Hello, There are mainly 2 types of diabetic patients. Type 1: Pancreas doesn t produce enough insulin or no insulin at all (as is the case with this person, because his pancreas has been totally removed).Type 2: Pancreas produces insulin, but the body develops resistance to normal amounts of insulin and requires even higher doses (endogenously or in the form of insulin syringes) than normal to respond adequately to lower down blood sugar to normal levels. Type 1 diabetic patients doesn t have insulin resistance only just the partial or total lake of insulin due to inadequate pancreatic tissue(removal in this case), these patients respond very well to Basal Bolus regimen of insulin. Which means Basal , a long acting insulin at bedtime which helps to keep sugar within normal range, and Bolus a short acting insulin administered just before meal, usually three times a day which helps to lower down insulin in the setting of higher loads of nutrients and glucose at the time of taking meal. Alternatively these patients are offered automatic insulin delivery patches, which sense your glucose from sweat every 10 to 15 minute and administers required insulin dose through skin to lower down blood sugar towards normal(working like a pancreas). There are no oral medications till date for type 1 diabetic patients. Type 2 diabetic patients however have many choices, they can be offered medicines in the form of oral pills, which reduce the resistance of body to available endogenous insulin or they stimulate pancreas to produce more insulin or they can be offered higher doses of insulin in the form of insulin injections administered during waking hours at intervals, dose is adjusted according to blood glucose levels checked just before breakfast or dinner. As this patient is type 1 diabetic, having whole pancreas removed, he shouldn t be on any pills for blood sugar control. The doctor might have prescribed medication for some other coexisting illness or symptoms. There are plenty of list of medicines which can cause agitation. It is better to know what medication he is actually taking and for what. It could be antibiotics or even antidepressants keeping in view the recent surge in insulin level. Could be due to malfunction of transdermal patch, missed doses of insulin (if prescribed) or even infection. Take care. Hope I have answered your question. Let me know if I can assist you further. Regards, Dr. Haneef Abbasi, Internal Medicine Specialist