Coping with cancerMonday, 20 June 2022
There is some evidence that points to the fact that having type 2 diabetes can increase your risk of some cancers; particularly liver, pancreas, uterus, bowel, breast and bladder cancer.
To reduce your risk of these cancers aim to:
- Achieve a waistline suitable for your age and gender
- Take part in regular exercise
- Eat two serves of fruit and five serves of vegetables a day
- Eat plenty of high fibre foods every day, aim for 25g for women and 30g for men of fibre each day
- Stop smoking and also reduce passive smoking
- Talk to your general practitioner about having regular screenings for cancer including for bowel cancer, a mammogram for breast cancer, and pathology to check for other cancer markers
Cancer treatment may cause type 2 diabetes
The liver is a storage organ for glucose. When steroid hormones, either from your own supply or from a medication, are released into the blood stream then glucose is released from the liver. This allows your body to have extra energy sent to the muscles to escape danger – such as in the “flight or fight” response. If your body is not using the extra glucose for running away from danger then the blood glucose levels remain high. The body then stores this excess glucose as fat which increases insulin resistance. Insulin resistance can lead to elevated blood glucose levels over a long period of time and may then develop into type 2 diabetes.
The stress on the body during cancer treatment may also be enough to cause an increased release of glucose from the liver. Steroid medications such as corticosteroids, for example Prednisone, encourages the body’s flight or fight response. Talk to your cancer team to work out if you need insulin treatment while you are taking corticosteroids. If you are already taking insulin you may need to increase the dose or change the type of insulin.
Some cancers also affect the body’s ability to produce insulin. Pancreatic cancer will require insulin if the beta cells that make insulin in the pancreas are damaged or removed.
Pituitary and neuroendocrine tumours effect the balance of all hormones in the body. Thus, insulin may be required since the beta cells may not receive the message to produce insulin.
Looking after you
When having treatment for cancer it is also important to look after your health. Regular exercise is important as it helps to increase or maintain your muscle mass and helps improve your mood. Maintaining muscle mass is important for maintaining good balance, being able to do everyday tasks and, statistically, for reducing the risk of death. Cachexia is the term used for significant muscle wasting and accounts for 30% of all cancer-related deaths. A referral to an exercise physiologist will assist in developing a movement plan that is achievable while on chemotherapy or radiotherapy.
It is important to see a dietitian who specialises in cancer and diabetes to reduce or manage cachexia. The dietitian will suggest foods and drinks to have to achieve a high energy, high protein diet, based on what you like and can tolerate. A higher protein intake is required to maintain your muscle mass. A higher energy intake using monounsaturated fats instead of saturated fats is preferred as saturated fat increases insulin resistance. Another side effect of cancer medication is mouth ulcers, nausea and altered taste. Seeing a dietitian will provide you with advice on how to reduce these unwanted side effects.
Ask your doctor or diabetes educator to help with adjusting your insulin regimen to manage the higher carbohydrate intake required to maintain a high energy meal plan. They may give you higher blood glucose targets to aim for as well.
Due this period of change in your life mental health support is important. Ensure a mental health worker, psychologist or psychiatrist is also part of your team.
Palliative care is more than end of life care. It is care that is provided to improve quality of life and to manage pain. Pain causes a stress response which increases blood glucose levels. Seek out palliative care early in your care plan. You may be discharged from palliative care if your pain is managed.
If you feel like having a chat with a health professional the NDSS Helpline is available to discuss ideas with living with the challenges of diabetes and cancer. Call us on 1800 637 700.
By Pollyemma Antees APD CDE