The Pancreas - Functions, Location and how to keep it healthy

The pancreas is an organ that sits in the abdominal cavity behind the stomach and in front of the spine. Most people don’t pay it much thought, but it is extremely important for the process of digestion and for regulating blood sugar levels. 

The pancreas produces both digestive enzymes, that directly contribute to the digestion of food in the gut, as well as hormones that travel in the blood stream having effects all around the body.

The digestive enzymes that the pancreas produces empty into the small intestine when food arrives there. These enzymes help break down protein, fats and carbohydrates so that these can be absorbed through the gut wall and into the blood stream. The pancreatic fluids also contain bicarbonate which helps neutralise stomach acid that has travelled into the small intestine with the food. 

The major hormone function of the pancreas is regulating blood sugar. 

The pancreas produces two main hormones; insulin and glucagon. 

Insulin is released in response to rising blood sugar levels, acting to reduce these levels by moving the sugar into the cells of the body where it is either used immediately or stored for later use. Glucagon effectively does the opposite by causing the body to release stored sugar when blood sugar levels fall.

The major health issue associated with the pancreas is diabetes mellitus.

In diabetes, the pancreas either stops producing enough insulin or the body stops responding to the insulin that the pancreas produces. Sometimes a combination of both things happens.

Type 1 diabetes

This is an autoimmune condition that is usually diagnosed in children and young adults. It occurs when the ‘islet cells’ that produce insulin within the pancreas are destroyed by the body’s immune system. This means that the pancreas no longer produces insulin and so people with type 1 diabetes always need to inject insulin.

Type 2 diabetes 

This is much commoner and traditionally has been an illness diagnosed in middle aged and older adults although it is now increasingly being found in young adults and even children. Whilst genetics plays some role in the development of type 2 diabetes, the main factors are a poor diet, particularly if it is high in sugar, and a sedentary lifestyle. Type 2 diabetes is strongly associated with overweight and obesity.

In type 2 diabetes the pancreas has been producing high levels of insulin over a long time in response to a diet high in sugars. Eventually, either the rest of the body stops responding to the insulin (insulin resistance) or the pancreas effectively becomes exhausted and produces too little insulin to properly reduce blood sugar levels. Treatments for type 2 diabetes include medications that either stimulate the pancreas to produce more insulin or make the rest of the body more sensitive to insulin. Sometimes people with type 2 diabetes will end up needing to inject insulin as well.

Symptoms of Diabetes

Symptoms of diabetes vary widely with some people experiencing no symptoms at all, but common symptoms include excess thirst, excess urination, and tiredness. If blood sugar levels are very high then people may experience blurred vision and, if the problem is not recognised early, people may develop symptoms of the complications of diabetes including tingling, numbness and pain in the feet (a sign of nerve damage), kidney problems, or recurrent infections. Weight loss is common in younger people who have developed type 1 diabetes but it is unusual in older people with type 2 diabetes. 

Diagnosing diabetes is straightforward and can be done using a blood test to check blood glucose levels or the HbA1C blood test which gives an average estimate of your blood sugar levels over the last three months. 

Another condition affecting the pancreas might be considered the opposite of diabetes. This occurs when an insulin producing tumour, called an ‘insulinoma’, grows (almost always in the pancreas). 

This is extremely rare, but it means that too much insulin is produced and blood sugar levels keep dropping to levels that are too low. It is usually treated by surgery to remove the tumour.

Whilst diabetes and insulinoma are long term or ‘chronic’ conditions that involve the pancreas, another relatively common ‘acute’, or short term, condition is acute pancreatitis. This is when the pancreas becomes inflamed which causes severe abdominal pain and vomiting. 

It is an emergency and can sometimes be fatal. Acute pancreatitis can be caused by a wide range of different triggers from certain medications to scorpion venom, but the two most common causes are excess alcohol consumption and gallstones (stones that form in the gallbladder and can block the ducts of the pancreas when they move). 

This is diagnosed by physical examination and the use of a blood test called amylase – very high levels of amylase in association with abdominal pain suggest acute pancreatitis. People with acute pancreatitis should be admitted to hospital.

Some people who have experienced acute pancreatitis will go on to develop longstanding issues known as ‘chronic pancreatitis’. This is where persistent inflammation causes permanent damage to the pancreas. It causes symptoms such as recurrent abdominal pain, weight loss, nausea, and it can lead to the development of diabetes as the damage to the pancreas stops it functioning properly. 

Diagnosis of this condition is usually made with a combination of history and examination, imaging studies such as CT scans or MRIs, blood tests and stool tests. It cannot be cured but the symptoms can usually be managed. 

Perhaps the most feared pancreatic condition is pancreatic cancer. 

Pancreatic cancer can be difficult to diagnose because it often does not cause any symptoms until it is quite advanced. Cancers usually cause symptoms due to the physical effect of the tumour growing, for example a growing tumour may cause bleeding such as in bowel cancer, or pain when it presses on other structures, or you may actually be able to feel a lump such as in breast cancer. Because the pancreas sits in the middle of the abdominal cavity, any tumour that develops in the pancreas has a lot of space and time to grow before it causes any symptoms.

Investigations for pancreatic cancer are usually triggered in older people who have developed diabetes with unexpected weight loss, or in people who suddenly develop jaundice (yellowing of the skin and eyes) without any pain. The most common first step is a CT scan, but blood tests are also usually performed, particularly checking liver function tests which may be abnormal in pancreatic cancer and blood sugar levels. 

There is a blood test called CA 19-9 which is a ‘tumour marker’ for pancreatic cancer. This is most useful for monitoring the condition and is not considered to be a good screening test for pancreatic cancer. CA 19-9 often gives false positive results which can be unnecessarily alarming, or false negative results which are falsely reassuring.

As you can see from the above, the pancreas is an important organ. The biggest health concern in the UK associated with the pancreas is type 2 diabetes. If you are interested in the health of your pancreas then testing blood sugar levels to exclude diabetes or pre-diabetes is a good first step.

At One Day Tests we offer a wide range of health check blood tests, including full body MOTs.

Full body MOTs are a great way of investigating how the body is currently functioning and identifying any potential issues before they get too serious.

Take a look at out selection of MOT health checks.