Exocrine Pancreatic Insufficiency in Type 1 Diabetes Mellitus Masquerading as Gastroparesis

Exocrine pancreatic insufficiency (EPI) is a common but underdiagnosed complication of type 1 diabetes mellitus (T1DM), characterized by insufficient pancreatic enzyme production leading to malabsorption. We report the case of a 19-year-old male with T1DM presenting with recurrent episodes of vomiting and abdominal pain. Initially diagnosed and treated for diabetic ketoacidosis and diabetic gastroparesis based on clinical symptoms and diagnostic imaging, the patient experienced persistent symptoms despite standard therapies. Further evaluation revealed low fecal elastase levels, confirming EPI despite a structurally normal pancreas on imaging. Pancreatic enzyme replacement therapy (PERT) led to marked symptomatic improvement and resolution of gastrointestinal complaints. This case underscores the need for a high index of suspicion for EPI in T1DM patients presenting with persistent gastrointestinal symptoms, particularly when refractory to standard treatments. Early recognition and intervention with PERT can significantly enhance clinical outcomes and quality of life.