BC with diabetics

As I anticipate my neoadjuvant chemo therapy, I have anxiety about coping with Type I diabetes (41 years) and stage 3 kidney disease, too. I am interested in others' experiences with managing it all, especially related to side effects-nausea (I have drugs prescribed), steroid effect on BG, staying hydrated, etc. I am on an insulin pump. Adjustments to basals and boluses? Any advice from those of you who have gone through this?

I was originally prescribed Taxotere-Cytoxan, but when I flat out refused to take steroids I was switched to Adriamycin-Cytoxan and had no nausea (they wouldn't give me TC therapy without steroids because of the danger of severe edema). I'm type 1 and refuse to take anything that will jack my blood sugars into the stratosphere (which dexamethasone will do if you are type 1) without being able to predict when the effects on my blood sugar will disappear. You can bolus daytime correction doses till the cows come home, but if you change your basal rate you'd better set the alarm to wake up several times a night until you know the steroid has worn off, and that could be days or even weeks. Or you could, as many people have done, ask for a reduced steroid dose to minimize the side effects.

I was worried about hydration too because I just can't make myself drink large volumes of anything, let alone two quarts. So I drank what I could, which wasn't much, and I did have a blood clot in the vein I got my first dose in which caused me to require a Picc line, and the soles of one of my feet peeled a little, but I have no idea if hydration played any part in either of those things. What I can tell you is that I didn't drink anything close to two quarts of water a day, and I survived.

The other medications I got were Aloxi and Emend, and neither those nor the chemo drugs had any effect on my blood sugar. I never tried the anti-nausea drugs they sent me home with, so I'm not sure about those.

SDCA, how's it going? Please check in so others can see what might work!

Much love

Whew! Most hospitals have an ombudsman for patient advocacy--you might want to contact that person.

I'm feeling much better this week, but my kidney function has dropped way off. I saw nephrologist today and he is monitoring me very closely. I do hope this is a temporary problem. He seemed to think it was an acute assault on my kidneys, but I could be facing some temporary dialysis if numbers don't improve. I am hoping to avoid that. I did get Granux (?) shots--generic for Neupogen, I think. It did raise my WBC count effectively. One day at a time. My next treatment is supposed to be on Tuesday, but it will depend on whether or not my blood tests are at an acceptable level. Such a delicate balance to manage all of my comorbidities! This is not for the weak and feeble. Here's hoping the chemo kills the cancer but saves the host! Yes, I agree, cancer sucks! Thanks for your input and concern. Take care.

Moonflwr912--I have had some of my meds reduced/changed, so there is a good chance that could be a factor. How long were you in kidney failure or on dialysis? Have you completely recovered from that? I appreciate your sharing your experience because this is new territory for me.

Hi everyone

I've been diagnosed with Insulin Resistance (which is I guess is pre-diabetes) around the same time as my BCA diagnosis. I've been hearing mixed reports about starting a course of metformin during AC therapy. No-one has mentioned anything to me about managing insulin through medication other than dietary methods.

I've always tried to maintain a healthy diet and prior to diagnosis I was following a low carb/high protein paleo diet and went to the gym 3-5 times a week. Very little has changed since (diet wise), however I have stopped gyming because of the fatigue. I feel my insulin levels are still out of whack and I'm considering asking my GP to put me on a course of metformin after reading This journal article.

I'm also taking 10mg rosuvostatin for cholestrol (the genetic type )

What is your POV? Do you think I should manage my insulin levels after chemo or should I start now? Has anyone had any horrible side effects with metformin and AC + T therapy? Just a little bit confused on what to do here.

Love,
S

Hi there! I'm new to the boards - just looking to connect with others who are dealing with type 1 diabetes + breast cancer.

I've had type 1 for about 20 years, managed via Minimed insulin pump and, now, Enlite sensor. The past couple of years haven't been well controlled, with my A1C around 7.5%, but my first A1C this month while on TCHP chemo since October has dropped to 5.7% (due to both drastic diet changes and an overall drop in blood count). I also have a few days of high blood sugars around each chemo infusion due to the steroids.

One of the most confusing issues for me is understanding exactly how having type 1 impacts the growth of breast cancer cells, and then how I help control it. Is it the glucose associated with high blood sugar that feeds it? Or is it the higher level of insulin needed to deal with the high blood sugar?

Welcome Sadie064. I don't really know the answer to your question but a PA who is an expert in diabetes suggests there may be a higher incidence of breast cancer in type I diabetics. I have had it for 41 years, on pump. I had to abandon chemo due to major complications, and after good pathology results post-surgery, we decided benefits were not worth risks for me. Biggest blood sugar problems were related to steroids (hyperglycemia surrounding chemo and surgery) and poor appetite (hypoglycemia related to kidney problems, nausea and vomiting, reduced food intake) which both required major adjustments to basals and boluses for those periods. A1Cs are somewhat varying (have been both higher and lower than average, depending on phase of treatment) but endocrinologist is OK with it until I get through the major treatment for the cancer which takes priority for the time being. She participates in helping me make adjustments as we travel through this journey. Herceptin does not have a negative impact for my blood sugars, so I think I am through the toughest phase for the diabetes management part, now that I am doing only radiation and Herceptin. Anemia has been another major problem for me. Good luck during your treatments.

My daughter has type 1 and I have partnered her from age 4 to 26 on management. We never look to endocrinologists for help unless we have to (if the hospital requires it) though she sees one regularly- they are needed for prescriptions.

As for hospitals- every type 1 knows the hospital is the most dangerous place on earth for a type 1. My daughter had several other health problems and had a major traumatic brain injury as well. Diabetes management in the hospital was a nightmare. They had never had a type 1 on the neuro ICU and one ICU nurse told me that in 30 years she had never had a type 1 under her care. I met with the endocrinolgy department and wrote the attending a long letter (which was deemed "eloquent") but everyone told me that because of the rarity of type 1's, noone would train nurses on pumps. Gee, we were expected to go home with one and work it and we are lay people. It's not rocket science! These various staff and MD's told me that addressing DKA was their minimal focus at the time.

I strongly suggest going on a CGM (sensor) for anyone dealing with type 1 and cancer treatment. As a side note, for some reason, we have had two experiences now in hospitals where the sensor made ALL the diffference. Even in the ICU again, the nurses and MD's left us entirely alone to manage things with the sensor.

My daughter has had steroids a lot. IV dexamethasone lasts longer than pills but is easier to handle with blood sugars. In fact, in some ways, it stabilize hers!

I cannot imagine having type 1 and not changing basals even in ordinary circumtances but everyone is different. We certailny would not consult an endo about this: they are almost always wrong. These things are just too individua and in our experience, generalized formulas are dangerous. My daughter triples her basal an hour before steroids, then gradually reduces it as it becomes apparent it is leaving her body. Yes, lows are a potential problem, but highs over more than 2 or 3 hours are terrible too.

This IS doable. But get a Dex4 CGM and it will be even more doable!

Hi there!

I was diagnosed December 2014 and had a Sentinel guided lumpectomy and one node removal. I also have Type 2 Diabetes, IBS and Clinical Depression. Oh, and a frozen shoulder which makes taking my cardigan off and putting it on again for the sweats and chills (over 10 a day) very painful!

I'm in Manchester, England.

I was just wondering if there is anyone with similar problems to myself, and whether anyone feels that the combination of medications is making the side effects of their cancer meds worse.

I have been on Citalopram for depression for about 5 years. I tried to come off it so that I could take Venlafaxine for the flushes and chills, as was recommended, but I couldn't hack it.

After being on Letrozole for a year, it was decided to try me on Tamoxifen at the beginning of this year. Again I'm sweating like it's going out of fashion etc.

I'm on Metformin 1000 for Diabetes, and Dicycloverine for IBS, Co-dydramol for the shoulder pain and Simvastatin.

I get a bit down when I'm lining up all my tablets to take for the day.

I'm only 58, so I'll have to be thinking of looking for a job again, but as it is, I really don't think anyone would employ me.

We do have our own Breast Cancer Care organization in this country, but I find this site is much better informed.

So, anyone out there?

Jools