What Is Type 3c Diabetes and How Is It Different From Other Types?

Type 3c diabetes, also called pancreatogenic diabetes, is a type of diabetes that develops when the pancreas is damaged by conditions (e.g., chronic pancreatitis, pancreatic surgery, pancreatic cancer, cystic fibrosis, or iron overload). This damage affects both the main jobs of the pancreas, which are to make hormones like insulin and glucagon to control blood sugar, and releasing digestive enzymes to break down fat, protein, and carbohydrates.

Because of this, people with type 3c diabetes can have rising blood sugar and symptoms of poor digestion (e.g., weight loss, greasy stools, abdominal pain or discomfort after meals). It is often mistaken for type 2 diabetes at first, especially if the person already has a history of pancreas problems. Treatment usually includes diabetes medicines (often insulin), pancreatic enzyme replacement, an easy-to-digest food plan, and regular monitoring with blood tests and home tools like glucose meters and urine test strips. Understanding type 3c diabetes can help you ask clearer questions and get care that truly fits what your body needs.

Key Insights

• Type 3c diabetes is caused by direct damage to the pancreas, often from chronic pancreatitis, pancreatic surgery, pancreatic cancer, cystic fibrosis, or iron overload conditions.

• It affects both insulin production and digestive enzyme output, so people often have high blood sugar along with greasy stools, weight loss, and vitamin shortages.

• Many adults with type 3c diabetes are first labeled as having type 2 diabetes, especially if no one looks closely at their pancreas history or digestive symptoms.

• Diagnosis usually combines blood sugar tests, stool or enzyme tests, and imaging of the pancreas, along with checks for autoimmune markers to rule out type 1 diabetes.

• Treatment often requires insulin, pancreatic enzyme replacement therapy, a steady food plan with small, frequent meals, and vitamin supplementation when needed.

• At home, people can use blood glucose meters and urine test strips for glucose and ketones to watch for dangerous spikes or changes related to illness between clinic visits.

• Life expectancy depends on blood sugar control and the severity of the underlying pancreas disease, but good management and lifestyle changes can improve health in real and measurable ways.

What Causes Type 3c Diabetes?

Type 3c diabetes usually develops when the pancreas could no longer release sufficient insulin or digestive enzymes. This damage is usually visible on imaging tests and often appears after months or years of inflammation, scarring, or surgery. Doctors sometimes call this form “secondary to pancreatic disease.”

The most common cause is chronic pancreatitis, which is a long-term inflammation of the pancreas. It often follows repeated attacks of acute pancreatitis or years of heavy alcohol use. Over time, normal pancreatic tissue turns into scar tissue. That scar tissue does not make insulin or enzymes. So, your body has to manage with less.

Pancreatic surgery is another major cause. People who have part of their pancreas removed for tumors, cyst, or trauma lose some of their insulin-producing cells. If a large part is taken out, the remaining tissue may not keep up with the body’s needs. Diabetes may soon appear after surgery or develop slowly over the next few years.

Pancreatic cancer can also damage the gland, especially when the tumor blocks ducts or replaces healthy tissue. Cystic fibrosis, a genetic disease, can lead to thick secretions that block the pancreas and cause scarring. Iron overload disorders, such as hemochromatosis, store extra iron in organs, including the pancreas, and that can injure the insulin-producing cells over time.

In all these situations, the pattern is similar:

• The gland gets damaged

• Enzyme output falls

• Insulin production drops

• Blood sugar begins to rise

Type 3c diabetes is the term used when it develops in this setting.

What causes pancreatic damage?

You may wonder what starts the damage in the first place. The list of triggers is fairly clear, although each person’s condition is different.

• Long-term alcohol use: It inflames the pancreas and makes digestive enzymes activate too early inside the gland.

• Gallstones: It may block the duct that drains the pancreas, which may lead to swelling or pain.

• Genetic form: This may appear in childhood or early adulthood, even without alcohol use. A strong family history, early attacks, or unexplained episodes often trigger evaluation for genetic variants.

• Trauma: Severe trauma (e.g., car crashes) can bruise or tear the pancreas.

• Large surgeries in the upper abdomen: Reduces blood flow to the gland or removes part of it, resulting in scarring that replaces the healthy cells and function falls.

• Iron overload: Excess iron can damage the organ, which slowly damages insulin-producing cells and raises the risk of diabetes. When this happens along with exocrine failure, it results in type 3c diabetes.

If your medical history includes any of these triggers, and you notice changes in your sugar or digestion, type 3c diabetes is something that may be considered.

What Are the Common Symptoms of Type 3c Diabetes?

Type 3c diabetes combines symptoms of diabetes and signs of poor digestion. Some symptoms look like classic diabetes. Others point to problems with pancreatic enzymes.

Common diabetes-related symptoms include:

• Increased thirst

• More frequent urination (especially at night)

• Fatigue that does not match your level of activity

• Blurred vision

• Slow-healing cuts

• More frequent infections

• Tingling or numbness in hands or feet

• Unexplained weight loss

Many people with type 3c also have exocrine pancreatic insufficiency. This means the pancreas does not release enough enzymes to digest food. This often leads to abdominal pain or cramps, bloating after meals, and gas. Stools may appear loose, pale, greasy, foul-smelling, or hard to flush. You may even see oil in the toilet water. These are signs that fat is not being broken down properly.

Over time, poor digestion can lead to vitamin shortages. Fat-soluble vitamins A, D, E, and K are especially affected. You may feel weak, have bone pain or fractures, or notice frequent bruising. Because nutrients and calories are lost in the stool, weight can drop even when you eat normal portions.

How Is Type 3c Diabetes Diagnosed?

Diagnosing type 3c diabetes usually involves multiple approaches. It’s usually a series of:

• Diabetes confirmation

• Demonstrate pancreatic damage

• Rule out type 1 autoimmunity as the main cause

Blood tests

These are standard tests that involve blood collection and measurement of your blood glucose concentration:

• Fasting blood glucose

• Random blood sugar

• HbA1c levels

• OGTT (oral glucose tolerance test)

Imaging

Evaluation of the pancreas involves:

• Ultrasound

• CT scans

• MRI

• Endoscopic ultrasound

These imaging tests evaluate the size, shape, and structure of the pancreas. In chronic pancreatitis, for example, the gland may look smaller, irregular, or scarred. Calcifications or duct changes can be visible. After surgery, missing segments, or altered anatomy can appear.

Other Tests

Stool examination (e.g., fecal elastase) may be requested as low elastase levels often suggest that the pancreas is not making enough enzymes. When it occurs along with greasy stools and weight loss, it should prompt evaluation of the pancreas.

Autoimmune markers are also frequently used to ensure that it is not type 1 diabetes. This test determines the presence of antibodies that attack insulin-producing beta cells. If these are negative, insulin resistance is low, and there’s evidence of pancreatic damage. The picture fits type 3c more than type 1 or 2.

In real life, these lines can blur, and some people have mixed features. These lines could be clear with:

• History of pancreatic disease

• Abnormal imaging

• Exocrine insufficiency

• Onset of new diabetes symptoms

How do at-home urine test strips help?

At-home urine tests do not diagnose type 3c diabetes by themselves. But, they add useful information between clinic visits. They give you and your care team extra information about your daily or weekly status.

Glucose in urine testing shows when blood glucose rises more than the renal threshold of about ~180 mg/dL. However, mild elevations of blood sugar may not be captured using urine testing. This helps you notice patterns, like repeated highs after meals or during illness.

Ketone in urine strips are also important, particularly when you’re using insulin, have poor intake, or not feeling well. High ketones often signal that your body is breaking down fat or fuel because it is not getting enough or using glucose. High levels of ketone may become dangerous when ignored. Quick home checks can catch problems early so you can adjust insulin dosing, drink fluids, and even seek urgent care.

Some multipanel urine strips also check protein, blood, or infection markers like nitrites. Since diabetes can affect the kidneys, early changes in urine can help your doctor decide when to order more detailed kidney tests.

However, urine strips do not replace finger-stick meters or lab tests. They are simple, low-cost tools that can help you stay informed and involved in your own care.

How Is Type 3c Diabetes Managed and Treated?

Managing type 3c diabetes means treating both the diabetes and the pancreatic disease that causes it. Care usually aims to control blood sugar, support digestion and nutrition, manage pain (if there is), and slow further damage.

Key parts of treatment include:

• Insulin therapy

• Many people with type 3c diabetes need insulin earlier than those with type 2 diabetes

• Oral diabetes medicines may be used at first but injections or pumps often become the main treatment

• The goal is to keep the blood sugar in safe range and reduce any damage to the eyes, kidneys, nerves, and heart

• Pancreatic enzyme replacement therapy (PERT)

• Capsules are taken with meals and snacks to replace missing digestive enzymes

• Help break down food and improve nutrient proportion

• Can improve stool consistency, reduce belly pain, and help stabilize or increase weight

• Nutrition and meal planning

• Often guided by a dietician familiar with both diabetes and pancreatic disease

• Emphasis is made on small, frequent meals that are gentle on the gut

• Focus on steady carbohydrates, enough calories and protein, and healthy fats

• Treating the underlying pancreatic condition

• May include stopping alcohol, treating gallstones, managing high triglycerides, or continuing cancer or post-surgical care.

• Pain control and vitamin or mineral supplements are often needed.

• Home monitoring

• Regular blood glucose checks with finger sticks or a continuous glucose monitor (CGM).

• Sometimes urine tests for glucose and ketones.

• Logging readings, symptoms, and food intake helps fine-tune insulin, enzymes, and meal plans.

Is type 3c diabetes permanent?

In most cases, yes. Type 3c diabetes is usually permanent because the damage to the pancreas and its insulin-producing cells doesn’t grow back, especially after chronic pancreatitis or major surgery.

However, permanent doesn’t mean unchangeable. With good treatment, blood sugar levels can move from very high to well controlled, A1c can improve, and symptoms like thirst, frequent urination, fatigue, and digestive issues can ease.

So while the diagnosis usually stays, your day-to-day life can improve a lot. The goal isn’t to cure type 3c diabetes, but to manage it well enough to lower complications and support a better quality of life.

Can type 3c diabetes be reversed?

Unlike many cases of type 2 diabetes, type 3c diabetes usually cannot be “reversed”. The pancreas is structurally damaged or partly removed, and those changes typically do not grow back.

What can change are your numbers and symptoms. Stopping alcohol and smoking, taking pancreatic enzymes correctly, adjusting your diet, and using insulin as prescribed can move blood sugars into safer ranges, reduce pain episodes, improve weight, and lower the risk of complications.

It’s more helpful to see type 3c diabetes as a chronic condition that can be well managed, rather than something that can be erased. You can’t undo the damage to the pancreas, but you can significantly improve your health and quality of life.

What foods are best for type 3c diabetes?

The overall goal for diet in type 3c diabetes is to support blood sugar control and digestion. It should be focused on eating patterns that you can follow long-term, which should also fit your culture and preferences.

You can consider the following:

• Meal pattern (e.g., small, frequent meals instead of large ones) can help spread out the work of pancreas and gut

• Protein with every meal (e.g., fish, skinless chicken, tofu, eggs, beans, lentils) supports muscle and helps you feel full

• Smart carbs (e.g., whole grains, beans, lentils, vegetables, fruits) while limiting white bread, sugary drinks, and sweets to reduce sugar spikes

• Fats in moderation: Avoid fried, greasy, and very fatty foods that could worsen diarrhea or oily stools (e.g., olive oil, avocado, nuts, seeds) and take enzyme capsules with any meal that contains fat

• Strictly limit alcohol intake or avoid it completely

• Consult a dietician or diabetes educator to customize a plan fit to your goals, symptoms, and lifestyle

How Does Type 3c Diabetes Differ From Types 1 and 2?

Here’s a concise comparison table:

What is the prognosis/life expectancy?

Life expectancy in type 3c diabetes depends on several factors. These include how well the blood sugar is controlled, how severe the underlying pancreas disease is, and whether complications have already developed.

Poorly controlled blood sugar, regardless of type, can damage blood vessels in the eyes, kidneys, nerves, and heart. Over the years, this raises the risk of blindness, kidney failure, nerve pain or numbness, heart attacks, or strokes. The same risks exist in type 3c, so aiming for near-target glucose levels matters.

The pancreas disease itself also affects outlook. Chronic pancreatitis can lead to ongoing pain, repeated hospital visits, and nutritional problems. Pancreatic cancer has its own serious course. Genetic or iron overload conditions can involve other organs, such as the liver and heart.

On the positive side, people who stop smoking and avoid heavy alcohol use tend to do better. Taking enzymes as prescribed, maintaining a healthy weight, staying physically active, and following recommended blood sugar targets all support a longer and better life. Regular visits with both diabetes and pancreas specialists help catch complications early, when they are easier to manage.

When Should You See a Doctor or Consider Self-Testing?

You should see a doctor if you notice signs that suggest either diabetes or pancreatic disease. The sooner you discuss your condition with your healthcare provider, the easier it is to get clear answers and a plan.

Red flags include:

• New or worsening upper abdominal pain, especially if it spreads to the back, or gets worse after eating

• Repeated bouts of severe abdominal pain, nausea, and vomiting

• Greasy, pale, or floating stools

• Feeling extremely thirsty

• Urinating often

• Losing weight without trying

Self-testing at home with blood glucose meters and urine strips makes sense in several settings. If you already have diabetes, your doctor will likely ask you to monitor. If you are at high risk, such as after a pancreatic surgery, short-term monitoring might help catch problems earlier. 

Urine strips are especially useful when you are sick, feel different than usual, or see higher readings on your meter. They are also helpful if you live far from a clinic and need a way to decide whether a change is urgent.

Final Takeaway

If you suspect type 3c diabetes, you are already taking an important step by looking for clear, practical information. This form of diabetes can feel confusing because it blends pancreas disease, digestion problems, and blood sugar changes. You are not alone in feeling that way. With the right diagnosis, a treatment plan that includes insulin and enzyme support when needed, careful food choices, and simple home tools such as urine strips, you can move from feeling in the dark to feeling more in control. Your health care team brings medical expertise, and you bring daily awareness of your own body. Working together, you can shape a plan that supports your energy, protects your organs, and helps you live the life you want as much as possible.

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Quick Summary Box

• Type 3c diabetes is a form of diabetes that develops after the pancreas is damaged, which affects both hormone and enzyme production.

• Common causes include chronic pancreatitis, pancreatic surgery, pancreatic cancer, cystic fibrosis, and iron overload disorders such as hemochromatosis.

• People often notice a mix of diabetes symptoms, like thirst and frequent urination, and digestive symptoms, like greasy stools, abdominal pain, and weight loss.

• Doctors diagnose type 3c diabetes by confirming diabetes, showing pancreatic damage and exocrine insufficiency, and ruling out classic type 1 autoimmunity as the main cause.

• Management usually involves insulin or other diabetes medicines, pancreatic enzyme capsules taken with meals, targeted nutrition, and monitoring for vitamin shortages.

• At home, urine test strips for glucose and ketones, along with regular blood sugar checks, help you and your care team catch rising risk and adjust treatment sooner.

• Stopping smoking, avoiding heavy alcohol use, staying active, and following a clear care plan can reduce complications and support a longer, more stable life with type 3c diabetes.

References

References

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Coulthard, M. G. (2019). Using urine nitrite sticks to test for urinary tract infection in children aged < 2 years: a meta-analysis. Pediatric Nephrology, 34(7), 1283–1288. https://doi.org/10.1007/s00467-019-04226-6 

Hart, P. A., Bellin, M. D., Andersen, D. K., Bradley, D., Cruz-Monserrate, Z., Forsmark, C. E., Goodarzi, M. O., Habtezion, A., Korc, M., Kudva, Y. C., Pandol, S. J., Yadav, D., & Chari, S. T. (2016). Type 3c (pancreatogenic) diabetes mellitus secondary to chronic pancreatitis and pancreatic cancer. The Lancet Gastroenterology & Hepatology, 1(3), 226–237. https://doi.org/10.1016/s2468-1253(16)30106-6 

Hieshima, K., Sugiyama, S., Yoshida, A., Kurinami, N., Suzuki, T., Ijima, H., Miyamoto, F., Kajiwara, K., Jinnouchi, K., Jinnouchi, T., & Jinnouchi, H. (2020). Elevation of the renal threshold for glucose is associated with insulin resistance and higher glycated hemoglobin levels. Journal of Diabetes Investigation, 11(3), 617–625. https://doi.org/10.1111/jdi.13191 

Jimenez-Luna, C., Martin-Blazquez, A., Dieguez-Castillo, C., Diaz, C., Martin-Ruiz, J. L., Genilloud, O., Vicente, F., del Palacio, J. P., Prados, J., & Caba, O. (2020). Novel Biomarkers to Distinguish between Type 3c and Type 2 Diabetes Mellitus by Untargeted Metabolomics. Metabolites, 10(11), 423. https://doi.org/10.3390/metabo10110423 

Nebraska Medicine. (2024, December 20). Pancreatitis and diabetes: Relationships, causes and risks. Nebraskamed.com; Nebraska Medicine. https://www.nebraskamed.com/health/conditions-and-services/transplant/pancreatitis-and-diabetes-relationships-causes-and-risks 

NHS. (2024). Type 3c Diabetes :: County Durham and Darlington NHS Foundation Trust. County Durham and Darlington NHS Foundation Trust. https://www.cddft.nhs.uk/services/diabetes-endocrinology/living-diabetes/type-3c-diabetes 

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Wayne, C. D., Chahrazed Benbetka, Besner, G. E., & Narayanan, S. (2024). Challenges of Managing Type 3c Diabetes in the Context of Pancreatic Resection, Cancer and Trauma. Journal of Clinical Medicine, 13(10), 2993–2993. https://doi.org/10.3390/jcm13102993

Frequently Asked Questions

Q: What is type 3c diabetes?

A: It is a form of diabetes that develops after damage to the pancreas. Both insulin production and digestive enzyme output are reduced.

Q: How do you treat type 3c diabetes?

A: Treatment usually involves insulin or other diabetes medicines, pancreatic enzyme capsules, a food plan tailored to your needs, and regular monitoring with blood and sometimes urine tests.

Q: Is type 3c diabetes permanent?

A: In most cases, yes. The pancreas damage is lasting, but blood sugar control and symptoms can improve with good care.