A progressive pathological process with damage to the entire organ (including the cells of the islet apparatus) causes not only excretory, but also endocrine pancreatic insufficiency, leading to a deficiency of not only insulin, but also glucagon, and the development of secondary diabetes mellitus.

Deficiency of glucagon determines the peculiarities of the course of pancreatogenic diabetes mellitus: a tendency to hypoglycemia, the need for low doses of insulin, the rare development of ketoacidosis, vascular and other complications.

The diet of patients with developed endocrine pancreatic insufficiency is based on the principles of nutrition for patients with diabetes mellitus with changes necessary for damage to the pancreas. For cooking, food products are often used that are recommended for pancreatic diseases, in addition to those containing a large amount of easily digestible carbohydrates, such as semolina, rice, oatmeal, potatoes, confectionery and flour products (white wheat bread), sugar and sweets. Buckwheat is recommended from cereals..

Allow special diabetic or gray wheat bread made from wholemeal flour in limited quantities (no more than 250 g / day). When preparing cutlets, instead of bread, it is recommended to introduce fresh cottage cheese (for 100 g of meat - 50 g of cottage cheese). Various sweeteners are widely used. Compotes, jellies, mousses are prepared with the addition of saccharin or xylitol.

Foods rich in carbohydrates are distributed evenly throughout the day, or their consumption is timed to coincide with the time of administration of antidiabetic drugs. Sample menus are shown in the table. 28. 6, 28.

Table 28. Sample menu for patients with endocrine pancreatic insufficiency during exacerbation of chronic pancreatitis 1st breakfast: boiled tongue, carrot puree, tea with milk.

2nd breakfast: steamed cottage cheese souffle, baked apple.

Lunch: vegetable puree soup, boiled beef stroganoff, mashed potatoes.

potato, fruit juice mousse.

Afternoon snack: grated cheese, rosehip broth, croutons from protein-wheat bread.

At night: kefir.

For the whole day: protein-wheat bread of yesterday's baking 200 g, butter 20 g Table 28. Sample diet menu for patients with endocrine pancreatic insufficiency during remission 1st breakfast: baked fish (low-fat species), stewed vegetables, tea, cheese.

2nd breakfast: scrambled eggs, rosehip broth, croutons from protein-wheat bread.

Lunch: vegetable soup with meat broth, meat roll, carrot puree, fruit jelly.

juice.

Afternoon snack: calcined cottage cheese, oatmeal jelly, protein-wheat croutons.

of bread.

Dinner: salad of carrots and pumpkin, stewed chicken, vegetables stewed in milk, diabetic sausage.

At night: kefir Outside of exacerbation and in the stage of compensation of the disease (6 months after exacerbation of pancreatitis), patients can be recommended sanatorium treatment in specialized sanatoriums in Yessentuki, Truskavets, Zheleznovodsk, Jermuk, Pyatigorsk, Arzni, etc..

The main therapeutic factors will be nutritional therapy, mineral waters, physiotherapy, exercise therapy and climatotherapy.

Compliance with secondary prevention allows in some cases to extend the relapse period and prevent the development of severe complications of chronic pancreatitis. Prevention of exacerbations of chronic pancreatitis is carried out taking into account the etiological factors that occur in a particular patient.

With alcoholic pancreatitis, an important condition is strict abstinence from alcoholic beverages. In the case of biliary pancreatitis, a strict diet is required with the use of enzyme preparations and litholytic therapy.

Baranovskiy medbe. ru.