Managing diabetes among cancer patients

Controlling blood sugar levels during cancer treatment is crucial to maintain overall health.

Cancer is a chronic debilitating disease. For cancer patients who are already diabetic or diagnosed with diabetes during the course of treatment, therapeutic management can be challenging.

 As per epidemiologic data, between 8% and 18% of cancer patients have diabetes, and for many patients, diabetes management takes a backseat once cancer treatment starts. Treatment modalities like radiation therapy, chemotherapy, immunotherapy, hormonal therapy, surgery etc. may interfere with the patient’s blood sugar levels. Steroids are known to increase blood sugar levels. It is, therefore, crucial to constantly monitor blood glucose levels. A healthy balanced diet rich in fruits, vegetables, and whole grains and low in fat and calories helps maintain safe sugar levels. 

Diabetes Mellitus is a well-known risk factor for developing certain types of cancers. Diabetes almost doubles the risk of developing cancers of the liver, pancreas, and endometrium. Certain other types of cancer like breast, bladder, and colon, are more common in diabetics compared to the non-diabetic population. This association may be due to the presence of some common underlying risk factors like increased blood sugar, obesity, physical inactivity, poor dietary habits etc. There is however no clear biologic link identified except hyperglycemia and chronic inflammation. Evidence from certain observational studies suggests that some medications used to treat diabetes may also increase the risk of developing cancer. Hence it is important to screen individuals with diabetes for early detection of cancer. The American Diabetes Association guidelines recommend that patients with diabetes should be encouraged to undergo recommended age and sex appropriate cancer screenings.

Common cancers to be screened include:

Colon cancer testing– All people at average risk should start testing at age 45. Various tests are available, Commonest being 

Stool-based tests: These tests check the stool (faeces) for signs of cancer. These tests are less invasive and easier to have done, but they need to be done more often.

Visual (structural) exams: These tests look at the structure of the colon and rectum for any abnormal areas. This is done either with a scope (a tube-like instrument with a light and tiny video camera on the end) put into the rectum or with special imaging (x-ray) tests, as per the American Cancer Society.

• Breast cancer testing– Women ages 40 to 44 should have the choice to start annual breast cancer screening with mammograms and at age 45, they should get mammograms every year.

• Lung cancer testing-For patients 50 years and older based on their smoking history should be evaluated to undergo a low dose CT screening for lung nodules.

• Cervical cancer testing-Women with a cervix should get a primary HPV test every 5 years. If a primary HPV test is not available, then acceptable options include a co-test (an HPV test done at the same time as a Pap test) every 5 years or a Pap test alone every 3 years. 

• To lower risks of developing diabetes and cancer:

• Lose weight– If you are overweight, try losing extra weight to achieve your target weight per height.

• Eat healthily– Choose a diet with plenty of fresh fruits and vegetables – Try to eat at least 4-5daily servings of vegetables, including broccoli, carrots, cauliflower, celery, beans, peas, peppers, and tomatoes. Include common fruits like apples, dates, figs, grapes, oranges, pears, and strawberries. Opt for whole grains over refined flours. Choose healthier options for dairy and meat: Low-fat or non-fat dairy products, cuts of meats, and meat alternatives that are lower in saturated fat and calories. Include fish and seafood, poultry without the skin, and eggs, most importantly, be sure to watch portion sizes.

• Stay active– By setting a goal to exercise five days a week. Thirty minutes of brisk walking or similar activity will work. The aim is 150 minutes of moderate physical activity or 75 minutes of vigorous exercise each week.

• Quit smoking– A strong willpower to stay away from Cigarettes.

• Limit your alcohol intake– Research shows that heavy drinking damages cells and can lead to cancer. Alcohol is also high in calories and sugar. The National Cancer Institute recommends that women have no more than one drink per day and men have no more than two drinks per day. (A drink serving is defined as 12 ounces of beer, five ounces of wine or 1.5 ounces of liquor.)

Results of some, but not all, epidemiological studies suggest that diabetes may significantly increase mortality in patients with cancer. Hence controlling blood sugar levels is very important to maintain overall health.

The writer is Head- Research & Development and Academics cell, Metropolis Healthcare Ltd.