This upcoming Sunday is National Cancer Survivors Day, a worldwide observance the first Sunday in June, dedicated to "showing the world that life after a cancer diagnosis can be meaningful and productive."
We almost hate to mention it, but there is some question about a possible link between cancer and diabetes — and there are many people out there dealing with both. There's no real proof that one causes the other, yet there are a lot of studies linking the two. Results suggest that anywhere from 8 to 18% of people with cancer also have diabetes. One recent study published in Diabetes Care showed that 16 out of every 100 men with diabetes and 17 out of every 100 women with diabetes said they had cancer, compared to just 7 out of 100 men and 10 out of 100 women without diabetes. So maybe there is some connection...?
We're not pointing this out to scare anybody, but rather to pay homage to the folks who are dealing with both illnesses. Despite the stats cited, there's hardly any available literature on treating this combination. One of the few things we found was a 2006 Diabetes Spectrum article by Helen Psarakis, a diabetes nurse practitioner at Yale New Haven Hospital. She states that cancer patients who are on glucocorticoids — a steroid used in short term, high-dose chemo treatments — often suffer with high blood sugar. In fact, patients at risk for diabetes who begin taking glucocorticoids during cancer treatment are often quickly diagnosed with diabetes too. Insulin is recommended to treat steroid-induced blood sugar, as patients "may require two to three times their usual dose(s) of insulin." Woah.
Helen points out a few key things: For diabetics with cancer, insulin is nearly always more useful than oral meds, because dosing can be based on what a patient is able to eat. Chemo almost always causes nausea and vomiting, which can result in low blood sugar if a patient can't keep food down. So she suggests giving meal-time doses after eating, matched to the precise amount of carbohydrate the patient took in.
But the truth is that most articles about diabetes and cancer focus on the mutual causes of the two, not necessarily on how to live with both at the same time. So we're honored today to introduce Barbara Campbell, a 48-year-old woman with LADA, recently also diagnosed with breast cancer, who was willing to share her story with us here at the 'Mine:
A Guest Post by Barbara Campbell
By the time I arrived at work, I'd already received three voicemails from the imaging center. The previous day, I had presented myself for the annual mammogram. Admittedly, I was six months late, but I hadn't noticed any changes and thought this would be like every other mammogram. I was wrong.
Each message was the same, "We need you to return to the imaging center as soon as possible this morning. The radiologist is requesting additional views and possibly an ultrasound. There is something suspicious in your mammogram." I took a deep breath, tried to calm myself and left the office for the afternoon. By the end of the day, I had six additional mammogram films and an ultrasound of my left breast and lymph nodes. The radiologist came in to tell me that I needed to see a surgeon immediately.
I was referred to a surgeon who worked me in to his schedule right away. He examined me, reviewed the reports and the films, and drew a deep breath. "I need you to wrap your head around the fact that you have breast cancer," he said. It is kind of a punch in the gut when you hear that you have cancer.
More tests were ordered: a biopsy, breast MRI, and BRAC genetic testing. My mother and I were diagnosed the exact same week! The week before, she felt a lump in her breast, while I did not, and she and I just happened to have our mammograms on the same day. That's why we had the BRAC test, to find out if it was a genetic cancer. However, her cancer is completely different. Hers is responsive to hormone medication, and it's shrinking just from that so she doesn't need chemotherapy.
A weight has been lifted knowing she just has to take a pill every day, rather than having to run to her treatment hours and taking care of her, and then having my own treatment.
I didn't have a big melt-down until about three weeks into it, when I was waiting for the BRAC results. I was afraid that it was genetic, because if it were then I may have passed this on to my own daughters. But thankfully, it isn't.
Once all the results were gathered, we again met with the surgeon and our worst fears were realized. The surgeon went into great detail, showing me diagrams, photos and charts. I have Invasive Ductile Carcinoma, Stage 2b, Grade 3. It is aggressive and it is spreading.
Oh yeah... and I also have Type 1 (LADA) Diabetes.
We spoke several times with the surgeon about treatment plans and had to make adjustments due to diabetes management. Generally, he would suggest a left mastectomy and remove the lymph nodes, followed by chemotherapy and radiation. This regimen, however, posed issues for me, because people with diabetes sometimes heal slower from surgery. This would then push my chemotherapy program out further than is generally recommended. So we decided to start with chemotherapy, and follow-up with surgery and radiation. I've only had a few times when I feel lousy and feel sorry for myself, but I'm mostly high-spirited and in "work mode", ready to battle it and find out what we need to do "
I am now undergoing chemotherapy and was initially worried about how this treatment would affect my diabetes self-management. My oncologist has made every effort to plan my chemotherapy program without steroids, which is what usually causes blood glucose levels to soar. The regimen we are using is usually administered every three weeks. However, due to the aggressive nature of this cancer, the doctor has ordered my treatment every other week. This has been quite difficult as I am denied the extra week to recover from each treatment.
However, the only issue I've had with regard to diabetes is that I have more low blood glucose readings. Chemo hasn't directly affected my blood sugar numbers, but the nausea and upset stomach from the chemo makes it difficult to eat enough to keep my glucose levels within normal range. On treatment day and for the following few days, I drink Gatorade or Vitamin Water to keep my numbers up and treat lows. I've not had to use glucagon... Knock on wood. We're currently reviewing my basal rates with my endocrinologist to manage these low blood sugar episodes.
I'm happy to report, that after three treatments, the tumor is shrinking. I will have another five treatments, surgery and then radiation. My husband has been a great support and has really stepped in to help manage my diabetes. The day of chemo is the worst for me. The nausea is so awful and the oral meds that I take that day keep me sleeping most of the day. My husband wakes me every two hours, gives me the next dose, makes sure I eat something and checks my blood sugar.
One of the meds I'm taking, Ativan, really knocks me out and keeps me from recognizing a low blood sugar during the night. My husband gets up every two hours to test my blood sugar to make sure I'm not crashing. I have just been approved for a Dexcom CGM, but I'm still working through the paperwork for that. I could never manage all this without my husband and I'm eternally grateful to him!
I know I can get through this. I know I'll have big cryfest when we get that all-clear signal. I know this year will continue to be a challenge, but when we reach the end of this journey, there will be quite a celebration!