The pancreas performs two distinct functions necessary for life. Although the organ itself is not strictly necessary for survival in the modern era, losing it—often due to surgical removal (total pancreatectomy)—introduces two severe, lifelong conditions requiring intensive, artificial replacement therapy. Survival is possible, but it depends entirely on constant management of blood sugar and digestion.
The Essential Dual Functions of the Pancreas
The pancreas is a mixed gland, serving both an endocrine and an exocrine role. Its absence creates two separate medical problems.
The endocrine function involves cell clusters called the Islets of Langerhans, which make up a small percentage of the pancreas’s mass. These islets release hormones directly into the bloodstream to manage metabolism. Beta cells produce insulin (which lowers blood sugar), and alpha cells produce glucagon (which raises it), maintaining glucose balance.
The exocrine function, dedicated to digestion, makes up about 99% of the tissue. This part produces powerful digestive juices containing enzymes secreted into the small intestine. These enzymes include lipase for fats, amylase for carbohydrates, and proteases for proteins. Without these enzymes, the body cannot effectively absorb nutrients from food.
The Consequences of Pancreatic Failure or Removal
The complete loss of the pancreas results in two severe conditions: a volatile form of diabetes and severe malabsorption.
The lack of insulin production creates pancreatogenic diabetes (Type 3c diabetes). This condition is difficult to manage because the body loses both insulin and glucagon, the counter-regulatory hormone. This absence of internal regulation leads to unstable, “brittle” blood sugar levels and a high risk of dangerous hypoglycemia (low blood sugar).
Simultaneously, the absence of exocrine tissue causes Pancreatic Exocrine Insufficiency (PEI), resulting in profound digestive failure. The body cannot break down and absorb fats, proteins, and carbohydrates, leading to malabsorption. This failure results in weight loss, digestive discomfort, and a deficiency in fat-soluble vitamins (A, D, E, and K). Undigested fat causes steatorrhea, which involves loose, fatty stools.
Lifelong Management Strategies for Survival
Survival after total pancreatectomy depends on the lifelong replacement of both lost hormones and digestive enzymes.
Managing Diabetes
Managing the resulting diabetes requires intensive insulin therapy, typically involving a basal-bolus regimen of long-acting and rapid-acting insulin analogs. Many patients use continuous glucose monitors (CGMs) and insulin pumps for precise delivery and tracking. Management is complicated because the lack of glucagon removes the body’s natural defense mechanism to raise blood sugar, making hypoglycemia a constant threat.
Managing Digestion (PERT)
Digestive issues are managed through Pancreatic Enzyme Replacement Therapy (PERT). This involves taking oral capsules containing a mixture of lipase, amylase, and protease. These capsules must be taken with every meal and snack containing fat or protein, as the enzymes need to mix with the food in the stomach to be effective in the small intestine. Proper dosing and timing are crucial to prevent malabsorption.
Typical adult starting doses range from 25,000 to 40,000 units of lipase with a meal. Failure to take the enzymes correctly leads to a return of painful digestive symptoms and nutritional deficiencies.
The goal of PERT is to allow the body to absorb nutrients, which is necessary for maintaining stable body weight and preventing malnutrition. Patients also require regular monitoring and supplementation for fat-soluble vitamins (A, D, E, K), which are poorly absorbed without natural pancreatic enzymes. This comprehensive, dual-therapy approach allows individuals to maintain a reasonable quality of life.