Managing Diabetes during Cancer treatment

Patients with Diabetes, who are suffering from any of the three types of the condition (type-1, type-2 or gestational), when diagnosed with Cancer, must be aware of the challenges they can face during cancer treatment. This article explains them and  advises how to manage diabetes during Cancer treatment.

What is the connection between cancer and diabetes?

Diabetes and Cancer have a close connection.

• To begin with, both cause inflammation at the cellular level. While insulin taken for diabetes in low doses can have anti-inflammatory and anti-angiogenic (prevents the spread of cancer) properties, in higher doses, insulin being a growth factor can stimulate cancer growth in some people.
• Further, patients with diabetes tend to be sicker and less able to fight infections. This can delay or slow down cancer treatments. For example, surgery cannot be initiated till blood-sugar levels are normal.
• Finally, medication given as part of cancer treatment can cause spikes in blood-sugar which must be managed well during the cancer treatment. Side-effects from the treatment can cause low blood-sugar. But if the cancer is in an advanced stage, treating it is the first priority and controlling blood-sugar becomes the second

All these create a chicken and egg situation for patients with diabetes undergoing cancer treatment. However, a qualified oncologist will make it easy, by taking the right decisions at the right time.

The risk from cancer treatment for patients with diabetes

Diabetes can create challenges during cancer treatment and make it difficult to complete the treatment plan for the following reasons.

• Some cancer treatments, and side-effects caused by them, can make the patient’s blood-sugar levels go up or down. This is true even if the person does not have diabetes.
• Diabetes can cause secondary ailments such as neuropathy, and some cancer treatments make these existing health problems worse. The doctors must then treat the diabetes, the cancer and other ailments, all at the same time.
• In people whose suffer from uncontrolled diabetes, treatment for cancer can have severe side-effects. This includes infection which is the most common one, and such side-effects will require hospitalization.

Cancer treatments that affect diabetes

• Chemotherapy: Some of the drugs used in chemotherapy can cause spikes in blood-sugar. These include 5-fluorouracil, busulfan (Busulfex, Myleran), asparaginase (Elspar) and cisplatin (Platinol). Further, if the patient is suffering diabetic peripheral neuropathy (nerve damage in the limbs), some of the chemotherapy drugs can make it worse.
• Steroids: Steroids may be prescribed as a medication for the cancer, or for treating side-effects such as nausea and pain. These steroids are of 2 types: glucocorticoids or minerelo-corticoids. The former increase insulin-resistance and cause high blood-sugar. Some of the commonly-used steroids include methylprednisolone, dexamethasone, prednisone and hydrocortisone. To overcome this problem, the steroids may be given in several small doses, or over a long duration through an intravenous (IV) tube. At the same time, the insulin dosage may be increased.
• Targeted therapies: These therapies can affect some of the cellular pathways that control how insulin is used up by the body. These include ABL kinase inhibitors such as nilotinib (Tasigna) and mTOR kinase inhibitors such as everolimus (Afinitor, Zortress).

• Immunotherapy: Drugs that are given to increase the body’s immunity and help it fight cancer can affect the patient’s blood-sugar. That is because these drugs block a protein called PD-1 which helps keep the immune responses in check ( and hence called Check Point Inhibitors). These include nivolumab (Opdivo) and pembrolizumab (Keytruda).
• Hormone therapy: These either manipulate or add hormones in the body in order to destroy or slow-down the growth of cancer cells. This therapy is used to treat cancers of the prostate and breast, and is known to increase blood-sugar.
• Surgery: If surgery is done when blood-sugars levels are high, the wounds heal slowly and further, the person is at a higher risk of infection.

Cancer side-effects that affect diabetes

Both the cancer and treatment for the same can cause side-effects that affect blood-sugar levels.

• Nausea and vomiting: These occur with chemotherapy, radiation therapy, and other cancer-treatments. These affect your ability to eat or drink normally which affects how much nutrition you are getting. This can cause low blood-sugar or hypoglycemia that is equally dangerous, as it can trigger fainting, excessive sweating and coma.
• Dehydration: Nausea, vomiting and diarrhea after consuming food, can cause dehydration. Further, high blood-sugar also causes dehydration. The combined dehydration can affect recovery after cancer treatment, while severe dehydration can even be life-threatening.
• Loss of appetite: As a result of this, the person is not eating enough which causes low blood-sugar. To make up for this, the person may binge-eat on junk food that is rich in carbohydrates and salt. This can increase both blood-sugar and blood-pressure.
• Weight gain: Both steroids and chemotherapy can trigger weight-gain which again causes high blood-sugar.
• Fatigue: Both the cancer and the treatment can induce a lot of fatigue in the person. The body’s sensitivity to insulin is reduced, causing sugar to accumulate in the blood.

Tips to managing Diabetes during treatment

If you have diabetes who is undergoing cancer treatment, here are some tips that will help.

• Self-education: Read-up on diabetes and cancer treatment. The more you understand why your doctors are taking certain decisions, the less stressed or confused will you feel. You will approach the treatments with a positive frame-of-mind and take good care of yourself which helps reduce complications from diabetes.
• Ensure a balance: To maintain healthy blood-sugar levels, follow a routine or daily schedule involving healthy diet, exercise, regular meals, healthy snacks and staying hydrated.
• Monitor your blood-sugar: Your doctor may instruct you to check your blood-sugar every 4 hours. This helps prevent blood-sugar spikes that can cause nausea, infection, fatigue, etc.
• Monitor your BP: Diabetes and hypertension are a deadly combination that can damage your blood-vessels and affect your immune system. Together, these factors increase the risk of infection. If BP is high, you must stick to a healthy diet and exercise every day.
• Healthy diet: The diet should be rich in whole fruits and vegetables, whole grains, nuts, seeds, beans and lentils. Foods that are high in sugar, salt, fat and refined carbohydrates must be avoided. A qualified dietician will help you with this.

• Exercise: Regular exercise helps the body absorb glucose more efficiently and process it. Exercise also helps increase muscle-mass which helps reduce insulin resistance. Finally, it helps elevate your mood and de-stress you. A therapist will create an exercise plan for you.
• Smoking and drinking: The combination of cancer and diabetes can increase the risks from smoking, as smoking impairs the immune system, triggering cold and respiratory infections. You should also cut down on alcohol consumption as these can dehydrate you along with weakening the immune system.
• Manage stress well: Mental or psychological stress can increase the body’s production of hormones that block the functioning of insulin, thereby causing blood-sugar spikes. In addition to exercise, meditation, yoga and indulging in hobbies can help reduce stress. Further, you can join a support group of patients with diabetes who are confronted with cancer. Sharing your concerns with them will make you realize that you are not alone and help you cope with the treatment better. Reduced stress will improve your treatment outcomes and overall quality-of-life.

Outlook

If you have Diabetes and are undergoing cancer treatment, all the above information may look ominous, leaving you stressed-out. But in reality, it’s not so bad. A team of doctors which includes oncologists, diabetologists, general physicians, dieticians and therapists will be involved in your treatment at every step. They will take the right decisions at the right time and keep you informed throughout. The only thing you need to do is to take care of your feelings and emotions.

And if you have Diabetes, and has just been diagnosed with cancer, do not panic. Consult a reputed hospital. After a thorough diagnosis and review of your medical-history, a team of specialists would choose the right course of treatment for you aimed at speedy recovery, minimal complications and optimized hospitalization. They will ensure better outcomes for your treatment along with an optimum quality-of-life. This will make your experience less painful and more positive in the long run.

 

Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai, Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.

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