Dr Thng Yongxian
Medical Director, Senior Consultant Pancreas and Hepatobiliary Surgeon
MBBS (SG), M.Med (Surg), MRCS (Ire), FRCSEd (Gen), FAMS (Surg)
By Dr Thng Yongxian
Medical Director, Senior Consultant Pancreas and Hepatobiliary Surgeon
Search “pancreas removal diabetes” and most people expect a flat yes.
Well, the answer is more nuanced than that – it depends on how much pancreas is removed, not whether it’s removed at all.
Why is there a possibility of developing diabetes after pancreatic surgery?
The pancreas makes insulin, the hormone that moves sugar out of the bloodstream and into cells for energy. Take out enough insulin-producing tissue, and the body loses its ability to regulate blood sugar on its own.
Surgery can also reduce digestive enzyme output, and impaired nutrient absorption adds further pressure on blood sugar regulation. Together, these changes are what causes post-pancreatic surgery diabetes.
In general, most patients who undergo partial pancreatic removal retain enough insulin-producing tissue to avoid diabetes. However, removing the entire pancreas means the body can no longer produce insulin, making the chances of developing diabetes higher.
Partial pancreatectomy: There is a risk
When only part of the pancreas is removed, some insulin-producing cells are usually left behind. Studies following patients after partial pancreatectomy suggest that around 1 in 5 to 1 in 3 may develop new-onset diabetes, depending on how much of the pancreas is removed and the surgical approach used.
In other words, most patients who undergo partial pancreatectomy do not develop diabetes.
Factors that increase the risk of developing diabetes after a partial pancreatectomy include:
- Removing a larger share of the pancreas
- Surgery involving the tail and body of the pancreas, which holds more insulin-producing cells than the head
- Older age
- Higher BMI before surgery
- Blood sugar already trending high before the operation
Total pancreatectomy: Expect diabetes
If the entire pancreas is removed, diabetes is an expected part of recovery and should not be an unexpected complication.
Your surgeon and care team should prepare you for this before surgery and include diabetes management in your after-surgery care plan.
This form of diabetes –sometimes called pancreatogenic or type 3c diabetes– differs from typical type 1 or type 2 diabetes and requires specialised care, including insulin therapy and oral medication.
Is diabetes after pancreas surgery permanent?
If diabetes develops after pancreatic surgery, it is generally a long-term condition because the pancreas does not regenerate the insulin-producing tissue that has been removed.
However, it can be managed with the right treatment, routine and support.
Your care may include:
- Blood glucose monitoring, often more frequently in the weeks after surgery while your body adjusts
- Insulin therapy or oral medication, depending on how much pancreatic function remains
- Pancreatic enzyme replacement with meals if digestion is also affected
- Regular meals and stable eating patterns to help avoid low blood sugar episodes
- A gradual return to physical activity, which can support blood sugar control during recovery
All of this may sound life-altering, but remember: if you need pancreatic surgery, your surgeon recommended it for good reason.
For some patients, surgery is necessary to treat a tumour or prevent a serious condition from progressing. While diabetes may be a possibility, your surgical team should assess and prepare for it as part of your care so you can focus your mental energy on recovery.
Can diabetes be avoided entirely?
Certain advances in treatment have improved the outlook for patients with pancreatitis:
- Islet cell autotransplantation: In selected cases of total pancreatectomy, doctors can take insulin-producing islet cells from the removed pancreas and transplant them into the liver. These cells may continue to produce insulin after surgery. A systematic review of TPIAT outcomes found that nearly a third of adults became independent of insulin, while many others were able to reduce the amount of insulin they needed.
- Better ways to manage diabetes: We also have better tools and approaches for managing diabetes after pancreatic surgery. Research on quality of life after total pancreatectomy with islet autotransplantation found encouraging metabolic outcomes alongside improvements in quality of life.
Neither option can guarantee that you will avoid diabetes; but having your pancreas removed does not automatically mean you will have uncontrolled diabetes.
Can pancreatic surgery cure diabetes?
No, pancreatic surgery treats the underlying condition being operated on (cancer, cysts, chronic pancreatitis), not diabetes itself.
The exception is pre-existing diabetes tied directly to a pancreatic tumour disrupting insulin production; in rare cases, removing that tumour can improve blood sugar control.
Considering pancreatic surgery?
If you have concerns about pancreatic surgery or the risk of diabetes, speak to Dr Thng Yongxian. He can help you understand your options and give you honest, personalised advice based on your condition.
Contact us today.
References:
- https://www.ovid.com/jnls/journalacs/fulltext/10.1097/xcs.0000000000000360~pancreatogenic-diabetes-after-partial-pancreatectomy-a
- Khazaaleh, S., Babar, S., Alomari, M., Imam, Z., Chadalavada, P., Gonzalez, A. J., & Kurdi, B. E. (2023). Outcomes of total pancreatectomy with islet autotransplantation: A
systematic review and meta-analysis. World journal of transplantation, 13(1), 10–24. https://doi.org/10.5500/wjt.v13.i1.10 - https://www.nature.com/articles/s43856-022-00087-7
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