How Do I Know If My Pancreas Is Tired?
When we eat, our pancreas jumps into action. The pancreas makes and releases a hormone called insulin to help move sugar (glucose) from the bloodstream into our cells, where it can be used or stored for energy.
But what happens when our pancreas works too hard — day after day, year after year? Like anything else that’s overworked, it gets tired. And when the pancreas gets tired, it struggles to do its job.
After years of research, we know the early warning signs of a tired pancreas, even when blood sugar levels look normal. Let’s walk through what the science says.
The Pancreas Starts to Struggle Early – Even Before Prediabetes Sets In
If you’ve been told by a doctor that you have prediabetes or type 2 diabetes, your pancreas is already exhausted and not producing enough insulin. That’s why your body has a hard time moving glucose out of the bloodstream and your glucose levels rise.
Several studies measured glucose and insulin levels in teens with bigger bodies after they consumed a sugary drink (known as a glucose tolerance test). The teens had different glucose levels, from normal to prediabetes to full-blown type 2 diabetes.
The researchers found that the pancreas didn’t suddenly stop working, it declined progressively over time. In teens with prediabetes, the pancreas had trouble producing enough insulin right after eating. With type 2 diabetes, the pancreas had trouble producing enough insulin right after eating, and for up to two hours afterward.
What about teens with bigger bodies and normal glucose levels? The researchers found that most teens maintained normal levels over several years. However, 23% of teens shifted from having normal glucose levels to having prediabetes in a very short amount of time — just two and a half years. Clearly, some teens who had normal blood sugar must have had hidden issues.
When the investigators looked back at the initial tests of the teens who developed prediabetes, they saw that the pancreas was already struggling to produce enough insulin as blood sugar levels gradually crept upward — even within the "normal" range of glucose. These teens also had greater insulin resistance, meaning their muscle and liver cells were not listening to insulin’s message to receive and store the glucose.
So, insulin resistance was one reason why teens with normal glucose levels quickly became prediabetic. There were more reasons, too…
Our Gut and Pancreas Are Talking, But the Message Doesn’t Come Through for Everyone
Why do some teens not make enough insulin when they eat and drink? When we eat, the pancreas needs to be told to release the right amount of insulin. To do this, the gut sees the food and makes hormones called incretins. Incretins are the messengers from the gut to the pancreas, telling the pancreas to “make more insulin!”
Researchers found that teens who make less insulin also have weaker incretin messages. Meaning, the pancreas isn’t getting the message to release enough insulin. This is yet another cause of high blood glucose and prediabetes.
Thanks to research like this, medications were developed to act like incretins. One well-known incretin is GLP-1, and diabetes medications like Ozempic and Trulicity mimic GLP-1. They can increase insulin production and reduce blood sugar levels!
Some of Us Are Born with a Rougher Road
Another reason a teen might shift from normal glucose levels to prediabetes lies in their DNA. DNA is the genetic information we get from our parents that decides what our body looks like and how it functions. One study identified a variant of the TCF7L2 gene that makes it harder for incretins to effectively tell our pancreas to produce more insulin. Teens with the TCF7L2 gene variant did not make enough insulin in response to the sugary drink and were more likely to spiral toward prediabetes.
We can’t control our genes, but knowing more about them can help us work with them. This strategy can include medications that help our bodies work differently to lower glucose levels.
So… How Do You Know If Your Pancreas Is Tired?
Thanks to the participation of numerous kids and teens, researchers have identified several clues about why the pancreas may be working overtime and burning out. Your glucose, insulin and incretin levels, and genetic makeup can be hints of a tired pancreas.
Identifying a tired pancreas is not a dead end – it’s a wake-up call. With support, you can reduce the stress on your pancreas and allow it to rest, recover, and work well again.
This report was written by Abigail Kelley and Clare Flannery, MD
Scientific Studies
Beta-cell function across the spectrum of glucose tolerance in obese youth. Weiss R, Caprio S, Trombetta M, Taksali SE, Tamborlane WV, Bonadonna R. Diabetes. 2005 Jun;54(6):1735-43. doi: 10.2337/diabetes.54.6.1735. PMID: 15919795
Primary defects in beta-cell function further exacerbated by worsening of insulin resistance mark the development of impaired glucose tolerance in obese adolescents. Cali AM, Man CD, Cobelli C, Dziura J, Seyal A, Shaw M, Allen K, Chen S, Caprio S. Diabetes Care. 2009 Mar;32(3):456-61. doi: 10.2337/dc08-1274. Epub 2008 Dec 23. PMID: 19106382
The normal glucose tolerance continuum in obese youth: evidence for impairment in beta-cell function independent of insulin resistance. Yeckel CW, Taksali SE, Dziura J, Weiss R, Burgert TS, Sherwin RS, Tamborlane WV, Caprio S. J Clin Endocrinol Metab. 2005 Feb;90(2):747-54. doi: 10.1210/jc.2004-1258. Epub 2004 Nov 2. PMID: 15522932
Incretin effect determines glucose trajectory and insulin sensitivity in youths with obesity. Galderisi A, Tricò D, Lat J, Samuels S, Weiss R, Van Name M, Pierpont B, Santoro N, Caprio S. JCI Insight. 2023 Nov 22;8(22):e165709. doi: 10.1172/jci.insight.165709. PMID: 37847560
A Reduced Incretin Effect Mediated by the rs7903146 Variant in the TCF7L2 Gene Is an Early Marker of β-Cell Dysfunction in Obese Youth. Galderisi A, Tricò D, Pierpont B, Shabanova V, Samuels S, Dalla Man C, Galuppo B, Santoro N, Caprio S. Diabetes Care. 2020 Oct;43(10):2553-2563. doi: 10.2337/dc20-0445. Epub 2020 Aug 11. PMID: 32788279