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Your Pancreas – Don’t Take This Complex Organ For Granted!

 

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As of 2015, 9.4% of the American population had diabetes – that’s 30.3 million Americans. Unfortunately, that number is not a surprise considering we are living in a time when everything – including us – seems to move faster than the speed-of-light. With each surge of information and technological update, we are plummeted back on the hamster wheel, often in a vain attempt to try to keep up with life. Our stress levels rise, and our judgment is often impaired as we grow exhausted and fail to practice self-care. We readily grab food that’s fast, filling, and comes out of the freezer and/or microwave.  We skip the workout in favor of binge-watching Netflix, and try to hit the sack at a reasonable (though usually unreasonable) hour – only to start this whole process all over again in the morning.

Ugh. It’s no wonder our bodies suffer at some point.

If you are an individual with lupus, the rat-race lifestyle can catch up with you even more quickly. Your body is considerably more vulnerable to the stress and strain of what it’s put through. An organ of particular vulnerability – that we probably don’t even consciously consider – is our pancreas. We probably don’t even quite understand what the pancreas does, let alone what it looks like or where it is. Prone to inflammation, our pancreas can show signs of stress and neglect in the form of pancreatitis and even diabetes if we don’t stop and think for a minute about the toll today’s frenetic lifestyle – along with possibly having lupus thrown in the mix – can take.

What is the pancreas?

Shaped like a flat pear and located in the upper left abdomen behind the stomach, the pancreas plays a vital role in two very different systems of the body, the digestive system and the endocrine system.

In its digestive role, it produces a wealth of enzymes and chemicals that do everything from neutralize the acid from your stomach, to those that digest fats (lipase), carbohydrates, starch (amylase), and proteins.  It is the master digestive gland and does that job almost always without fanfare or problems.

More commonly, issues with the pancreas occur from its other role as part of the endocrine system, the system responsible for the creation and regulation of hormones in your body.   As an endocrine gland it produces and releases hormones that go directly into the blood system.  The two main hormones produced by the pancreas are insulin, which lowers blood sugar, and glucagon, which raises blood sugar. A healthy pancreas performs the delicate dance between the two hormones with ease, regulating each to keep the body in perfect, dynamic balance.

Sometimes, however, that balance can be disrupted. Individuals with lupus know that lupus often affects major systems and organs of the body, and the pancreas is no exception.  A 2015 study indicated that pancreatic inflammation in individuals with SLE may occur as often as 30% of the time, though an individual may not complain of experiencing symptoms. Lupus-related pancreatic inflammation – pancreatitis – occurs most often in women in their 30s.

Pancreatitis

Pancreatitis can be acute (quick onset, lasting for days) or chronic (existing over many years) and is often the first symptom of lupus. Because lupus-related pancreatitis is relatively uncommon, a healthcare practitioner will rule out other underlying causes of pancreatitis before attributing the symptoms to lupus, especially if an individual has yet to be diagnosed. Causes that aren’t lupus-related may include:

  • Gallstones
  • Chronic and excessive alcohol use
  • Abdominal surgery
  • Certain medications (e.g. Azathioprine, glucocorticoids, furosemide, isoniazid, metronidazole, sulindac)
  • Cigarette smoking
  • Cystic fibrosis
  • Family history of pancreatitis
  • High calcium levels in blood (hypercalcemia)
  • High triglyceride levels in the blood (hypertriglyceridemia)
  • Infection
  • Abdomen injury
  • Pancreatic cancer

If there are no underlying causes for pancreatitis and the individual experiencing symptoms has not been previously diagnosed with lupus yet exhibits other signs of active lupus, a healthcare practitioner may investigate for the autoimmune disease. If you have been recently diagnosed with lupus, your healthcare practitioner may still test for pancreatitis even if you have not experienced symptoms – pancreatic inflammation may still be present.

Symptoms of pancreatitis may include the following:

Acute Pancreatitis

  • Abdominal pain (the most common symptom)
  • Back pain
  • Pain that gets worse after eating
  • Nausea, vomiting, diarrhea, and/or cramping
  • Fever
  • Sweating
  • Weakness
  • Rapid pulse
  • Tenderness to the touch
  • Abdominal distension
  • Symptoms that mimic diabetes, but go away after diagnosis of pancreatitis and treatment (read more about diabetes below)

Chronic Pancreatitis

  • Upper abdominal pain
  • Unexplained loss of weight
  • Steatorrhea – fatty or oily, smelly stools

If you experience any of the symptoms and a healthcare practitioner suspects pancreatitis, they may order the following tests to properly diagnose your symptoms:

  • A complete medical history
  • A physical exam
  • Blood tests to analyze blood amylase and lipase levels which typically increase when pancreatitis is present
  • An abdominal ultrasound
  • A CT Scan

Individuals with lupus who have pancreatitis receive similar treatment as individuals with pancreatitis who do not have lupus. Treatment options may include:

  • Hydration, often intravenously.
  • A restricted, low-fat diet, which allows the pancreas to rest and heal.
  • Cessation of alcohol consumption.
  • Cessation of any antibiotics, which may have been prescribed.

Individuals with lupus, however, who have pancreatitis may be treated with corticosterioids with or without cytotoxic agents, including azathioprine, cyclophosphamide, and mycophenolate mofetil. A Texas Tech University Health Sciences Center study in 2014 noted that while the use of steroid treatments for acute pancreatitis in individuals with lupus is controversial “because of [a] steroid-induced toxic effect … this concern is regarded as minimal.  Because the immunosuppressive effect of steroids can significantly improve prognosis in patients with acute pancreatitis …” (p. 3).  For individuals with lupus, the benefit outweighs the risks.

Preventing Pancreatitis

While individuals with lupus are predisposed to inflammation throughout the body, and while pancreatitis may not be altogether unavoidable for some, there are precautions that can be taken to minimize the risk of occurrence:

  • Alcohol in moderation – limit or even avoid consumption.
  • Eat a low-fat diet – avoid greasy foods (deep fried foods make look can often be a trigger) and full-fat dairy products. Eat a diet rich in whole grains, fruits, and vegetables. Skip the crash, fad diets – just do what’s been determined and deemed healthy by the healthcare community. They are the experts!
  • Exercise – we’ve said it more than once here. Regular exercise – while acknowledging your limitations and remaining physically active in a way that suits you – is key to maintaining a healthy weight and improving overall well-being!
  • Avoid smoking – too many health risks come with smoking. It is just not worth it.

Working with a trusted healthcare practitioner is key to mitigating risk and achieving optimal health. Talk to your practitioner about your risks and what you can do to remain as healthy as possible.

Diabetes

As mentioned earlier, your pancreas is responsible for making insulin and maintaining healthy blood sugar levels. What happens when there’s a breakdown in that process? If your pancreas produces insufficient levels of insulin – or stops producing it at all – and if your body fails to use the insulin that is produced properly, glucose stays in your bloodstream and never reaches your cells that rely on it for energy. Your blood sugar levels remain too high, and you may find yourself diagnosed with diabetes.

There are three types of diabetes:

  • Individuals have type 1 diabetes if they are unable to produce insulin. It is typically diagnosed at a young age and the individual must rely on taking insulin every day.
  • Individuals have type 2 diabetes if their bodies not use nor make insulin efficiently. An individual may receive a diagnosis at any time in life, but typically when they are middle-aged or older.
  • Pregnant women may develop gestational diabetes that usually goes away after their baby is born, though sometimes it is a precursor to developing type 2 diabetes later on.

As you may have already guessed, individuals with lupus are at greater risk of developing diabetes – especially those treated with high-dose glucocorticoids. This medication interaction can increase diabetes risk due to chronic inflammation that occurs in individuals with lupus that can alter insulin homoeostasis, contributing to insulin resistance.

Symptoms of diabetes may include:

  • Increased thirst and/or hunger.
  • Frequent urination.
  • Fatigue.
  • Inexplicable weight loss.
  • Irritability
  • Blurred vision
  • Slow-healing sores
  • Frequent infections, especially of skin, mouth/gums, and vagina

Along with having lupus, individuals may be at greater risk for developing diabetes if:

  • You have a BMI (Body Mass Index) higher than 25 and if you have any of the following risk factors: family history of diabetes, high cholesterol, hypertension, a sedentary lifestyle, a history of heart disease, or polycystic ovary syndrome.
  • You are older than 45.
  • You have had gestational diabetes in the past.
  • You already have been diagnosed with pre-diabetes.

Diagnosing Diabetes

Diagnostic testing may include the following:

  • AC1 blood tests – test results of equal to or greater than 6.5% indicate diabetes, while less than 5.7% is considered normal.
  • Fasting blood sugar tests – two tests indicating a blood-sugar level of 126 mg/dl indicates diabetes. Having less than 100 mg/dl is considered normal.
  • Random blood sugar tests.  Equal to or greater than 200 mg/dl indicates diabetes, while less than this is considered normal.
  • Oral glucose intolerance tests – Equal to or greater than 200 mg/dl indicates diabetes while less than this is considered normal.
  • A zinc transporter 8 autoantibody (ZnT8Ab) test.
  • Urine tests.

Treating Diabetes

Treating diabetes in individuals with lupus is much like treating it in individuals who do not have lupus though closer monitoring by a healthcare practitioner may be advised. Monitoring your own blood sugar levels several times daily will be key to working with your healthcare practitioner to make sure they are implementing the correct and adequate treatment plan.

Type 1 diabetes treatment includes:

  • Injectable, oral, or inhaled insulin daily. Your healthcare practitioner will work with you to set up goals and determine which product and dose will work for you.
  • Diet modifications.
  • Exercise.
  • Maintaining a healthy weight.

Type 2 diabetes medication interventions include:

  • Drugs that increase insulin production by the pancreas.
  • Drugs that decrease sugar absorption by the intestines.
  • Drugs that decrease sugar production by the liver and improve insulin resistance.
  • Drugs that enhance how your body uses insulin.
  • Drugs that increase insulin production by the pancreas and reduce sugar production by the liver.
  • Drugs that inhibit the reabsorption of glucose by the kidneys and increase glucose excretion in urine.
  • Synthetic hormones that lower blood sugar levels after eating.
  • Recently FDA-approved drugs that combine types of diabetes medications into one.

Many individuals with type 2 diabetes can manage their diabetes through diet and exercise alone. Sometimes, however, a healthcare practitioner may prescribe insulin (see above) and oral drugs to maintain normal blood sugar levels.

Diabetes Prevention

Type 1 diabetes is difficult to prevent since its onset often occurs in childhood and may be hereditary. Type 2 diabetes, however, is a bit easier to prevent though a little trickier if you are an individual with lupus and, as mentioned earlier, you are taking high-dose glucocorticoids.  Glucocorticoids can interfere with glucose metabolism.

Individuals with lupus who have diabetes also have a greater risk of developing other diabetic complications such as neuropathy and renal insufficiency, making it even more imperative for individuals with lupus to work diabetes prevention into their overall health goals.

Type 2 diabetes prevention for individuals with lupus include:

  • Hydroxychloroquine (Plaquenil) – a 2015 National Yang-Ming University in Taipei study concluded that individuals with lupus who take a cumulative dose of hydroxychloroquine (Plaquenil) had a 74% lower risk of diabetes than individuals taking high-dose glucorcorticoids alone.
  • Exercise – both aerobic exercise and resistance exercise are beneficial to getting and staying healthy. Individuals with lupus and its related symptoms and co-diseases may find it difficult to exercise strenuously and regularly, making it even more important to talk with a trusted healthcare practitioner to help develop an exercise plan that you can manage and maintain – there are so many options out there these days that enhance both sound body and mind!
  • Diet – work with your healthcare practitioner to develop a healthy and delicious diet that will help control blood sugar levels as well as help you achieve and maintain a healthy weight/BMI. Your diet should include plenty of fiber and whole grains. Once again, skip those Hollywood fad diets!
  • See your healthcare practitioner regularly for checkups – make sure you tell this trusted individual right away if you’ve experienced any changes in your health and/or general well-being.

In Conclusion

It goes without saying to never take your health and well-being for granted. Take a minute and breathe. Be mindful for a moment and start paying attention to what goes into your body at every meal. Start considering how you spend your down time – can you catch up on your Netflix binge while you take a walk on the treadmill in your garage or ride the recumbent bike at the gym?  Can you throw a quick salad together for dinner or do some weekly meal planning instead of relying on McDonald’s? This may be a great time to examine the choices that we all make in an effort to save time and instead spend some time making some important life changes. Our bodies – in particular our pancreas – will thank us for the thoughtful consideration!

 

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References

Chen, D.Y., Chen, H.H., Chen, Y. H., Chen, Y. M., Chang, S., Hung, W.,…Lan, J.(2015).  Hydroxychloroquine reduces risk of incident diabetes mellitus in lupus patients in a dose-dependent manner: A population-based cohort study. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/25587177
Dallas, M. (2013). 5 ways to prevent pancreatitis and EPI. Retrieved from:
https://www.everydayhealth.com/hs/exocrine-pancreatic-insufficiency/prevent-pancreatitis-and-epi/
Diabetes. Retrieved from: https://www.mayoclinic.org/diseases-conditions/diabetes/symptoms-causes/syc-20371444
Diabetes: 5 tips for taking control. Retrieved from: https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/in-depth/diabetes-prevention/art-20047639
Favarato, M. (2015). Lupus-associated pancreatitis: Clinical aspects. Retrieved from: https://clinmedjournals.org/articles/jrdt/journal-of-rheumatic-diseases-and-treatment-jrdt-1-022.pdf
Glucocorticoids. Retrieved from: https://www.healthline.com/health/glucocorticoids
Hyperamylasemia (high blood amylase level). Retrieved from: http://chemocare.com/chemotherapy/side-effects/hyperamylasemia-high-amylase.aspx
Jewett-Tennant, J. (2018). Overview of lupus and pancreatitis. Retrieved from: https://www.verywellhealth.com/lupus-and-pancreatitis-2249986?print
Jia, Y., Mccallum, R., Ortiz, A., Salame H., & Serrato, P. (2014). Acute pancreatitis as the initial presentation of systematic lupus erythematosus. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4150433/pdf/CRIGM2014-571493.pdf
Pancreatitis. Retreived from: https://www.mayoclinic.org/diseases-conditions/pancreatitis/symptoms-causes/syc-20360227?p=1
Semedo, D. (2015). Risk of diabetes mellitus in patients with systemic lupus erythematosus can be reduced with the use of hydroxychloroquine. Retrieved from: https://lupusnewstoday.com/2015/01/21/risk-of-diabetes-mellitus-in-patients-with-systemic-lupus-erythematosus-can-be-reduced-with-the-use-of-hydroxychloroquine/
Statistics about diabetes. Retrieved from: http://www.diabetes.org/diabetes-basics/statistics/
The pancreas and its functions. Retrieved from: http://columbiasurgery.org/pancreas/pancreas-and-its-functions
Thomas, D. E. (2014). The lupus encyclopedia: A comprehensive guide for patients and families. Baltimore, MD: Johns Hopkins University Press.
What is diabetes? Retrieved from: https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes https://www.ncbi.nlm.nih.gov/pubmed/25587177
Understanding diabetes – diagnosis and treatment. Retrieved from: https://www.webmd.com/diabetes/guide/understanding-diabetes-detection-treatment#1
Walsh, N. (2015). Plaquenil cuts diabetes risk in lupus: The reduced risk was dose-dependent. Retrieved from: https://www.medpagetoday.com/rheumatology/lupus/49605

 

Article by: By Liz Heintz

Liz Heintz is a technical and creative writer who received her BA in Communications, Advocacy, and Relational Communications from Marylhurst University in Lake Oswego, Oregon. She most recently worked for several years in the healthcare industry. A native of San Francisco, California, Liz now calls the beautiful Pacific Northwest home.

All images unless otherwise noted are property of and were created by Kaleidoscope Fighting Lupus. To use one of these images, please contact us at info@kflupus.org for written permission; image credit and link-back must be given to Kaleidoscope Fighting Lupus.

All resources provided by us are for informational purposes only and should be used as a guide or for supplemental information, not to replace the advice of a medical professional. The personal views do not necessarily encompass the views of the organization, but the information has been vetted as a relevant resource. We encourage you to be your strongest advocate and always contact your healthcare practitioner with any specific questions or concerns.

 

Article by : Elizabeth Heintz

Liz Heintz is a technical and creative writer who received her BA in Communications, Advocacy, and Relational Communications from Marylhurst University in Lake Oswego, Oregon. She most recently worked for several years in the healthcare industry. A native of San Francisco, California, Liz now calls the beautiful Pacific Northwest home.