Hey There, wanted back to Ask D'Mine, our weekly advice column hosted by Wil Dubois in NM, a veteran typewrite 1 and diabetes author with experience running A a clinical diabetes specialist. This calendar week, a referee wants to know just how their diabetes technical school may play into cancer treatments. Ugh.

{Got your possess questions? E-mail us at AskDMine@diabetesmine.com}

Nancy, type 1 from South Carolina, writes: I am on the new cross loop Medtronic pump with CGM. I am starting chemo for HER2 constructive breast Cancer the Crab. The chemo meds are Doxorubicin and Cytoxan for round one; and Taxol and Herceptin for round two. My tumor has been removed. My question is: Will I be able to manage blood sugar, or will it spiral out of control??

Wil@Ask D'Mine answers: Oh man. As if diabetes doesn't suck decent. Wow, diabetes and Cancer. My heart goes out to you and your family, and I'm sending all possible sensationalism energy and best wishes your way.

Of path, you already experience Thomas More about breast cancer than I'll ever know, but for the benefit of our other readers the HER2 positive types of breast Cancer are fast movers. For those interested in how things work under the hood, HER2, whose formal name is human epidermal growing factor receptor 2, is a gene/protein combo that deals with the growth of healthy breast cells. When mixed with cancer, this has the fateful result of supersizing the growth of the cancer cells, which are already in the fast lane when it comes to cell growth in the low put over. Unhappily, that means HER2 breast cancers grow faster than other breast cancers, are more likely to spread to other parts of the body, and are more likely to get back in the future.

🙁

So wherefore am I dismal you away reminding you of this info today? Because everyone—including you—needs to understand that truehearted-moving cancers need to be treated more sharply and with stronger meds, a fact that's loss to matter to us on the blood sugar control front.

There is some good news present, however: We now have decorator drugs specifically engineered to chase after HER2 titty cancers. The Herceptin in your round two is an example of matchless of these new wonder drugs. Apparently IT's planned to block that ontogeny sign from the HER2 proteins. Yay! But will IT sham your rakehell lolly?

Actually, IT mightiness. Just not in the way you'd carry. Elevated railroad glucose isn't a common side effect listed on the prescribing information mainsheet for the drug, which agency that IT's unlikely the medication itself wish raise your blood sugar. And although post market reports suggest that it might cause saccharide trouble for some people, information technology's a crazy-small number, less than one-fractional of one percent of folks WHO take Herceptin. Where you mightiness have some trouble is indirectly from a public broadside impression of Herceptin: Diarrhea.

Diarrhea, along with vomiting, which is another common chemo lateral effect, dump carbs from meals back out of your body off-schedule, before the carbs are absorbed into the bloodstream. That puts you at risk for low blood sugars from the insulin you took for food that exited in an untimely manner from one final stage of your body or the other.

Pin-up.

OK, while we're happening the subject of your specific meds, rent out's quickly unravel through the rest of your list in front we jump into the pump office of your question.

  • Doxorubicin: No official set up on blood glucose, but IT's some other same of those puke and dash drugs. If works away blocking enzymes that supporte cancer cells grow and divide.
  • Cytoxan: Nobelium specific effect on descent sugar, only like all cancer drugs, the list of possible side effects is impressively long, and includes a high likeliness of the two side personal effects we've been talking just about. It works against Cancer the Crab in the "resting phase" of cell division. The med is a first generation cancer drug and is actually affiliated to the World State of war I chemical warfare agent Mustard Gas. Remember that chemo works by nearly putting to death the patient to kill the cancer.
  • Taxol: It may or may not matter to you to know that this med was developed from plant alkaloids, in this case the barque of the Ocean Yew tree. Information technology works against cancer prison cell division by piece of ass with the cell's microtubules. Again, there's nary specific glucose-raising side effect, but more vomiting and diarrhea.

And then the good tidings here, if you can call it that, is that none of your chemo meds, on their own, should cause your blood glucose to go fruity. But that same, there's heretofore one much shadow. Evidently, steroids are often given along with chemo meds as a way to lessen sickness, which is a common fallout of all of the drugs you'll be taking; and steroids are one of the worst things you can undergo when it comes to controlling blood sugar. Worse than cotton candy-topped macaroni and tall mallow with a side of ice cream drenched in fudge sauce.

Steroids bequeath have your blood carbohydrate to surge like Old Faithful. Plus, I've read that cancer patients, when they aren't throwing up, tend towards comfort foods. And who tush blame them? Merely most solace foods are notoriously high in carbs. So I'm sure glad you are on a CGM. That means, that any happens with your blood loot, at least you'll know it. It'll be like CNN with those little intelligence briefs that scroll crosswise the tail of the screen day in and day out.

Aside the means, as a matter of course in cancer treatment, for all the reasons above, insulin often needs to be increased for insulin-using PWDs getting chemo. And, in fact, insulin often has to be started on PWDs getting chemo that antecedently didn't demand insulin.

Anyway, I think that being connected a pump is going to be a gigantic vantage for you here, especially this pump—if it can conserve with the dynamical surroundings in your body quickly enough. This particular pump has the capability of adapting to your body's changing sugar surround by automatically increasing or decreasing the flow of insulin in response to the CGM readings. Even at night when you are sleeping. Wish you have sweet control? I rather doubt it, but I think you'll do better with it on your team up than you'd do with a conventional pump, or not pump in the least.

The only downside of this pump is that thither's not much that you can monkey with when IT comes to the pump's settings if the inbuilt algorithms prove non to be nimble enough to conserve with the changes in your body. In self-winding manner, the only user-adjustable variables are the insulin-to-carb ratio and the duration of insulin action. If you feel the chemo essentially makes you Thomas More insulin resistant, one possible workaround to jumpstart the algorithm would be to use a more aggressive IC ratio and a shorter length of action. That will make insulin flow in higher volumes for meals and pretend the micro boli that supercede the basal grade trigger more frequently. Also, connect with your innovative pump flight simulator and run into if she (he?) has any other tricks that might help.

Merely let's keep our center on the endgame here, which is survival. You've got an self-asserting, severe cancer. I don't want to say, "Screw the diabetes," exactly, but it might need to take a back seat for a while. Act up the best you nates, but short of going DKA, don't sweat the high blood sugars too much.

Hardly beat the blessed cancer. So you hindquarters focus on holdfast the diabetes. It's willing to hold off.

This is non a medical advice column. We are PWDs freely and openly share-out the wisdom of our collected experiences — our been-there-cooked-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Seat line: we are only a small part of your total prescription. You still pauperism the pro advice, treatment, and care for of a licensed medical job.