Pancan is a very challenging disease; it’s not for sissies! You’ve made it this far which shows your sense of courage and strength. I became diabetic after my distal surgery Oct. 2022. I lost a lot of weight trying to stick with the carb schedule until an 8 year survivor (stage 4) told mri worry about carbs later and eat what I want (within reason) and adjust the insulin accordingly. I was told the main goal now is to keep up the weight and strength. It worked! Too well I think sometimes cause now I wish I weighed just a little less. My cancer came back in Nov 2023 or else it really never was eradicated due to my 5 FU chemo. My ca19-9 rose to 3840 while drs looked for a visual of the cancer. I asked for chemo in the interim and my surgeon said “no surgeon in their right mind would give me chemo” at that point. They finally confirmed its presence via MRI and EUS. I’m on chemo again (aggressively 3 sessions on and 1 wk off), but on the gem-abraxane-cis combo and it’s working as my ca19-9 is at 550. Nausea is horrific now, but I’m sure I’ll find something out there eventually to help with it. I have 2 young adult college age children to live for (and a husband) and I ask for God’s help and give Him thanks constantly. I’m sure you have much to live for also and I dint know your beliefs and I hope I don’t offend them in any way, but I will be praying for you that you find the strength to be on the positive side of this nasty disease.