SUN-688 Pancreatic Cancer in Longstanding Diabetes

Background Pancreatic Cancer carries one of the highest mortality rates in the US and it is established that there is a relationship between Pancreatic Cancer and Type 2 Diabetes Mellitus. We present a case of a woman with longstanding T2DM who developed Pancreatic Cancer and worsening of her T2DM. Case Presentation 86 year old female was brought to the ER by her family due to jaundice and scleral icterus. Additionally, her blood glucose levels had been uncontrolled in the previous month despite good control for years. Her AST was 871 and ALT was 827, Alkaline Phosphatase was 591, and Total Bilirubin was 13.9, mainly direct with a value of 11.11. The patient had a CT Abdomen and was found to have a mass in the head of her pancreas. She underwent an Endoscopic Ultrasound and FNA biopsy. Cytology results were consistent with Pancreatic Adenocarcinoma. The mass was unresectable and it was recommended she transition to hospice. Regarding her T2DM, she was diagnosed 15 years ago and prior to the last month, her glucose had been well controlled on Metformin and Glipizide, never requiring Insulin. HbA1C 1 year prior was 6.7 and HbA1C during the admission was 8.5. During the month preceding her pancreatic cancer diagnosis, her family noticed her blood glucose levels were running higher than usual. During her admission, her glucose continued to range from 178-315 even though she was on Lantus 12 units nightly and an Insulin Sliding Scale before meals. Discussion Although a relationship between Pancreatic Cancer and T2DM has been found, recent studies have shown that this relationship is bidirectional and complex. Several reports have shown that there is a risk association that the shorter the duration of T2DM the higher the average risk association between Pancreatic Cancer and T2DM. Several cohort and case-control studies of patients diagnosed with Pancreatic Cancer show that 25-50% of patients will have developed T2DM within 1-3 years before their diagnosis of Pancreatic Cancer and 85% of patients diagnosed with Pancreatic cancer have impaired glucose tolerance. The mechanism of action of T2DM causing Pancreatic Cancer includes insulin resistance, hyperinsulinemia, hyperglycemia, and chronic inflammation and it is proposed that this pathogenesis is more of a humoral process rather than local tumor destruction of the gland. A factor supporting this is that insulin and C-Peptide levels are reported to be higher in patients with Pancreatic Cancer and T2DM. Conclusion Unexplained elevation in HA1C should prompt clinicians to run a differential diagnosis of factors that can induced hyperglycemia. This case highlights the importance of recognizing pancreatic malignancy as a possible cause of worsening hyperglycemia in T2DM.