Living with Diabetes and Cancer
by Veronica Brady, FNP-BC, BC-ADM, CDE
Glucometer, check. Test strips, check. Lancets, check. Snack, check. Bottled water, check. Diabetes medications, check. Cell phone, check. These items are part of the daily checklist of every person with diabetes leaving home for any length of time. Now imagine this same individual going to a cancer treatment center for a full day of testing, chemotherapy, office visits, etc. Sound familiar?
You’ve had diabetes for several years, and now you’ve been told that you have cancer. How on earth are you supposed to manage both of these diseases at the same time? Where do you start? Do you ignore the diabetes and focus on the cancer? Is your diabetes going to affect your cancer treatment? Will you be able to continue to enjoy good glucose control while effectively fighting the cancer?
This struggle is being faced daily by increasing numbers of people as the diagnosis of cancer continues to be made in more and more people with diabetes.
Although the medications used to treat cancer may often worsen blood sugar control, control is still possible.
Diabetes and cancer are two of the most commonly talked about diseases of the 21st century. Coping with one of these diseases is a challenge, but when they are both present in the same body, the real fight for survival begins. Diabetes and cancer are present in higher numbers of people because these two diseases have several commonalities:
- They are both defined as a “group of diseases.” Cancer is a group of diseases characterized by the uncontrolled growth and spread of abnormal cells. Diabetes is a group of diseases marked by high levels of blood glucose resulting from the body not making enough insulin, the insulin not working as well as it should, or both.
- The risk factors for each of these diseases include being overweight, older age, lack of exercise, and poor eating habits.
Although the medications used to treat cancer may often worsen blood sugar control, control is still possible. Diabetes is one of the few diseases in which “self-management” can lead to good outcomes. The key to successful glucose management in the person with cancer is to utilize the tools needed for self-management. These tools include diet, exercise, and medications.
It is essential to try to continue to eat a healthy diet consisting of three balanced meals plus snacks. However, during the course of treatment, sweets are often tolerated best. At those times, it is more important to get the calories in than it is to avoid high blood sugars. During these times, the motto of many healthcare providers is “Eat what you can, and we will adjust the medications to control the blood sugar.”
During the course of treatment, many people will complain of extreme tiredness. One of the key things to remember is that the less you do, the less you will want to do. It is important to try to continue to exercise. If you can walk for ten minutes three times a day, this will help to improve your strength and endurance, as well as improve your overall sense of well-being.
During the course of treatment for cancer, blood sugar targets are usually
- Fasting – 90-130 mg/dL
- 2 hours after a meal – 140-160 mg/dL; maximum 180mg/dL
- Bedtime – 100-110 mg/dL
Often during the course of treatment, blood sugars will run higher due to the stress that your body is under. However, if you are not eating well, you may require less medication in order to avoid low blood sugars. The key to medication adjustment is to check your blood sugars at least daily if you are taking oral medications, or three to four times a day if you are on insulin therapy, and to inform your healthcare team if you are seeing blood sugars less than 70 or greater than 250 mg/dL. Often, a simple adjustment is all that is required. However, insulin therapy may occasionally be needed for a period of time in order to keep glucoses under control.
The majority of the work that is necessary to managing diabetes is done by the individual. It is the responsibility of the individual to continue to make healthy food choices, exercise at least five days a week, and take medications as prescribed. However, during times of hospitalization or when blood sugars are out of control, intervention from a specialist may be required.
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Veronica Brady is a Nurse Practitioner in the department of Endocrine Neoplasia and Hormonal Disorders at M. D. Anderson Cancer Center in Houston, TX.
This article was originally published in Coping® with Cancer magazine, January/February 2010.