Q&A: Diabetes and Cancer

CancerWise - January 2007

Cancer and treatment take most patients to a new level of concern and stress, but sometimes they also can cause or aggravate symptoms of diabetes.

Why does cancer sometimes cause diabetes? How can you manage diabetes when you have a million other things on your mind?

For answers to these and other questions, CancerWise consulted Pankaj Shah, M.D., assistant professor in the Department of Endocrine Neoplasia and Hormonal Disorders, and Melissa Hamilton, R.D., L.D., a clinical dietitian, both at
M. D. Anderson.

First, Shah explains some of the medical aspects of diabetes.

Can cancer or treatment cause diabetes?

Speaking very broadly, cancer and the treatment of cancer can cause diabetes.

Certain treatments and certain cancers, particularly pancreatic, adrenal and lung, can produce diabetes. Sometimes diabetes appears a few years after chemotherapy.

Cancer or treatment can bring about metabolic changes that cause or worsen diabetes. For example, you can lose muscle and not be able to exercise.

Do some types of cancer or chemo make diabetes worse?

Pancreatic cancer and treatment with steroids can worsen diabetes.

What are the risk factors for diabetes?

Risk factors for diabetes include:

• Obesity
• Family history: Having one or more family members with diabetes
• Race: Some groups are more susceptible to Type II diabetes, sometimes called adult-onset diabetes:
  • African-Americans
  • Hispanics
  • Asian-Americans
  • Pacific Islanders
  • Native Americans
• History of high blood sugar
• Smoking or tobacco use
• Stress
• Gestational diabetes, which occurs in some pregnant women

What should I do during treatment if I am at risk?

If you are at increased risk for diabetes:

• Be cautious about your blood sugar
• Get as much physical activity as you can
• Don’t overeat
• Know your risk and monitor it

Why should I worry about diabetes while I’m being treated for cancer? Don’t I have enough to worry about?

Maintaining good blood sugar control has shown to:

• Make for better outcomes for certain cancers
• Help prevent infection

Not controlling blood sugar can cause:

• Postponement of cancer treatment
• Muscle wasting, weight loss and nausea
• Fatigue
• Slower healing
• More complications and less success during treatment

What should my blood sugar level be during treatment?

Talk to your doctor about your glucose level target. Everyone is different, and medications can change your target.

It all sounds like so much trouble. How can I make it easier?

Take charge of your diabetes. Be proactive:

• Talk to your doctor and dietitian
• Know your blood glucose targets
• Make plans for sick days, for instance whom to call and when
• Monitor blood glucose and keep a record, especially when you are ill
• Know about your medicines and disease
• Wear diabetes identification jewelry

Hamilton answers dietary questions about the control of diabetes.

What should I do on days I am in clinics and waiting rooms, or it’s not convenient to have meals?

Make a plan and be prepared:

• Bring healthy snacks like peanut butter and crackers or string cheese
• Try a peanut butter and jelly sandwich, piece of fruit or cut-up vegetables
• Pack trail mix or yogurt
• Avoid vending machines
• Try oral nutritional supplements such as Glucerna® or Boost Diabetic®

What if I am nauseated and don’t feel like eating?

Nausea is a common side effect for many cancer patients.

If you are nauseated:

• Eat frequent small meals
• Wear loose-fitting clothes
• Take advantage of times when you are hungry
• Sit up for at least 30 minutes to allow your food to digest
• Sip liquids between meals throughout the day

Don’t:

• Eat foods that are fatty, greasy or fried; spicy or hot; or have strong odors
• Drink too much fluid with meals
• Force yourself to eat favorite foods because you may develop a dislike
• Lie down after meals

How can I keep my energy up?

To fight fatigue:

• Make sure you are getting adequate calories and not skipping meals
• Focus on a balance between carbohydrate, fat and protein
• Get enough fluid to stay well hydrated

M. D. Anderson resources:

• Department of Endocrine Neoplasia and Hormonal Disorders