Other Cancer Information

Overcoming Treatment-Induced Diabetes

Good nutrition is key

Mali R. Schantz-Feld

Betty Overfelt's oncologist back home in Missouri informed her that she had stage IV small-cell lung cancer. His prognosis was grim — "I think I can get you three months if you'll take treatment," he said. Jerry, her husband of 45 years, decided immediately to seek a second opinion, which led them to Cancer Treatment Centers of America© (CTCA). There, Jerry remembered, doctors told Betty that they couldn't promise a cure but thought they might be able to control the cancer. Subsequent blood tests at CTCA delivered unexpected news — Betty had developed treatment-induced diabetes, in a big way.

"We had just visited the pulmonologist and were waiting at the scheduler's desk when my cell phone rang," Jerry recalled. It was Sue, [the pulmonologist's nurse], who said, "Don't move; stay right there."

Sue came to their location and told them Betty needed an immediate infusion of insulin. Her initial lab screening indicated a blood sugar of 863. Normal range is from 80 to 110, with above 500 signaling a critical situation. The diagnosis for diabetes was confusing because Betty never had diabetes, nor did it run in her family.

The Overfelts were not alone — 8 to 18 percent of all cancer patients also have diabetes, according to CTCA. Type 1 diabetes is linked to cervical cancer and stomach cancer, and type 2 diabetes is linked to breast, endometrial, pancreatic, liver, kidney and colon cancers. Treatmentinduced diabetes can be triggered by chemotherapy and steroid use.

"It is very overwhelming to a patient to be diagnosed with cancer, and then be told that they have diabetes as well," said Andrea Reser, RD, LD, nutrition supervisor/diabetes program coordinator at CTCA. "People need to know how to regulate their blood sugar while on a cancer-fighting diet, and we try to inform them in a way that does not overwhelm them."

Proper nutrition key to cancer and diabetes treatment

Once diagnosed, the patient is scheduled for diabetes education. The dietitian and nurse educator discuss the acute and chronic complications of diabetes and the importance of regulating blood sugar and establishing a diet to fit the individual's lifestyle and tastes.

Maintaining proper nutrition is imperative to effective cancer treatment. Unregulated high blood sugar is related directly to higher infection rates, shorter remission periods, higher morbidity and mortality rates, and decreased immune function. Improper nutrition can result in dehydration that delays cancer treatments, as well as other complications, such as amputations and heart disease. Patients who cannot meet nutrition needs through oral intake are supplemented with intravenous nutrition.

Regulating diabetes affects the patient's quality of life. "Control will prevent delays in treatment," said Reser, who noted it is important to check blood sugar during treatment and to educate patients on the connection between diabetes and cancer.

Cancer and cancer treatment can bring about metabolic changes that cause or aggravate symptoms of diabetes. High blood sugar levels brought on by diabetes can also weaken the immune system's response to cancer. Likewise, diabetes could potentially delay cancer treatment or increase the risk of infection during treatment.

"Betty's diabetes only flares up when she takes steroids," said Jerry, who checks his wife's blood sugar levels each morning. "During treatment, I would carry her to infusion [at the hospital] if her blood sugar rose to 300 or more to bring her levels down. After internist Dr. Don King got her blood sugar levels figured out, they taught me to adjust her medications."

Caregivers can help

Caregivers are encouraged to attend diabetes counseling and nutrition sessions to assist in integrating the healthpromoting diet into the family's life. "My husband has been 110 percent involved," Betty said. "He has gotten so adept at my treatments that at CTCA, they jokingly call him Dr. Jerry."

Reser said that while formulating the diabetic diet at CTCA, "we make sure to assess patients through highly individualized preferences, teaching about counting carbohydrates in a way tailored to their own needs."

The CTCA team educates patients and offers continued support. After Dr. King discussed Betty's diabetes, Reser helped establish her diet. "Andrea has been so supportive," Jerry said. "When they put Betty on tube feeding, Andrea decided which type she'd need. Now, she gets 10 milligrams of Glipozide {which increases insulin levels] each day, and she eats anything she wants."

Betty added that Reser and other nutritionists on the team are "totally accessible. We have all their phone numbers. We are using voluntary supplements, so Jerry calls with questions about those."

Jerry concurred. "If they put Betty on a steroid for brain swelling from the radiation, we adjusted her medicine right away," he said. "I trust Andrea implicitly. She is a true professional and has a heart as big as all outdoors."

In addition to regulating the diabetes, Reser said, "We focus on sick-day management at home, so patients are prepared for what may happen while they are going through chemotherapy or radiation. If they experience nausea and vomiting after treatment or as part of disease process, many diabetic patients don't have foods containing sugar in the house. We show them how to put together a sick-day kit containing regular sodas or juices containing sugar."

If patients cannot keep their medication in their system, their blood sugar levels could fluctuate. A hypoglycemic or low blood sugar episode could result in a coma if levels dip too low. "Even if they are vomiting, we encourage them to continue taking their medications," Reser said. "If they can't keep it down, we urge them to go to the hospital or to the infusion center here in Tulsa for insulin injections or related medications."

Two birthdays, 25 radiation treatments, two rounds of chemotherapy and 13 brain radiations have passed since Betty started her fight against cancer. As of her last check up, she noted, "My tumor was gone, there were no outbreaks and everything looked really good."

This article is from the fall 2008 edition of Cancer Fighter Thrive Magazine. To learn more or subscribe, please visit cfthrive.com.

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