DIABETES AND PANCREATIC EXOCRINE INSUFFICIENCY

Transcription

1 YOU AND YOUR BODY DIABETES AND PANCREATIC EXOCRINE INSUFFICIENCY kk WHY IS THIS LEAFLET FOR YOU? Pancreatic excrine insufficiency (PEI) is imprtant t understand in diabetes care due t the changing functins in the pancreas. This leaflet will give yu essential infrmatin n: What is PEI? What are the symptms? Hw is it treated? Hw t get the mst ut f yur treatment Hw PEI affects yur diabetes 1

2 WHAT IS PANCREATIC EXOCRINE INSUFFICIENCY? The pancreas gland lies underneath the stmach. It prduces insulin which is secreted directly int the bld (endcrine), and digestive enzymes which are secreted via ducts int the gut (excrine). Insulin cntrls bld glucse levels. A ttal r partial lack f insulin results in diabetes. Digestive enzymes secreted by the pancreas break dwn the fd yu eat (fats, prteins and carbhydrates), s that it can be absrbed frm yur gut int the bldstream. Pancreatic excrine insufficiency (PEI) means the pancreas des nt prduce enugh digestive enzymes t digest fd prperly. This means that yur bdy des nt get all the nutrients it needs, especially fat-sluble vitamins. This is called malabsrptin. Stmach Pancreas Gland Hw is it diagnsed? PEI is diagnsed by testing a sample f yur stl fr an enzyme called faecalelastase-1. Smetimes a scan f yur abdmen may be required. Wh is at risk? Yu may be at particular risk if yu have r have had the fllwing: Surgery t yur pancreas and stmach Acute Pancreatitis Chrnic Pancreatitis Cystic Fibrsis Pancreatic Cancer If left untreated, PEI can lead t malnutritin and this may result in bne weakness (steprsis, stepenia), and deficiency f fat-sluble vitamins (A, D, E and K) which may lead t further cmplicatins. 2

3 WHAT ARE THE SYMPTOMS? Blating Excessive wind Abdminal discmfrt Diarrhea Fatigue Oily and pale r yellw stls (undigested fats in the stmach result in frthy, ful-smelling stls that flat and are difficult t flush) Weight lss, in severe cases PEI may ptentially be respnsible fr variable glycaemic cntrl in peple with diabetes. If yu have these symptms, yu can use this chart t shw yur dctr what yur stls lk like: Type 1 Separate hard lumps, like nuts (hard t pass) Type 2 Sausage-shaped but lumpy Type 3 Like a sausage but with cracks n its surface Type 4 Like a sausage r snake, smth and sft Type 5 Sft blbs with clear-cut edges (passed easily) Type 6 Fluffy pieces with ragged edges, a mushy stl Type 7 Watery, n slid pieces, entirely liquid Yur dctr will want t exclude ther cnditins that have similar symptms and may be assciated with diabetes, such as diabetic neurpathy, celiac disease r an intlerance t metfrmin if yu are taking this medicatin, as well as cnditins that are nt assciated with diabetes, such as irritable bwel syndrme. 3

4 HOW IS PEI TREATED? Pancreatic enzyme replacement therapy (PERT) PEI is treated by replacing the enzymes that are nt being prduced by the pancreas, usually in a capsule frm. The medicatin shuld be swallwed whle, nt crushed r chewed, with a cld drink. Ht drinks will stp the enzymes wrking prperly. T wrk effectively, these enzymes need t be taken each time yu eat r have a milky drink, including meals and snacks. Take them just befre yu begin eating r with the first few muthfuls f fd as they need t be taken with fd/milky drink t wrk. If yu take mre than ne capsule yu shuld space them ut thrughut yur meal r snack. If yu are unable t swallw the capsules r yu have been prescribed granules, pen them carefully and mix the granules (withut crushing them) in a spnful f sft acidic fd r drink such as yghurt r apple juice. D nt chew. Swallw immediately as PERT may cause irritatin t the tissue inside yur muth causing ulcers. Fllw this with a cld drink t wash any residue frm yur muth. The usual starting dse fr PERT is 50,000 units with meals and 25,000 units fr snacks. If yu take insulin, yu will be familiar with measuring yur dse in units and may be alarmed at the number f units required fr PERT. Hwever, this therapy aims t replace the digestive enzymes yur pancreas is unable t prduce. In smene withut PEI, the pancreas typically prduces arund 720,000 units fr a 300 t 600 kcal meal! Pancreatic enzyme supplements are made frm prk prducts. There is currently n alternative. Please discuss this with yur healthcare prfessinal if yu have any cncerns. 4

5 GETTING THE MOST OUT OF YOUR TREATMENT Keep Use Yur u Stp Sme Yu u Cut Frequent u u yur treatment at rm temperature as it is damaged by high temperature. Yur treatment may als be affected if yu keep the capsules r granules in yur pcket. by the expiry date. dctr will adjust the dse t suit yu, until yu have relief frm diarrhea and abdminal symptms. When yu are digesting fd and absrbing nutrients prperly, yu will als feel less tired. Cntinue taking PERT: d nt stp because yu feel better. smking as smking may cause mre damage t yur pancreas. fds d nt need PERT. These are generally fat-free fds, such as fruit and vegetables (except avcads) and sugar (e.g. jam, hney, fruit juice, fizzy drinks, jelly, biled sweets, srbets and fruit lllies). Everyne shuld aim t eat healthily, but if yu have PEI, yu shuld eat a nutrientrich diet. If yu need advice abut this, ask yur dctr r nurse t refer yu t see a dietitian. may be advised t take fat-sluble vitamins (e.g. A, D, E, K) and mineral supplements. Hwever, if the treatment is effective and yu eat a nutrientrich diet, supplements are usually unnecessary. ut alchl. Alchl may cause mre damage t yur pancreas. diarrhea can make yur anal area sre. This shuld imprve when yu have fund the right dse f PERT, but using a barrier cream can prtect tender skin in the meantime. Yu can ask yur pharmacist fr advice. Washing gently after every bwel mtin will help t prevent sreness. 5

6 HOW PEI AFFECTS YOUR DIABETES Pancreatic enzymes are needed t digest carbhydrates fund in starchy and sugary fds, s if yu have PEI, yu may have difficulty cntrlling yur bld glucse levels. When yu start t digest and absrb fd prperly during PERT, especially if yu regain weight, yu may find a change in yur bld glucse levels. If yu are able t test yur bld glucse, yu shuld mnitr mre frequently until yur PERT is stable, as yur diabetes tablets r insulin dses may need adjusting. Cnsult yur diabetes nurse r dctr if yu have cncerns abut yur bld glucse levels. Insulin and sme diabetes tablets can cause lw bld glucse (hypglycaemia). Check with yur pharmacist if yu are nt sure if this is a side effect f yur treatment. Lw bld glucse shuld be treated immediately with quick-acting glucse which des nt require PERT, but if yu fllw this with a starchy snack, yu will need t take PERT with this. kk REPORTING OF SIDE EFFECTS Please be aware sme side effects may be experienced with PERT. Cnsult yur prduct patient infrmatin leaflet r speak t yur healthcare prfessinal if yu need further infrmatin. This includes any pssible side effects nt listed in the package leaflet. Yu can als reprt side effects directly via the Yellw Card Scheme at By reprting side effects, yu can help prvide mre infrmatin n the safety f these medicines. 6

7 YOUR NOTES 7

8 KEY POINTS: Pancreatic Excrine Insufficiency (PEI) may affect peple with diabetes. A simple test can diagnse the cnditin. If yu think yu have symptms, discuss with yur healthcare prfessinal. kk USEFUL RESOURCES: Please nte Mylan has had n invlvement in any f the websites listed abve. TM TREND-UK Limited. Cntent t be reviewed January 2020 The cntent f this leaflet was develped by TREND-UK in cllabratin with Mylan. This leaflet was initiated and funded by Mylan. DOP: January