Author(s): Blaslov K, Bulum T, Cuca JK and Duvnjak L
Objective and importance: Pancreatic exocrine insufficiency (PEI) is a phenomenon observed in type 1 diabetic mellitus (T1DM) patients interpreted as a disease complication and explained by several hypothesis: Impairment of enteropancreatic reflex and changes in gastrointestinal peptides due to diabetic autonomic neuropathy (DAN) is one of them. Autoimmune damage is speculated as one of the underlying cause in the DAN pathogenesis. Recent studies report that high levels of tyrosine phosphatase antibodies (IA-2Abs) may predict rapid pancreatic β cell failure and could be indicative for more aggressive autoimmunity.
Case presentation: A 55-year old T1DM male patient with 13 years diabetes duration presented with the symptoms of tingling and spasms in the hands and legs and every day diarrhea followed by meals. Several times he has been hospitalized at the Department of Gastroenterology due to diarrhea. No bacteriological or viral causes were found.
Intervention: Neurological examination has showed severe case of DAN. Fecal fat tests as well as muscle fiber presence in stool were positive. Immunology tests for T1DM specific antibodies revealed highly positive IA-2Ab (2128.0 IU/mL), low glutamic acid antibody titre (12,9 IU/mL) and negative islet cell antibody titre (<5 JDF U). Following the metoclopramide three times 10 mg per os and pancreatin three times 400 mg per os daily, the patient started to recover and was subsequently discharged.
Conclusion: We consider high IA-2Ab levels are involved in the pancreatic and autonomic nerve tissue damage either simultaneously or predominantly on one of them which consequently lead to the development of the another.
