Chronic Relapsing Pancreatic Disease Of The Tropic Or Pancreatic Diabetes And Other Causes Of Mellituria
A Pancreatic Disorder
A General Overview
Diagnosis: The disease should be suspected when a young individual presents with abdominal pain and juvenile diabetes. Plain X-ray of the abdomen reveals radio-opaque calculi in the pancreas and this confirms the diagnosis. The calculi are found mainly in the head and body of the organ. They are of varying size and shape and may show translucent centers.
Complications: Complications are those of diabetes, pancreatic calculi and pancreatic exocrine dysfunction.
- Diabetic complications are similar to the complications seen in maturity-onset diabetes
- Complications due to calculi and exocrine dysfunction include obstructive jaundice, recurrent attacks of pancreatitis, and malabsorption state. Steatorrhea manifests if the diet contains normal amounts of fat (80 – 100 g/day).
Prognosis: Untreated, death occurs within a few years of onset. With adequate control of diabetes by diet and insulin, many cases survive up to the fourth and fifth decades. With proper control of the disease, women resume menstruation. Pregnancy and normal child birth are on record. Early onset of microangiopathy shortens life considerably.
Treatment: The treatment is only symptomatic. Control of the diabetic state is similar to the other forms of juvenile diabetes. Since they are all insulin- dependent, oral hypoglycemic drugs are ineffective. Generally, the insulin requirement is high and proper control can be achieved only by giving repeated doses of soluble insulin.
Abdominal pain of recurrent pancreatitis is very disabling and response to common antispasmodics like atropine and propantheline bromide is unsatisfactory. During acute attacks, the cases have to be managed on the same lines as acute pancreatitis. In intractable cases, with demonstrable calculi, surgical removal of the stones and dilatation of the sphincter of Oddi have been beneficial in many cases. When signs of malabsorption are present, dietary management and administration of pancreatic enzymes are indicated.
Sugar In Urine
Other Causes Of Mellituria
Though, glucose is the commonest sugar present in urine, other sugars may be encountered at times. Some are present due to inborn metabolic errors whereas others are of the ‘overflow’ type. In the latter type, sugars appear in urine whenever the blood levels rise above the renal threshold even in the absence of metabolic abnormalities. Indentification of the sugar is important since many cases of innocent melliturias may be wrongly treated as diabetes mellitus with disastrous consequences. A positive Benedict’s test with negative diastrix should suggest the possibility of non-glucose reducing substances in urine. These include sugars like lactose, fructose, galactose,
© 2014 Funom Theophilus Makama