IGF1 and pachyonychia congenita: Hyperglycaemia and insulin resistance have been hypothesized as the underlying mechanisms linking diabetes and PC.7, 32, 33 Hyperglycaemia might increase the risk of PC by providing more glucose to fuel tumour growth, thereby enhancing proliferation and invasion ability of PC cells.30 Insulin has growth promoting and mitogenic effects on PC cells.32, 33 Insulin also indirectly impacts pancreatic carcinogenesis by increasing bioavailability of insulin‐like growth factor (IGF), a multifunctional peptide that regulates cell proliferation, differentiation and apoptosis.34, 35