Thedegree of pancreatic insufficiency correlates with risk of developingCFRD.31, –33 However,patients without CFRD may also show exocrine damage.9,34 An autopsy study of pancreatafrom young CF patients showed that even before ultrastructural changes of theexocrine pancreas could be detected, there was evidence of altered isletarchitecture with a reduced number of insulin positive cells and increased number ofglucagon positive cells.35 Moreover, adolescent CF patients with pancreatic insufficiency display adysfunctional enteroinsular axis. Here, INS is linked to exocrine pancreatic insufficiency.