Endocrine Abstracts

Diabetes education plays a vital role especially in newly diagnosed patients to prevent long-term complications and hospital admissions. We present a 68-year old female who was admitted with nausea, vomiting and poor oral intake. She was discharged two weeks ago after having complete pancreatectomy, splenectomy and left adrenalectomy for pancreatic cancer and a left adrenal mass. She did not have past medical history of diabetes and was commenced on basal bolus insulin after surgery but admitted to omitting the insulin. Examination showed signs of dehydration, a healed surgical scar but no localising signs of infections. Investigations revealed hyperglycaemic ketosis without acidosis. She was initially given variable rate insulin infusion (VRII) with transition to subcutaneous insulin when she was able to eat and drink. VRII was restarted 24 h later by the admitting team due to persistent hyperglycaemia and ketonaemia. She was referred to diabetes team and was noted to have several hypoglycaemic episodes on VRII. She had a glucometer and ketometer, but was not confident enough to manage diabetes related sick days independently. She was provided with extensive education by diabetes specialist nurses and dietitians. Basal bolus insulin was recommenced based on re-calculation of insulin requirements and no further hypoglycaemic or hyperglycaemic events were noted afterwards. Patients develop diabetes immediately after total pancreatectomy and, unlike patients with other types of diabetes, have no honeymoon phase. They are at high risk of acute and chronic diabetes complications and need more vigorous and ongoing diabetes education. If admitted to the hospital, early referral to diabetes team can prevent further complications and reduce the length of hospital stay.