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February 12, 2008

Other, Other Illnesses

Question from Long Island, New York, USA:

I have had type 1 diabetes for 37 years. I never thought of writing a question to the site until I read the newest listed question from a woman who was in a bike accident and asked if trauma could cause diabetes. First of all, thank you Dr. Lane for a great answer including the sentence that mentioned digestive enzymes. I am desperately seeking as much info as I can for my 37-year-old daughter. My daughter was in a car accident in November and, days later, had abdominal pain. She then had a CAT scan which revealed a mass. The doctors are divided about whether the mass is trauma induced or incidental to this. An endoscopic procedure revealed this mass to be in her pancreas. This mass, in the tail region, will be removed next month along with a portion of the pancreas. Can you please tell me how these digestive enzymes will be affected or will the endocrine portion be affected, too? Could the result be her requiring insulin? In addition, we both have pernicious anemia and I would love to read at this site about this in relation with diabetes. Since this accident, I have learned so much through the Internet. I thought I knew so much about the pancreas, but all I have known is how it relates to my own diabetes.

Answer:

The tail of the pancreas is the distal most part of the pancreas to the junction where it meets the small bowel. It contains the largest concentration of islets, compared to the more proximal portion. Whether your daughter will have secondary diabetes from the removal of this tissue is directly proportional to how much is removed. Her doctors most likely do not know if that is the case. Whether the mass is trauma-related or not will depend on what they find. If it is inflammatory tissue, it is possible. If it is something else, they may be able to say it is not related to the trauma. Unfortunately, it will have to be determined after the surgery. I wish you all our best.

As far as the pernicious anemia, this may have a more immediate relationship to diabetes and autoimmune endocrine disorders, in general. Pernicious anemia is the result of antibodies that are produced by your immune system that destroy the parietal cells in the stomach. These specialized cells produce acid. They also produce a substance called intrinsic factor that binds the vitamin B12 from the diet. The complex of intrinsic factor plus vitamin B12 is then absorbed in the small intestine. Without vitamin B12, a person can develop pernicious anemia. Not only does it cause anemia, but, in its most severe form, it can cause a severe form of peripheral neuropathy and can affect the heart. The treatment is the injection of vitamin B12. This gets around the fact that any B12 would not be absorbed from the gut. Since your body can store a year of B12, the injections can be as infrequently as monthly in order to maintain stores for health. Levels of vitamin B12 can be measured in the blood. Pernicious anemia is one of several other autoimmune endocrine disorders that can simultaneously occur as part of a polyendocrine deficiency syndrome. These disorders are caused by autoantibodies produced from your immune system.

JTL