2.5　Other Pancreatic Endocrine Function Tests

Other pancreatic endocrine function test include glucagon，glucagon-like peptide-1（GLP-1）and glucose-dependent insulinotropic polypeptide（GIP）（Cui and Andersen 2011）.

Diminished pancreatic exocrine function has been reported to correlate with impairment of pancreatic β-cell function（Larsen et al.1987）.Although it is likely that reduction in a-cell mass results in the defect in insulin secretion，exocrine pancreatic insufficiency may also play a role in developing impaired insulin secretion by affecting the insulinotropic hormones GIP and GLP-1（Meier and Giese 2015；Meier and Nauck 2010）.The secretion of GIP and GLP-1 from enteroendocrine cells is associated with absorption of nutrients，so malabsorption in the proximal gut due to exocrine pancreatic insufficiency may impair GIP and GLP-1 secretion and thereby diminish postprandial insulin release（Knop et al.2007；Ebert and Creutzfeldt 1980）.(https://www.daowen.com)

Glucagon secretion can also be impaired in CP patients（Meier and Giese 2015）.A study on patients with advanced CP demonstrated that the glucagon counter-regulatory response to hypoglycemia is significantly reduced（Linde et al.1977）.When patients with CP associated T3cDM were treated with insulin or insulinotropic agents，an increased risk for large swings in blood glucose and frequent hypoglycemic episodes should be taken into account（Meier and Giese 2015）.Therefore，early evaluation of glucagon level should also be performed in CP patients.