Background: Total pancreatectomy (TP) is most used for pancreatic adenocarcinoma (PC) but also for main duct intra-ductal papillary mucinous neoplasm. The authors report on a retrospective study of 61 patients who underwent TP in an integrated healthcare system. Methods: A retrospective review was performed of all patients treated with TP between January 2012 and December 2022. Patient demographics, tumor characteristics, treatment modalities, and mean overall survival (OS) were evaluated. Results: An intra-operative positive pancreatic neck margin for cancer or high-grade dysplasia was the most common indication for TP in 77% (47/61) of patients. The mean OS for patients with pancreatic cancer was 18 months, however, patients with a pre-op diagnosis of IPMN had a mean OS of 50 months. Multivariate analysis of PC without IPMN showed that neoadjuvant and NPH insulin were associated with a decrease in overall survival (p< .05). Overall HbA1c were higher in patients after one year after surgery for patients taking NPH (8.6) as opposed to an insulin pump (7.6) or Lantus (7.6) but not significant (p= .346). Mean OS for patients with PC and type of insulin used was statistically significant at 24.4 months vs 13.1 months respectively for Lantus vs NPH (p= .033). Conclusions: Conversion to TP for positive neck margins did not improve survival in patients who receive neoadjuvant chemotherapy but may be helpful in patients with IPMN. Blood sugar control after one year was similar among the various indication groups as well the type of insulin use. Although Lantus insulin was associated with improved overall survival for patients with pancreatic cancer, the exact reason is unclear and requires further studies.