High Insulin Resistance in Pancreatic Adenocarcinoma

Abstract Introduction: Diabetes mellitus and obesity is associated with increased risk of pancreatic cancer which has been postulated to be due beta cell dysfunction insulin resistance. Pancreatic also exerts its effect on cells, reducing secretion, affecting glucose uptake increasing We present a case adenocarcinoma severe resistance uncontrolled diabetes reversed after tumor removal. Clinical Description: 79 year old male patient no prior diagnosis diabetes, history hypertension, atrial fibrillation, cerebrovascular accident got admitted the hospital painless jaundice, dark colored urine pruritus for month. He endorsed polyuria, polydipsia weight loss 2 months. underwent Magnetic Resonance Cholangiopancreatography was diagnosed 2.8 cm head mass, consistent along intraductal papillary mucinous neoplasm. new onset A1c 12.6% during that hospitalization. weighed about 75 kg height 170cm (BMI 26.6). Labs showed normal renal function, deranged liver enzymes direct hyperbilirubinemia, elevated transaminases alkaline phosphatase. C-peptide level 1.2 ng/ml blood 197 mg/dl. discharged once daily Glargine 25 units mealtime Lispro 10 three times day (TID) requiring 0.7 units/kg. During follow-up, his requirement started increase despite proper injection technique medication compliance. required glargine 150 units/day U500 50 TID 4 Whipple’s procedure, partial pancreas resection month diagnosis. Patient clear liquid diet get better post-op 1 just correctional insulin. Repaglinide 0.5mg each meal all discontinued. His in range 80 160 mg/dl clinical follow-up regular diabetic diet. Conclusion: The pathogenesis not studied well. Basic science research found adrenomedullin, an amionopeptide, up-regulated patients causes β Cells. Cancer theories metabolic reprogramming cross talk happens between peripheral tissue, inhibiting cellular intake inducing More understand these paraneoplastic phenomenon caused by diabetogenic tumor-secreted product diabetes.