Managing Diabetes When You Have Cancer

WHAT IS THE RELATIONSHIP BETWEEN DIABETES AND CANCER?

Diabetes or Diabetes mellitus is a metabolic disorder characterised by high blood glucose (sugar) levels. Around 8 to 18 percent of people living with cancer also have diabetes. While many patients already know that they have diabetes when they are diagnosed with cancer, others may only discover the condition after a cancer diagnosis or during treatment. Type 2 diabetes and certain cancers share some risk factors such as obesity, age, physical inactivity, smoking and alcohol. Therefore people with type2 diabetes may have an increased risk of breast, endometrial, pancreatic, liver, kidney and colon cancers.

A recent study revealed that cancer appears to have overtaken cardiovascular disease (CVD) as a leading cause of death in adults with type 2 diabetes. Cancer prevention strategies therefore deserve at least a similar level of attention as cardiovascular disease prevention.

HOW DOES HAVING DIABETES AFFECT THE CANCER TREATMENT?

Having diabetes poses certain challenges which can make it hard to finish cancer treatment as planned because people with diabetes tend to have more health problems before beginning their treatments. People with uncontrolled diabetes may have more severe cancer treatment side effects. For example, they are more likely to get infections and need hospital stays during treatment.

HOW CANCER TREATMENT CAN AFFECT BLOOD SUGAR?

Cancer treatments and their side effects can make blood sugar levels go up or down.Steroids are often given with chemotherapy and steroids are known to raise blood sugar levels pretty markedly. For this reason, diabetes medications need to be adjusted, and insulin injections are often required to control blood sugar levels especially around the time that the steroids are given. Steroids can also give rise to new diabetes, especially in people who already have risk factors for developing the disease. Certain types of chemotherapies, targeted therapies and immunotherapies can also increase the blood sugar levels. At the same time people with diabetes receiving cancer treatment are prone to hypoglycemia (low blood sugar). This happens because often their appetite is reduced or they are experiencing side effects of cancer treatment like nausea, vomiting and dehydration.

HOW TO MANAGE DIABETES DURING CANCER TREATMENT?

It is important to understand that during cancer treatment, the goal is to maintain a good blood sugar control without increasing the risk of hypoglycemia. Targets of fasting blood sugar should be between 100-140 mg/dl and 2 hours after meal up to 200 mg/dl. In some advanced cancers, these targets can be even higher. Oral medications dose may need to be modified and many patients need insulin to control their blood sugars. Patients are advised to check their blood sugar levels more often with the help of glucometer at home and adjust their insulin dose accordingly. Staying physically active like daily 30 mins walk or yoga, eating healthy diet and managing stress are equally important parts of management of diabetes during cancer treatment.

WHAT TO EAT WHEN ONE HAS DIABETES AND CANCER?

Eating can be a challenge during cancer treatment if one feels nauseous or has loss of appetite. If it is hard to eat a big meal then try eating small portions which can give you the calories, protein, and nutrition you need to live with diabetes and fight cancer. Choose whole fruits and vegetables, whole grains, include protein in every meal and reduce the amount of white, refined products, simple sugars. Include unrefined flours like bajra, jowar, oats, brown rice etc. A registered dietitian may help you develop a healthy eating plan tailored to you and your needs.

MESSAGE TO AUDIENCE

Managing diabetes when you have cancer can be challenging but possible and doable by following these simple tips:

1. Know the effects of diabetes on cancer treatment and vice versa

2. Consult your Endocrinologist/Diabetologist for change in diabetes medications or the need for insulin

3. Monitor blood sugars at home and do not aim for very strict blood sugar targets

4. Eat healthy, do not skip meals, stay physically active as much as possible, stay hydrated, manage your stress and talk about your feelings with others.

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