Onset of diabetes. Pancreatic cancer?

Sorry to hear this. The CA 19-9 is semi-reliable for diagnosis, so it wouldn't be the only test. To diagnose, you'd likely need some sort of imaging (CT, MRI) and an endoscopic ultrasound with biopsy of any suspicious areas. That said, doctors often (usually?) take the CA 19-9 as part of the diagnostic workup so there's a baseline figure. It's more reliable when used to track progress of treatment.

Not medically trained here, just a patient...

Sudden-onset diabetes does happen sometimes in conjunction with pancreatic cancer. It happened with me. But it was not considered Type 2, although sometimes it happens this way. Type 2 is, iirc, the body being resistant to insulin you produce, and Type 1 is (iirc) the failure to produce insulin. Mine was labeled "Diabetes associated with pancreatic disease," but more similar to Type 1 than Type 2.

The jaundice made the pancreatic cancer more obvious in my case, pointing to a blocked common bile duct in the head of my pancreas, but if a different part of your pancreas is "malfunctioning," it might not block the duct. It's also possible the "malfunction" is a temporary issue affecting insulin production or something else.

Ask your doc for a couple of the basic tests: CA19-9 is the marker most closely associated with pancreatic cancer. CEA is another cheap and easy test that might suggest other related cancers. Ask if they can get you in for a germline genetic test as well (Invitae is one example) to see if you've inherited any mutations that make you more susceptible to pancreatic (or other cancers). The result could also help steer your treatment if you do have cancer and a mutation, or at least determine your risk and monitoring schedule if you have mutations without cancer.

There are other blood tests based on DNA that would be more expensive. You might have to self-pay for them if there's no obvious indication of cancer, but they can be useful. Guardant 360 and Grail's Galleri are two examples. Neither is approved by the FDA and neither is guaranteed sensitive enough to detect early stage PC, but they do offer data points you can collect to better understand your status and support or rebut the other diagnostics.

You should push for good imaging if possible. MRI with the pancreas protocol (MRCP) is probably the best non-invasive approach. An external ultrasound can get a decent picture of your liver, but not your pancreas. If there is a reason to get invasive, the next step is probably an endoscopic (internal) ultrasound (EUS with ERCP looking backward through the pancreas and common bile duct, possibly with a tissue biopsy which can determine if malignant cells are present.

If malignant cells are present, ask the surgeon (before the procedure, because it's general anesthesia and you'll be too groggy to remember afterward) if they can get enough tissue to send out for full NGS (next generation sequencing) of the DNA to see what genetic properties it has (mutations, etc) that might provide better guidance into your treatment. It's helpful to have this data as soon as possible, because if you do have cancer, they generally try and rush you into chemo right away w/o any more data guiding them.

I hope it all goes well for you, and hope this post doesn't scare you, but only provides you more information to be proactive with if necessary.

Thank you

Since I do not see any mention of lifestyle changes to help with NEW onset of T2, I'd like to share the good news that there seems a window when it can be Reversed. Knowing how terrible this T2 thing is please consider this as one important and Urgent step. I say this as an 80 y.o. who has apparently no health issues and able to accomplish independently my life (and take care of my cat carrying 15 kg litter box from bus stop to my apt.
DIABETES – Is it reversible? European Society of Cardiology (80,000 Members) Press Release
http://www.escardio.org/The-ESC/Press-Office/Press-releases/Last-5-years/Type-2-diabetes-reversible-with-lifestyle-changes 14 Nov 2014
“There is no question that people who have had type 2 diabetes for just a short period of time can reverse it with a low calorie diet. This can be effective within 3 to 5 days. Of course the continuing challenge is to maintain the lower body weight.”

Of course the central challenge is sticking with nutricious (and fairly tasty foods) over life. The way i do it is to aim for a life where More simple healthy pleasures (we knew these as newborns and toddlers) result into Fewer health problems. Essentially in food, physical activity (actually PLAY), social contacts and stress magnt.

I'd be very interested in your progress...or questions u have. Good luck!

Your fatigue and breathing issues may be related. Diabetes can be the cause of your weight loss as many lose weight with diabetes. I’m not hearing much that would point towards pancreatic cancer.

Are you speaking of the cancer antigen or marker blood test - CA19-9? Sometimes its reliability or ability to detect depends on the mutation type you have - apparently it’s not as good with BRCA mutation. I have ATM mutation and CA19-9 is a very good indicator. It’s been about 2 weeks since your post so wondering if you have any new news from your dr? This is just my scenario: my type 2 diabetes was controlled before my diagnosis but it was how it all of a sudden went “insane” and uncontrolled is what clued my endocrinologist to consider doing a CT. I couldn’t get a CT quick enough so I asked for ultrasound and that’s how my distal or pancreatic cancer in tail was found. Much of islets of Langerhans which produce insulin (related to diabetes) is in the tail - so that’s my theory why my diabetes went crazy. I had no jaundice since no bile ducts were clogged - (near the head if pancreas). I’ve always had underlying tachycardia induced by stress on my body that was pretty well uncontrolled but now with my GAC chemo which is stressful for my body (but working somewhat at the very least) my heart rate is high and makes it difficult to breathe when I walk around. There could be a myriad of other reasons for your difficulty breathing so your best answer is to keep working with your drs and I’m hoping things go in your favor.

@margie444, did you learn more about your symptoms and the cause?

The link between sudden onset of diabetes in those age 50 and over with no family history or risk factors and the appearance of pancreatic cancer within 36 months was discovered and elucidated by Suresh Chari, M.D. when he was at the Mayo Clinic and now at MD Anderson. It was somewhere around 2015 or 2016 that this finding was published and continues to be expanded upon.

Despite its publication, many PCP’s and even endocrinologists are not following up on this link and ordering a CT scan and doing frequent surveillance on this patient cohort that could lead to earlier detection and treatment started when easier to treat. As a result, the opportunity of finding the disease at an earlier stage is squandered.

It’s also interesting to note that the American Diabetes Association refused to acknowledged what Dr. Chari discovered. When he would apply for research grants through the NCI, the ADA would not support his grant applications. I looked into approaching a local chapter of the ADA to see if they were interested in participating with PanCan.org with adjacent boots at local health fairs to bring heightened awareness to the public, especially in underserved communities. I never received indication of interest from that organization and they don’t seem to be interested with PanCan.org on a national level.

Good points, but sad overall.

I saw a study reference a few months ago attempting to tie the two together. I can't find it now, but will keep looking. I'm pretty sure I saw it as a news article off LetsWinPC.org.

If this link for the general search works, the first several hits on the page have good articles about pancreatic cancer and diabetes. Try this one:

I’ve known Dr. Chari for many years now first meeting him at a PanCan Advocacy Day event in Washington. We’ve crossed paths several times since talking about the need for heightened awareness of late onset diabetes, the link and testing that needs to be done by the care provider.

After reading the initial post in this thread, I decided to to see where things are regarding awareness in the professional medical community. First stop today was a UPS Distribution Facility to ship a package. I’m standing in line wearing my PanCan.org sweatshirt and the person in front of me notices. He was a physician and had 4 patients that were diagnosed with pancreatic cancer. I asked him if he was aware of the relationship of late onset diabetes and the link to pancreatic cancer. He never heard of it and he is not a newly minted physician. So I provided him with the details and the suggestion of doing imaging and frequent surveillance of his patients based on papers that have been published.

My next stop today after UPS was to my PCP for my Medicare Annual Wellness Examination. He has been my PCP all through my pancreatic cancer journey. I asked him if he was aware of the link between late onset diabetes and pancreatic cancer and again-same answer. So my exam turned into making a second PCP aware of the link. My PCP thanked me for making him aware and will now be more vigilant in doing additional testing before concluding a diagnosis.

There are continuing education programs for every medical discipline. Physicians are required to do a minimum amount of continuing education annually. While my sample size is small, I would guess there is significant need in educating PCP’s and probably some endocrinologists on this link so there is less “missed opportunities” at earlier detection leading to a better outcome. If everyone reading this mentions to their PCP or an endocrinologist if they use one about the association, it’s a start in the right direction.