As a diagnostic tool for "pre-diabetic" patients, we often order a glucose-insulin tolerance test. Diet & lifestyle are our primary treatment strategies. We use the paradigm of Diana Schwarzbein, M.D. (protein, fat, vegetable, and carbohydrate) in trying to create a balanced meal.
I have found on histologic studies including transmission electron microscope the presence of marked fibrosis in the interlobular areas of the exocrine pancreas associated with fatty infiltration and loss of acinar cells in addition to a marked deposition of adipose tissue. This exocrine fibrosis and adiposity in the exocrine pancreas would surely lead to some loss of exocrine function and thus interfere with the exocrine - gut hormone (GLP-1) - endocrine axis
I do research at the University of Missouri and when I examine patients pancreata at autopsy in our hospital I find that most of them have rather significant exocrine fibrosis with peri-islet fibrosis.
I was wondering if anyone is treating these prediabetic patients with pancreatic enzyme supplementation or even checking to see if they have deficient fecal elastase-1 to indicate significant pancreatic exocrine insufficiency?
Siince proper GLP-1 functioning might be imporved with pancreatic enzymes I think it might be helpful to preseve insulin function and also maybe help to preserve beta cells...?
Any thoughts regarding these findings and this concept?
I am a clinician of 30 years who has gone back to full time research and I use primarily the electron microscope to study type 2diabetic models.
Thanks for sending this. I must say that in my 30 years in medicine the studies on diabetes at first say that aggressive treatment is wonderful and then when more studies are done it shows that it kills people or is not as good as once thought. I must say that more study needs to be done. I can see the metformin but trip therapy for prediabetes is a hard sell at this point in time.
Regarding the comments by fxmedpa, there is really no need to to diagnostic testing on pre-diabetes patients. Just follow the ADA guidelines for making the diagnosis: Fasting blood glucose level 100-126 mg/dL and 2 hour PPG 140-199 mg/dL. Not sure whe the glucose-insulin tolerance test is. Thanks. Jeff Unger, MD
4 comments:
As a diagnostic tool for "pre-diabetic" patients, we often order a glucose-insulin tolerance test. Diet & lifestyle are our primary treatment strategies. We use the paradigm of Diana Schwarzbein, M.D. (protein, fat, vegetable, and carbohydrate) in trying to create a balanced meal.
I have found on histologic studies including transmission electron microscope the presence of marked fibrosis in the interlobular areas of the exocrine pancreas associated with fatty infiltration and loss of acinar cells in addition to a marked deposition of adipose tissue. This exocrine fibrosis and adiposity in the exocrine pancreas would surely lead to some loss of exocrine function and thus interfere with the exocrine - gut hormone (GLP-1) - endocrine axis
I do research at the University of Missouri and when I examine patients pancreata at autopsy in our hospital I find that most of them have rather significant exocrine fibrosis with peri-islet fibrosis.
I was wondering if anyone is treating these prediabetic patients with pancreatic enzyme supplementation or even checking to see if they have deficient fecal elastase-1 to indicate significant pancreatic exocrine insufficiency?
Siince proper GLP-1 functioning might be imporved with pancreatic enzymes I think it might be helpful to preseve insulin function and also maybe help to preserve beta cells...?
Any thoughts regarding these findings and this concept?
I am a clinician of 30 years who has gone back to full time research and I use primarily the electron microscope to study type 2diabetic models.
Dear Jeff,
Thanks for sending this. I must say that in my 30 years in medicine the studies on diabetes at first say that aggressive treatment is wonderful and then when more studies are done it shows that it kills people or is not as good as once thought. I must say that more study needs to be done. I can see the metformin but trip therapy for prediabetes is a hard sell at this point in time.
Thanks again for sending this.
Rich Adelman, MD
Regarding the comments by fxmedpa, there is really no need to to diagnostic testing on pre-diabetes patients. Just follow the ADA guidelines for making the diagnosis: Fasting blood glucose level 100-126 mg/dL and 2 hour PPG 140-199 mg/dL. Not sure whe the glucose-insulin tolerance test is. Thanks. Jeff Unger, MD
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