What is Exocrine Pancreatic Insufficiency?


People with diabetes understand that the pancreas has an important role—it’s where the body produces insulin, an essential hormone for regulating blood sugar levels. But you might not know that the pancreas doesn’t just produce hormones that control blood sugar—it also secretes digestive enzymes, which help your body break down food.

Why is this relevant? Type 1 diabetes develops when your immune system attacks the cells secreted by your pancreas that produce insulin. In type 2 diabetes, the pancreas is producing insulin but your body may struggle to produce enough or make use of the insulin you do produce. But for many people with diabetes, the pancreas is impaired in other ways related to digestion, too.

When the pancreas stops producing digestive enzymes, it can cause a condition called exocrine pancreatic insufficiency (EPI), which commonly coexists with type 1 or type 2 diabetes.

The digestive enzymes a person with EPI struggles to produce include:

  • Amylase for sugars and carbohydrates
  • Protease for proteins
  • Lipase for fats

People with diabetes are at greater risk of developing EPI. Nearly 40 percent of people with type 1 diabetes (T1D) and nearly 30 percent of people with type 2 diabetes (T2D) also develop EPI.

Understanding exocrine pancreatic insufficiency

Exocrine pancreatic insufficiency can lead to digestive problems:

  • Abdominal pain, gas and bloating
  • Constipation
  • Diarrhea
  • Fatty stools
  • Bloating

Without essential digestive enzymes, it’s difficult to absorb nutrients from food, which can lead to things like osteoporosis.

The connection to diabetes

It’s uncertain why people with diabetes often experience complications with the exocrine pancreas function (which produces digestive enzymes), but theories include:

  • Damaged pancreatic tissue and fibrosis as a result of abnormal levels of inflammation (acute pancreatitis)
  • Diabetic neuropathy, a complication of diabetes, can interfere with the signaling of pancreatic cells carrying out exocrine functions
  • Loss of pancreatic tissue as a result of lack of insulin production

Can EPI affect my blood glucose management?

EPI can affect how you manage your blood glucose levels. The lack of digestive enzymes can make it more difficult for your body to digest and absorb the carbohydrates in starchy, sugary foods.

With treatment, your digestion will become more effective and consistent, which will help in your daily effort to manage your blood sugar levels. If you start treatment for EPI,  patterns in your blood sugar levels may change. You’ll want to work closely with your healthcare team to adjust your insulin dosing or other medications as needed.

How can digestive enzymes treat EPI?

EPI is commonly treated with pancreatic enzyme replacement therapy, which replaces digestive enzymes. These enzymes are proteins that help break down the food you eat into substances that can be absorbed by your digestive tract and replace the ones your pancreas is no longer making. The enzymes can be found in your saliva, in organs like the liver and pancreas and even in cells on the surface of your intestines.

People with type 3c diabetes, a rare form of diabetes that involves both the endocrine (insulin-producing) and digestive function of the pancreas, also require enzyme replacement therapy.

Digestive enzymes can also be found naturally in foods such as whole grains, leafy greens, lean proteins and citrus fruits.

If you have EPI, your provider may suggest a protocol that includes taking digestive enzymes in the form of prescription medication.

You might have seen digestive enzymes on the shelf at the pharmacy or health food store since they are also sold as supplements. Unlike prescription medications, the FDA does not regulate supplements and makers don’t have to prove their efficacy. Talk to your doctor before taking any supplements.

The bottom line

The symptoms of exocrine pancreatic insufficiency vary depending on the severity, so if you notice any problems such as loose bowel movements, abdominal discomfort, or erratic blood glucose levels, talk to your healthcare team!

Remember that EPI is a common and treatable condition, and there are many resources available to help you!

WRITTEN BY Kaley Kwan, POSTED 08/11/22, UPDATED 12/20/22

Kaley Kwan is an editorial content intern. She is a student at Purdue University and has written for The Los Altos Town Crier, Beyond Type 1 and other publications. While she’s not working on her computer science degree, she enjoys swimming and diving into a new fantasy book.