INS and familial pancreatic carcinoma: Due to the high prevalence of prediabetic hyperglycemia and diabetes mellitus (DM) in pancreatic cancer patients (over 75% in high glucose status and 50% in diabetic status), a peripheral increase of insulin level and exogenous insulin injection can often be seen in PDA cases (Cetin et al., 2002; Korc, 2007; Dugnani et al., 2016; Andersen et al., 2017; Dev et al., 2018).