Diabetes Question

[Fluff Bottom]

During FOLFOX my blood sugar ran fairly high and I had to occasionally give myself insulin shots. During the past five months I fell so far off the healthy eating wagon that it's not even funny. I quit checking my blood sugar in July but a couple weeks ago my neuropathy was really bad and I figured my BS was probably sky high. Well it wasn't so I started checking it regularly.

It seems like something has changed. I know my diabetes hasn't improved because I haven't lost weight, exercised or anything I know I should be doing. My BS actually is low (for me) if I don't eat junk.

I've read about insulinomas on your pancreas that can make your body produce insulin and lower your blood sugar but that is apparently pretty rare. I'm seeing my GP tomorrow and my oncologist next week but I wanted to see if anyone had a similar experience.

Thanks in advance for any insight. Please no negative comments about my poor habits, I already know I'm a fool for not taking care of myself

[jhocno197]

Were you diabetic before chemo? If not, your body could just be recovering in that aspect now and you no longer are diabetic...

[wwroam]

Sounds like reactive hypoglycaemia to me.
The best solution is to cut back on the carbs to cut back on the wild swings

[Fluff Bottom]

I was diabetic before chemo. Thanks for the responses!

The swings aren't really wild. No matter what I eat it doesn't go above 160. Before chemo it would be in the mid 200s eating the same thing.

[Bev G]

Were you getting steroids with your chemo? Steroids can raise BG like little else. If you WERE getting steroids, and no longer are, it would explain your normalized BG levels.The chances of you having an insulinoma are virtually non-existent.

[LPL]

Hi Fluff Bottom,

Can you share how long before your CRC diagnosis you had diabetes? My hubby got diabetes type 2 (treated with tablets) around 1 1/2 year before he got a total block & emergency surgery, his first symptom of Colon cancer. Doctors have told us that his cancer tumor had been growing in him for like 5-7years.
I'm writing this because to me that sounds as in his case the cancer came 1st and the diabetes 2nd. So I have been thinking: could the cancer have caused his diabetes? And if/when the tumors/cancer is gone - will this effect his diabetes, as in getting better?

A quote from this paper (from 2000)
Diabetes and Cancer: Scientists Search for a Possible Link
" Some studies have been troubled by the chicken-and-egg phenomenon—did the cancer alter the workings of the body such that diabetes resulted, or did the diabetes eventually lead to cancer? In the Nurses’ Health Study, Hu said, the temporal relationship was clear: “The women had diabetes first, for sure, and later they got colon cancer.” "
http://m.jnci.oxfordjournals.org/content/92/3/192.full?

OK.. but as I understand it my DH already had cancer (even though unknown to us) when he got diabetes.

Member Bev posted and mentioned steroids and it's possible effect on blood sugar. That happened Big time to hubby, his blood sugar spiked(!) and was 408 mg/dl when he had to be hospitalized for 3days. After that he is on insulin. After his latest surgery (removing liver mets) he has been able to lower the insulin each day, without problems, so maybe he can manage without it soon?

Just wanted to share my thoughts about this and what happened to hubby.

All the best to you /LPL

[Fluff Bottom]

I had diabetes almost 2 years before I found out about the cancer. My BS wasn't great before the FOLFOX and steroids. I guess my issues will get figured out eventually. Thanks for the responses!

[MissMolly]

FluffBottom:
I have been on glucocorticosteroids for 20+ years so consider myself knowledgeable about the effects of steroids from real-life experience.

I am somewhat surprised on this forum that individuals look at the steroids that receive as pre-medications to their chemotherapy as somewhat funny and humorous. People discuss the "steroid rage" after a round of chemotherapy or talk about the "steroid crash" as if the events are innocuous.

Glucocorticosteroids are powerful medications not to be dismissed or taken lightly. The dexamethasone that is provided as a pre-medication to the standard chemotherapy infusion is not an incidental additive. Glucocorticosteroids have wide systemic effects on the body, especially if taken on a long-standing basis or at high dosages.

One of the most prevalent effects of steroids is on the pancreas. Corticosteorids (dexamethasone, prednisone, prednisolone, cortisone, et. al) act on the pancreas to release more insulin. The rise in insulin will cause a rise in blood glucose - all other factors equal or stable (meaning no change in diet or increased intake of carbohydrates).

Corticosteroids = action on the pancreas = pancreas will produce and release insulin = rise in serum blood glucose levels.

Type II diabetes can be one secondary effect of continued use of corticosteroids. So, too, avascular necrosis of the hips/shoulders; severe osteoporosis; internal tissue thinning of organs (ex. stomach, intestine).

Increased disposition of fat in the body is also a secondary effect of corticosteorids. Fat will be distributed in predictable areas: The face (thus the term "moon face" for the steroid appearance of rounded, full cheeks); the upper back and shoulder blades (thus the term "hump back" for the steroid appearance of a rounded upper back fat pads distribution); the girth of the abdomen.

It is wise for anyone on chemotherapy, especially those who will be on chemotherapy long-term, to discuss with their oncologist to take the lowest dosing of glucocorticosteoids possible as a pre-medication. Steroids (dexamethasone, prednisone, prednisolone, cortisone, hydrocortisone) are not benign medications.

At the most severe, corticosteroids interfere with the pituitary gland and the body's delicate balancing of the endocrine system. The HPA axis (hypothalamus-pituitary-adrenal gland axis) can be forever damaged by exogenous steroids.

Be aware. Be fully aware as a patient.

To survive colon cancer but to live with secondary effects of corticosteroids (secondary adrenal insufficiency) is a unfortunate fate. Be aware of the dosing of dexamethasone that you receive with each chemo infusion. Strive to take the lowest doing of steroid that you can to avoid adverse effects.

I live with Addison's disease (primary adrenal gland failure) and I am in hospice due a body exhausted by endocrine failure. It has not been a picnic and is a disease course that I would not wish on anyone.

[LPL]

Dear Miss Molly,

Thank You for warning about this!

No one at Our hospital reacted to tests before chemo NR3 when DH's Blood glucose was 295 mg/dl. So I thought the cancer treatment team did not care about the glucos. As a matter of fact The young lady doctor that came to us the day of/before chemo NR 3 said that DH's blood test was "very good".. That made us think that his glucos of 295 obviously did not matter to her and the Cancer treatment.

So husband contacted the family doctor about the High glucos. By the way that doctor had recently said to Hubby that he probably soon did not need to take the pills for Diabetes type 2 any more since he (due to cancer, surgery & treatment) had lost a lot of weight. Our family doctor did change his mind about that though when he saw 295mg/dl and he gave Hubby a stronger pill dose instead!

That did not help as we saw 324mg/dl before next treatment and yes after all this happened I have searched for info and read, that:
"Glucocorticoid-induced hyperglycemia is common in patients undergoing cancer treatment ... We recommend that all cancer patients receiving gc be screened for hyperglycemia at least 4–6 hours after gc administration." 2013 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3851349/ .

Our experience is that to test blood Glucos "at least 4-6 hours" after giving the 'Glucocorticoid' is not something they care about/prioritize at our hospital. Our Oncologists said to hubby this was very rare ! Well, not according to that article...

Oh I wish I had read your posts Miss Molly before this happened, I wish I had known that this could happen.. we could have taken tests ourselves at home. Hubby would not have had to feel so bad. With no experience of chemo we thought that hubby's Bad reactions was 'normal Bad chemo side effects' - it wasn't !

It was Steroid induced hyperglycemia.

[Ron50]

Hi Miss Molly,
I am sorry you are having such Problems due to steroids. We have discussed it before. I have been insulin resistant since I was in my thirties. It was two years of 75 mg daily of prednisone that pushed me into type two diabeties. I was fortunate that my adrenal glands were able to recover enough to restart cortisol production. I take cyclosporine twice a day for nephrotic syndrome of the kidneys (7+ grams of protein loss a day without treatment) . Recently my nephrologist asked me to take 5 mg of prednisone a day till further notice. It was to treat mild to moderate auto-immune hepatitis. All of my red liver markers returned to the black except one but after a month and a half of 5 mg pred my blood sugars nearly doubled. It has taken me nearly two months to get them back down . My fasting reading today was 6.6. Before the 5 mg of pred it was 5.8 . I see my neph on Wednesday. I will not ever take pred again. I suffer enough neuropathy already I suspect that it has been caused by long term insulin resistance. I suffer constantly from constipation and I suspect that the neuropathy may be starting to impact my colon.I had none of the platinum drugs as chemo , they were not available nineteen years when I was treated.I think that it is time for the emergence of another medical specialist , those that deal with the problems of long term cancer survivors. Ron.

[WriterGirl1969]

Please no negative comments about my poor habits, I already know I'm a fool for not taking care of myself

Honey, don't beat yourself up. You do whatever it takes to get through chemo and worry about being more nutrition conscious when you're out the other side. I'm in the same boat. Sometimes there's nothing for nausea like a good milkshake. I can't speak to the blood sugar questions, but I just wanted to chime in on that. You're no fool. You're human, and going through a lot. You do whatever you need to and don't apologize to anyone for it! If anyone gives you a hard time, send them to me!!!

Hugs and Prayers,
Tracy

[Nik Colon]

I always had low BS around 55. When on chemo mine were normal. Not sure what mine is now tho. I may have to look at my last test, but I don't recall it ever mentioned since.

[Fluff Bottom]

Thanks, Tracy! I really appreciate your post!

[Ron50]

I saw my nephrologist yesterday. We had a long talk about diabetes . In particular about the history blood test they do that checks the relationship between my daily fasting test results and the b/s sugar history stored as blood cells are made. I thought there was a simple and direct link between the two but as usual it is far more complicated.. I have been on low dose pred for a couple of months. It did cause a spike in my gluco meter test results but he said that If I needed pain relief a few days of pred would not hurt. I was concerned that long term insulin resistance may be responsible for my worsening neuropathy but he said that my type two diabetes (treated with metformin for many years), was very well controlled and would not be causing the neuropathy. I never had any of the platinum drugs just 5Fu and a drug called levamisole (now banned) I asked what is causing the neuropathy. In his opinion it is the same unknown auto immune disease causing my nephrotic syndrome of my kidneys and several other problems including mild to moderate auto immune hepatitis.Ron.