Pancreatectomy and diabetes

Post total pancreatectomy diabetes is a clearly defined form of unstable di abetes, requiring low doses of insulin, with frequent and seven hypoglycemi c events. This is due to both deficiency of pancreatic glucagon, hormone of primary importance for hepatic gluconeogenesis and glycogenolysis, and exo crine failure. The management of this form of diabetes is difficult, involv ing exact correction of malabsorption and low doses of insulin, Whenever po ssible, partial pancreatectomy should therefore to be preferred. After part ial pancreatectomy, the likelihood of diabetes depends on the volume of the remaining pancreas, the type of resection and above all the preexisting pa ncreatic status. Prevention of postoperative hyperglycemia could minimize t he risk of long-term diabetes. Pancreatic cancer is a particular case : the onset of diabetes could be a manifestation of occult pancreatic cancer and glucose metabolism may improve after tumour excision with preservation of some pancreatic tissue.