Pancreas
Pancreas If the pancreas were nominated for an Emmy, most likely it would be in the category of best supporting gland. It''''s often considered a behind-the-scenes player--not one of those star organs like the heart that captures the limelight of publicity.
Yet the role it plays is crucial.
The golden-colored gland is only about seven to eight inches long and three to four inches wide. It sits just behind the stomach, and the broadest end, the "head," is connected to the small intestine. The tail--the narrower part that''''s down at the lower end of the gland--is located near the spleen. Between the head and the tail is what''''s called the body of the pancreas--the main part of the gland. All in all, a drawing of a pancreas kind of resembles an oversize tongue.
Cell Director
Even though it seems like a small bit player in the body, the pancreas deserves our applause, because it contains special cells called beta cells that, in small clusters, are known as the islets of Langerhans. These beta cells secrete the hormone insulin. Insulin basically acts as stage director when it comes to our energy metabolism. It''''s essential to our body''''s ability to utilize food.
After we eat, a complex process takes place in which food gets broken down into a form of sugar--called glucose, or blood sugar--and also into fat. In the muscle cells that take in the glucose, it''''s converted to yet another chemical form called glycogen. The muscles then store the glycogen for use as an energy source. Fat cells take in the fat.
Throughout these processes, insulin plays the role of director. Insulin tells the fat cells to take in the fat and store it, and the muscle cells to take in the sugar.
Without insulin, or without enough of it, the body gets into serious trouble. The sugar in the bloodstream can''''t get transported into our muscle cells. So even though that blood sugar is available, it has nowhere to go, says Lawrence Hunsicker, M.D., professor of internal medicine at the University of Iowa College of Medicine in Iowa City. The same goes for the fat. Sugar and fat show up outside a muscle or fat cell, but they might as well be underage teenagers at a well-policed nightclub. Without their IDs--in the form of insulin--sugar can''''t get in, and the fat can get a table but can''''t get served.
When Insulin Poops Out
Diabetes is a disease where insulin either doesn''''t show up or is unable to do its job--depending on what kind of diabetes it is. One type of diabetes is insulin-dependent (called Type I): that''''s when the pancreas stops making insulin because those special islets of Langerhans cell clusters have been destroyed. This type of diabetes usually develops before a person is 20 years old.
| When Babies Grab Glucose The hormonal changes that take place during pregnancy sometimes trigger diabetes in women who have never had it before. The condition, known as gestational diabetes, presents a risk both to the fetus and to the mother, says Yvonne S. Thornton, M.D., visiting associate physician at Rockefeller University Hospital in New York City and director of the perinatal diagnostic testing center at Morristown Memorial Hospital in New Jersey. If you''''re pregnant, there''''s about a 3 to 5 percent chance that you''''ll develop gestational diabetes, according to Dr. Thornton. The risk is higher for Mexican-American and Native American women than it is for other women. While you can''''t prevent gestational diabetes, regular blood tests can lead to early detection, which is important for your health and the future health of your child. How does it happen? Normally, insulin helps escort glucose from the bloodstream into the cells that store it, so insulin is leaving the blood at the same time as the blood sugar. But when gestational diabetes develops, the placenta battles the pancreas for insulin needed for a growing baby and wins the war. With the pancreas exhausted and unable to keep up with the increasing demands for insulin, diabetes develops. The risk to the fetus is that it is likely to be a large baby that requires cesarean section or suffers birth trauma, she says. A large child also runs the risk of obesity in childhood and all the risks for chronic disease that come with obesity. As far as the mother is concerned, there''''s about a 30 to 50 percent chance that she will develop Type II (non-insulin-dependent) diabetes within the first five years after she has delivered the baby. Unfortunately, there''''s not a whole lot that women who are pregnant can do to prevent gestational diabetes, says Dr. Thornton. Because undetected diabetes can lead to unexplained stillborns, it is essential to get screened with a blood sugar test between the 24th and 28th weeks of pregnancy. That test will tell your doctors if your blood sugar is high and enable them to make dietary recommendations to address the problem. For women who develop gestational diabetes during pregnancy and want to prevent progressing on to Type II diabetes after pregnancy, the best thing to do is make sure to return to an ideal body weight, says Dr. Thornton. |
With the second type of diabetes, non-insulin-dependent (called Type II) diabetes, the pancreas usually makes some insulin, but either there is not enough of it produced, or the fat and muscle cells in the body become resistant to it and keep it from doing its job. Type II diabetes generally develops in adulthood and often arises around the age of 40. An estimated 13 million people in the United States have diabetes, and about 90 percent of them have Type II diabetes.
Type II diabetes can be dangerous, because you end up with excess sugar in the bloodstream, either because you don''''t have sufficient insulin or because your cells are resistant to it. High sugar levels are responsible for damage to the kidneys, eyes and other organs, says Dr. Hunsicker. And since fat isn''''t being properly slurped up by your cells, fat levels in the bloodstream can build up and contribute to the development of atherosclerosis, or hardening of the arteries. That''''s one reason why heart disease is frequently a major complication of diabetes.
Finding Out Where You Stand
Researchers hope that before long, they''''ll develop a way to help prevent Type I diabetes--because once the beta cells in the islets of Langherans are destroyed, they''''re gone for good. For the much more common Type II diabetes, however, experts already know steps that you can take to lower your chances of developing the disease.
The first thing to do is assess your risk of getting Type II diabetes. Here''''s what doctors recommend.
Take a hint from your folks. Having a family history of Type II diabetes places you at increased risk for the disease, says John Bantle, M.D., of the Division of Diabetes, Endocrinology and Metabolism at the University of Minnesota in Minneapolis. "If you have a parent with diabetes, your risk goes up." Chances are about one in three that you''''ll develop the disease if one parent had it. If both did, your chances are about 50/50. Anyone with a family history of the disease needs to be extra vigilant about taking preventive measures.
Watch for clues. An estimated half of those who have Type II diabetes don''''t know it. Often that is because there aren''''t any symptoms. But sometimes there are symptoms; you just need to know how to recognize them so that you can get help early. The three classic signs of diabetes are unusual thirst, frequent urination and unexplained weight loss, says Dr. Bantle. So if you experience these symptoms, be sure to tell your doctor.
Get screened. Since you can also have diabetes even if you don''''t have symptoms, find out for sure by asking your doctor to check how your pancreas is performing. This can be done with a blood sugar test. This test measures the amount of glucose in your blood to determine whether you might have the disease. If you have diabetes in your family, it''''s important to have your blood sugar checked once a year, says Dr. Hunsicker.
Watch that waist-to-hip ratio. There is evidence to suggest that the waist-to-hip ratio and, particularly, the waist circumference are important in determining whether you''''re likely to get Type II diabetes, says Gregory Dwyer, Ph.D., exercise physiology professor at Ball State University in Muncie, Indiana.
Women who carry their weight around their waists are a prime target for the disease, he says. To determine your waist-to-hip ratio, take the measurement of your waist and divide it by the measurement of your hips. If the result is 0.86 or higher, then you are at high risk, says Dr. Dwyer. For example, if your waist is 28 inches and your hips measure 34 inches, your waist-to-hip ratio is 0.82, so you''''re on the safe side. If you let your waist size swell to 30 inches, however, the ratio becomes 0.88--which may be asking for diabetes trouble. Time for a weight-loss plan.
Playing the Prevention Game
Researchers have a good idea of the dietary and exercise factors that put you at greater risk of Type II diabetes. Based on those studies, doctors recommend a number of important lifestyle habits that will help you fend off the disease.
Watch the weight gain. When it comes to preventing diabetes, the best strategy is to maintain an ideal body weight, says Dr. Bantle. Data suggest that if you are modestly overweight--that is, you need to lose about 10 pounds--losing those pounds won''''t make a dramatic difference. But if you''''re supposed to weigh about 125 pounds, and you''''re actually closer to 150, it''''s time to reduce. In general, anything greater than 120 percent of your ideal body weight puts you at increased risk, according to Dr. Bantle. Dropping some pounds is one thing that is clearly beneficial in preventing diabetes, he says. But you want to do it with steady weight loss, not by going on a crash diet--unless it''''s a diet your physician recommends and monitors for you.
| Snack for Stability If we were all smart, we''''d eat like cows. That''''s because grazing may be a major key to keeping insulin levels stable. One study illustrating the glories of grazing had 12 people with Type II (non-insulin-dependent) diabetes eating either two large or six small meals over an eight-hour period on two different occasions. When they ate the two big meals, their insulin levels rose much higher than when they ate the six meals over the eight-hour period. The two large meals also induced a yo-yo effect, with an 84 percent difference between the lowest and highest levels of glucose. "This attitude of ''''Suzy, don''''t snack'''' is dead wrong for us today," says Aaron Vinik, M.D., Ph.D., director of the Diabetes Research Institute in Norfolk, Virginia. "Research suggests that you get much healthier blood sugar and insulin levels from multiple feedings--having three small meals and three snacks throughout the day." Between a small breakfast and light lunch add fruit or a nonfat yogurt snack. Between lunch and a light dinner add another snack--a bowl of rice or some vegetable sticks. Then round out the evening with a postdinner snack--nonfat frozen yogurt or a small bowl of nonfat cereal with skim milk. |
Well, are you in that risk area of being overweight? Instead of just looking at what you weigh now, ask yourself how much weight you have gained since you were in your twenties, suggests Lesley Fels Tinker, M.D., nutrition scientist working on the Women''''s Health Initiative for the Clinical Coordinating Center at the Fred Hutchinson Cancer Research Center in Seattle. With some exceptions that''''s the age when most of us hover near our ideal weight.
If you are overweight, consider increasing your physical activity and decreasing your food intake, suggests Dr. Tinker.
Make a motion. Research shows that if you''''re more active, over the course of your lifetime, you''''ll have a much lower risk for diabetes than your couch-potato neighbor, according to Dr. Dwyer. A study of nearly 6,000 male alumni of the University of Pennsylvania in Philadelphia conducted by the University of California School of Public Health at Berkeley strongly suggests that physical activity may help prevent Type II diabetes. Two additional studies conducted at Harvard University--one of men and the other of more than 87,000 women--also suggest the protective effect of walking, running, bicycling and other steadily maintained activities. While there are no specific guidelines for how many hours of exercise you need to get each week to prevent the disease, says Dr. Dwyer, the message is that the more active you are, the better.
When Enzymes Run Rampant
While the islets of Langerhans are known for insulin production, the pancreas also produces other important chemicals--specifically, the digestive enzymes that we need to digest our food. But sometimes the pancreas gets an inflammation--for reasons unknown--that disrupts the release of digestive enzymes, says Joseph Lyon, M.D., professor in the Department of Family and Preventive Medicine at the University of Utah School of Medicine in Salt Lake City.
Because those digestive enzymes are powerful--after all, they''''re the chemical crunchers that break down food in your intestines--they can create a bad scene if they get misdirected. This happens when you have pancreatitis. Normally, your pancreas releases enzymes in an inactive state into the upper portion of the small intestine, and it is there where they become activated and go to work on food. When pancreatitis develops, however, the enzymes spill into the abdomen instead, says Dr. Lyon. The enzymes basically start attacking your internal digestive organs.
| Stroll for Control If you have diabetes and you''''re a walker, you''''re a step ahead in combating the effects of your condition. "Exercise helps improve blood sugar control by making the muscles more sensitive to insulin," says Neil F. Gordon, M.D., Ph.D., director of preventive cardiology at the Dallas Heart Group and Institute of Exercise and Environmental Medicine at Presbyterian Hospital and author of Diabetes: Your Complete Exercise Guide. "But even if the blood sugar level is not affected, we know that exercise reduces the risk of coronary heart disease, which is what most people with diabetes eventually die of." People with Type II (non-insulin-dependent) diabetes who aren''''t taking any medications can feel safe developing a walking program after a complete physical to rule out any heart or neurological problems, says Dr. Gordon. |
The problem is that nobody knows what causes pancreatitis. It''''s been associated with gallstones. There is some evidence that high levels of alcohol intake can trigger it. "But there is nothing really in the way of a prevention strategy for pancreatitis," says Dr. Lyon. "You just hope that you don''''t get it."
When it strikes, pancreatitis causes severe abdominal pain and vomiting. The pain is intense, and you''''ll know that you need medical help, says Dr. Lyon. Once it is diagnosed, there are a number of effective treatments.
When Cancer Strikes
Television celebs Michael Landon and Donna Reed got it. So did Jimmy Carter''''s brother, Billy. So pancreatic cancer has made the headlines now and then.
While pancreatic cancer isn''''t as prevalent as lung cancer or skin cancer, it''''s more likely to be fatal than many kinds of cancer that are more common. Even though it''''s the ninth most common malignancy in the United States, it''''s the fourth most common cause of cancer death.
Doctors have found a consistent link between smoking and pancreatic cancer. Since this cancer is so dangerous and smoking is clearly a risk factor, it just makes sense to give up the habit, says Dr. Lyon.
In addition to the smoking risk, some doctors say, there''''s a link between a high-fat diet and pancreatic cancer. The connection is less clear, says Dr. Lyon. But because a low-fat diet helps ward off many other health problems as well, sticking to a low-fat diet certainly couldn''''t hurt, he observes.
See also Digestive System, Endocrine System
