Any doctors or nurses with end stage pancreatic cancer experience around to help please?

[PussinJimmyWhoooos]

Have posted on here about MIL lots before...terminal cancer. Primary in the bile duct, secondary to liver and now they think pancreas.

Liver is ok, bile duct seems ok as stent been fitted, sepsis has diminished.

However, the latest thing is pain all up and down the spinal cord and her glucose levels are becoming increasingly hard to manage. They keep increasing the insulin and this makes her fine for a few days and then they have to increase it again

It seems that its taking more and more insulin for less effect. Is this normal with pancreatic cancer? She was diabetic to start with anyway btw

What to expect? Coma or??

Any help appreciated. Have posted this in bereavement also

TIA

Yes this is normal with pancreatic cancer. The important thing is to get you mils pain under control. Is she on a syring driver with painkillers? Are the macmillan nurses involved?

Your poor mil may well go into a coma. Is she in hospital?

Thinking of you. Will answer any questions if i can.

Yes, its normal as the damaged pancreas can't produce insulin effectively. As the disease becomes more advanced, the more artificial insulin is needed.

She may gradually pass into a coma, it is diffulcult to say.

TBH, keeping blood sugars normal for someone who is dying isn't a massive priority, whereas their pain and symptoms control is.

Sometimes, it is a more pleasant death when someone passes into a coma first.

Agree totally with emma.

Oh Puss, I saw this

Hiya all

Thank you for replying. She is on oral pain killers at the moment...opium based...however, she doesn't seem to be in the pain that I've read about pancreatic cancer causing - thank God.

DH and I have been talking and we are thinking that it maybe best for her to just slip into the coma due to diabetes etc rather than have a pain racked last few weeks...the end result is going to be the same, the only thing we are praying for now is the least painful way iyswim? It sounds so calculated talking about it like that though

No Mac nurses - she lives in the Middle East. All the palliative care is being done by her other son and daughter. The glucose thing is driving them crazy though as they think they have it under control then it goes up again, more insulin etc

So, what will happen here? Are we talking a stage where the insulin therapy will no longer work and then a coma?? Do they come out of it or is it something with pancreatic cancer that they dont?

Ps They are managing the glucose because they don't want to just leave it iyswim? They feel they need to be doing everything possible..totally understandable. The dips from the glucose are getting more defined though - difficult to wake, very heavy breathing etc

my father died of pancreatic cancer. he was on a syringe driver for the last few days. that made him much more comfortable. any chance of that happening?

She doesn't appear to be in enough pain to warrant a syringe driver - which is a positive thing. Its the glucose levels that are proving the pisser iyswim? So, what I/we are trying to find out is what will happen with the insulin therapy - is there a point where it will just not work anymore and what happens then? Coma? Treatable???

Sounds like her pain is being managed appropriately for now.

Sometimes all active treatments are withdrawn when the end is nigh, as it is kinder than prolonging the inevitable. It is a difficult thing to recognise and do, and a decision that should be made by the medics looking after her. What is their opinion? I hope that the family aren't being expected to shoulder the burden of all the decision-making.

I think that in this case, insulin could either be considered to be symptomatic or active treatment- it is a very difficult decision.

Hello Puss I have been wondering how you are all doing.

Nothing to add (as the very knowledgeable Emma has far more experience than I!) but just wanted to send you my good wishes.

Sorry, I missed your second part about the pain before my post.
I think Emma has it right really.

Well, if they don't give her the insulin, she will go into a coma and die so I guess they are carrying on until it stops working of its own accord because..well, its what you do for your parents isn't it? Besides, when the insulin has kicked in, shes up and about, albeit very weak but still with it and so I can see why they are carrying on with it. She's had a good last couple of days as they more than doubled the insulin dosage.

What I want to know though and I can't seem to get answers when I google, is what happens when the insulin no longer works?

I don't think Insulin will stop working. Type 1 diabetics (usually the young ones) need Insulin because their body stops producing it, so they are totally dependent on Insulin.

If your MIL's pancreas failed completely she would have no Insulin akin to a Type 1.

The likelihood is she will need increasing Insulin doses as her pancreas does fail.

HTH

It will still keep working. What is happening is that her own insulin supply is packing up, hence she is relying more on the artificial stuff. Her body's response to the insulin is independent of her having pancreatic cancer. Her body would still respond to the insulin even if she had no pancreas.

She would only go into an 'insulin' coma if the insulin was stopped. She may eventually go into a coma for other reasons associated with terminla illness.

I'm sorry, this must be incredibly hard for you and your DH.