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Dr Mohsin Aslam, Hyderabad 01 February 2018

of the exocrine pancreas. It is classified as type 3c diabetes mellitus (T3cDM) according to the current classification of diabetes mellitus by the ADA.
T3cDM is distinct from T1DM and T2DM as it arises due to chronic inflammation, has unique clinical and laboratory parameters and is associated with high incidence of pancreatic carcinoma. The altered glucose metabolism of T3cDM ranges from mild impairment to a severe form, characterized by frequent episodes of iatrogenic hypoglycemia, referred to as “brittle diabetes”, which is difficult to treat. It is not always easy to diagnose and classify a patient with T3cDM correctly. In distinguishing between the different diabetes types, the presence of islet cell antibodies is consistent with T1DM.
In T3cDM, metformin is the initial drug of choice for oral therapy due, in part, to its insulin-lowering effects on glucose metabolism, and also due to its specific antineoplastic actions on cellular mediators of replication and protein synthesis.
When insulin administration is required as primary therapy to adequately control hyperglycemia, adjunct therapy with additional oral agents to reduce the required insulin dose is beneficial. Pancreatic enzyme replacement therapy, in addition to improving exocrine insufficiency, may also help in controlling hyperglycemia by regulating incretin secretion.

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