-source do-it-yourself artificial pancreas. In 2021, Lewis learned that she also had EPI.
After diving into the medical literature to learn more about her condition, Lewis says that she “was a bit of dismayed that it was so clearly prevalent in diabetes, yet I had never ever heard of it. How can there be such a disconnect? Is there anything I can do about it?”
Published in Diabetes Technology & Therapeutics, Lewis’ study is a scientific review of the prevailing literature covering the connections between diabetes and EPI. (Though the paper is behind a paywall, Lewis shared an earlier draft on her blog.)
There have been many studies to look at pancreatic enzyme function in individuals with type 1 and kind 2 diabetes, starting as early because the Nineteen Sixties. Most studies employed the fecal elastase-1 (FE-1) test, which measures stool for a selected digestive enzyme that survives the passage through the gut, in keeping with Mayo Clinic Laboratories. Individuals with EPI have secrete less FE-1 after they eat, and have less FE-1 of their feces.
When Lewis tallied up all the information, she found that about 33 percent of individuals with type 1 diabetes and 29 percent of individuals with type 2 diabetes have lowered levels of FE-1, indicating some level of enzyme secretion abnormality. These results don’t necessarily mean that some 30 percent of individuals with diabetes have full-blown EPI — that may mean 100 million latest patients overnight. There may be some evidence that diabetes results in deceptively low FE-1 results, and most of the patients studied reported that they’d no gastrointestinal symptoms. But Lewis’ paper is just not the one recent work to argue that there’s an underdiscussed connection between the 2 conditions:
- A 2020 review called EPI “highly prevalent in type 1 diabetes and customary in type 2 diabetes,” even though it is commonly symptomatic.
- A 2021 evaluation concluded that EPI is, the truth is, more common in type 1 diabetes, but that EPI testing and therapy should be limited to patients with overt symptoms.
Advocating for Yourself
Lewis explained that when she took the FE-1 test, her results were in an indeterminate “mild-to-moderate” range — below the regular healthy level, but above the “severe range” that routinely indicates a necessity for enzyme therapy. The usual test is less accurate on this gray area, and the severity of a patient’s symptoms may not match the tested enzyme deficiency.
This uncertain test, Lewis explains, “has been considered to be indicative of how severe the symptoms are, when in point of fact, someone like me could be on the upper end of that test and have severe symptoms. There’s no standardized measure of symptom severity, there’s just this test and this loose categorization.”
After two years of looking for answers to her symptoms, Lewis wasn’t about to offer up. She convinced her cautious doctor to prescribe medicine for EPI; when the medication made “a remarkable difference,” it confirmed her diagnosis.
“But without my personal advocacy, I wouldn’t have necessarily gotten the treatment.”
Living with Diabetes and EPI
Readers that already manage diabetes are in position to know the immense struggle of living with EPI. Exocrine pancreatic insufficiency is primarily treated with Pancreatic Enzyme Alternative Therapy (PERT), which delivers enzymes straight to the digestive system in the shape of a pill. Patients swallow pills, sometimes a really large variety of them, directly with the food that they eat.
It’s demanding to dial PERT therapy in. Patients need different amounts of enzymes depending on what they’re eating; taking too little is ineffective, and taking an excessive amount of is wasteful. Identical to insulin therapy, it takes numerous practice to get management right. And similar to insulin therapy, PERT could be extremely expensive.
Lewis believes that PERT is even tougher to dose properly than insulin, and has gone up to now as to design an iPhone app to assist optimize dosing.
Takeaways:
Exocrine pancreatic insufficiency (EPI) is a condition during which the pancreas doesn’t make enough digestive enzymes, resulting in gastrointestinal distress and even malnutrition. Though EPI is believed to be rare, it may very well be much more prevalent than most clinicians realize, especially in individuals with type 1 and kind 2 diabetes. In the event you’ve had digestive issues that appear unrelated to common diabetes issues corresponding to celiac disease or gastroparesis, it could be price asking your doctor or endocrinologist about taking a diagnostic test for EPI.