In most PAMi studies, hyperglycemia is controlled with metformin less frequently with a second oral agent or insulin and rarely with chemotherapy discontinuation.[3],[29] [32] In 2012, an algorithm for screening and management of DM in PAMi-treated patients was proposed.[33] The treatment goals for patients with metastatic disease were to preserve quality of life, prevent symptoms of hyperglycemia, limit acute diabetes complications, and avoid hypoglycemia. The serine/threonine-phosphoinositide 3-kinase protein B mammalian target rapamycin (PI3K-PKB/AKT/mTOR-PAM) pathway regulates the cell proliferation.[1] PAM kinases are overexpressed in malignancies, prompting the development of PAM inhibitors (PAMi) as targeted cancer therapy.[2] Apart from its important role in cell survival, the PI3K-AKT pathway's role in glucose metabolism is also important. As high doses of insulin may be required to treat patients with cancer with severe PAMi-induced hyperglycemia, further analyses of the insulin effect to tumor growth in humans are required. [Extracted from the article]