SAT-622 Management of Diabetes Following Palliative Total Pancreatectomy in a 61-Year-Old Male

Abstract Disclosure: N. Torres: None. J. Bermúdez-Santos: None. D.A. Lopez: None. I.C. Arroyo: None. Z. Maisonet -Feliciano: None. J. Segarra-Villafane: None. A. Vazquez: None. M. Ramirez: None. M. Alvarado: None. L.A. Gonzalez-Rodriguez: None. New surgical techniques and diabetes technology have improved outcomes after total pancreatectomy (TP). Once reserved for severe cases, TP is now increasingly performed for conditions like pancreatic cancer, chronic pancreatitis, and other nonmalignant pancreatic diseases due to advancements in surgical techniques and postoperative management. Despite these improvements, the absence of pancreatic hormones such as insulin and glucagon introduces unique challenges for short- and long-term management, requiring highly individualized care protocols. Modern diabetes technologies, such as continuous glucose monitors (CGMs) and insulin delivery systems, have revolutionized the management of insulin-deficient diabetes, significantly improving patient outcomes and enhancing quality of life. A 61-year-old male with pancreatic adenocarcinoma presented with gastrointestinal bleeding, severe anemia, fatigue, and abdominal pain radiating to the back. Imaging revealed a 3.6 x 4.9 x 3.6 cm malignant duodenal mass. He had no prior history of diabetes or insulin use. The patient underwent a palliative TP, splenectomy, cholecystectomy, and liver wedge biopsy. Postoperatively, an IV insulin infusion was initiated to maintain blood glucose (BG) levels between 140–180 mg/dL. On post-op day 7, he was transitioned to subcutaneous basal-bolus insulin therapy with adequate response and discharged home. At follow-up 1 week later, BG control remained stable without hypoglycemia, and a continuous glucose monitor (CGM) was placed. This case highlights the need for tailored insulin management following TP to optimize metabolic stability and outcomes. The complete loss of pancreatic hormones, including insulin and glucagon, complicates glycemic management due to high variability and unpredictable insulin requirements. Effective control requires structured insulin protocols, multidisciplinary care, and patient education. Dietary counseling and advanced technologies, such as insulin pumps and CGMs, are vital for mitigating hypoglycemia risk, improving stability, and enhancing quality of life. Advances in oncologic surgery and therapies have increased survival rates for TP patients, creating opportunities for improved quality of life. Tools like CGMs and continuous subcutaneous insulin infusions (CSII) support active lifestyles, reduce stress, and foster confidence in managing diabetes. Multidisciplinary care, education, and psychological support remain essential for long-term success. Presentation: Saturday, July 12, 2025