Management of diabetes and pancreatic insufficiency after pancreatectomy

Abstract

Following near-total pancreatectomy to treat diffuse hyperinsulinism, disruption of the endocrine and exocrine functions of the pancreas is likely to occur. Initially after surgery, patients may experience persistent hypoglycemia, persistent diabetes mellitus, or transient diabetes followed by hypoglycemia. Insulin is indicated in patients with hyperglycemia in the immediate post-op period to maintain normal glucose levels. For persistent diabetes after resection, dilute insulin is recommended to allow for more precise dosing and to accommodate infant feeding patterns; however, providers and caregivers must be attuned to risks associated with administering nonstandard insulin concentrations. Children who initially continued to have hypoglycemia postoperatively later develop diabetes and need to be screened regularly for development of elevated blood glucose and hemoglobin A1C. In the same manner, exocrine pancreatic insufficiency may have a delayed onset after a subtotal pancreatectomy, and symptoms often arise only after nutritional sequela have occurred. Thus, careful screening for exocrine insufficiency with stool studies and labs should occur at baseline and at regular intervals during growth and development, allowing for prompt treatment with pancreatic enzyme replacement therapy. With attention to both endocrine and exocrine deficits after pancreatectomy, these children can be expected to attain their growth potential and maximize their quality of life.