Understanding Fibrocalculous Pancreatic Diabetes (FCPD)
Created on : #jan2025
Author: Dr. Om J Lakhani
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Corresponding notes for doctors : Metformin in pregnancy
What is FCPD?
FCPD is a type of diabetes linked to a condition called non-alcoholic calcific pancreatitis, which is more common in developing countries. It involves damage to the pancreas, leading to diabetes and other complications.
Key Points About FCPD:
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Prediabetic Form:
Before FCPD develops, a condition called tropical calcific pancreatitis (TCP) often occurs. This is an early stage where the pancreas starts to show damage. -
Difference Between TCP and Alcoholic Pancreatitis:
- TCP is caused by factors like malnutrition and is not related to alcohol.
- Alcoholic pancreatitis is caused by excessive alcohol consumption.
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Who Discovered FCPD?
The condition was first described by Dr. Geeverghese. -
Types of Malnutrition-Related Diabetes (MRDM):
- Fibrocalculous pancreatic diabetes (FCPD)
- Protein-deficient diabetes mellitus
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Typical Symptoms of FCPD (Triad):
- Abdominal pain (starts in childhood)
- Pancreatic stones (develop in adolescence)
- Diabetes (appears in adulthood)
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Where Are Pancreatic Stones Seen?
On an X-ray, these stones are usually found near the L1/L2 vertebrae in the spine. -
Ketosis in FCPD:
Unlike other types of diabetes, patients with FCPD do not develop ketosis (a condition where the body produces high levels of blood acids). -
Food Linked to FCPD:
Eating cassava (a root vegetable) has been linked to FCPD, especially in areas where malnutrition is common. -
Cancer Risk:
People with FCPD have a higher risk of pancreatic cancer. -
Complications:
FCPD can lead to microvascular complications (like eye and kidney problems) and pancreatic osteodystrophy (weak bones due to malnutrition and diabetes).
Diagnosis of FCPD:
To diagnose FCPD, doctors look for:
- Diabetes in a patient from a tropical country.
- No other cause of pancreatitis.
- Additional signs like abnormal pancreas imaging, recurrent abdominal pain, or digestive issues (steatorrhea).
Tests include:
- Imaging: X-rays, ultrasounds, or CT scans to check for pancreatic stones or damage.
- Pancreatic Function Tests: These measure how well the pancreas is working.
Treatment of FCPD:
-
Diabetes Management:
- Most patients need insulin to control blood sugar.
- Some may use oral medications, but certain drugs (like incretin-based therapies) are avoided.
-
Pain Management:
- Painkillers (non-opioid or opioid) are used for abdominal pain.
- In severe cases, procedures like ERCP (to remove stones) or surgery may be needed.
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Nutritional Support:
- A diet rich in proteins and carbohydrates is recommended to combat malnutrition.
- Fat-soluble vitamins (A, D, E, K) are given to address deficiencies.
- Pancreatic enzyme supplements (like Creon) help with digestion.
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Monitoring for Complications:
- Regular check-ups are needed to detect and manage complications like pancreatic cancer or osteoporosis.
Why No Ketosis in FCPD?
Patients with FCPD don’t develop ketosis because:
- Their bodies don’t produce enough fatty acids, which are needed for ketosis.
- They still have some insulin production, which prevents ketosis.
- Certain fats in their bodies are resistant to breaking down.
Real-Life Case Example:
A 30-year-old man lost a lot of weight and was diagnosed with diabetes. He had a history of abdominal pain in his 20s but was never tested. A CT scan showed pancreatic stones, confirming FCPD. He was treated with insulin, enzyme supplements, and nutritional support, which helped him regain weight and control his blood sugar.
Key Takeaways:
- FCPD is a rare but serious condition linked to malnutrition and pancreatic damage.
- Early diagnosis and proper treatment (insulin, enzymes, and nutrition) can improve quality of life.
- Regular monitoring is essential to prevent complications like pancreatic cancer.