Balancing Blood Sugar in the Face of Pancreatic Cancer

You may be eating plenty, but your cells could still be starving.

This is what happens in diabetes, when insulin, the hormone that shuttles glucose, the cellular energy supply around the body, is in short supply, is not made at all, or is not used properly by the body.  

Since the pancreas is the insulin-making factory, many pancreatic cancer patients are intimately familiar with the effects when insulin production or uptake goes wrong: fatigue, thirst, hunger, weight loss, frequent urination, low energy, blurry vision, dry skin, and nerve damage, among other things.

Some may have been under treatment for diabetes even before their cancer diagnosis. But as Duke Health (Durham, North Carolina) onco-endocrinologist Afreen Shariff, M.D., notes in “Pancreatic Cancer, Diabetes, and Endocrine Health: What You Need to Know,” the nature of a patient’s diabetes can change drastically due to their cancer.

Pancreatic Cancer and Diabetes Go Hand in Hand

Those who had insulin resistance previously could now also have insulin deficiency, compounding their condition and requiring a different treatment. In addition to the endocrine issue (insulin deficiency), they could also be facing an exocrine issue (digestive deficiencies) in which their food is not being absorbed properly. This, in turn, also affects the amount of glucose in the system, and must be taken into account when optimizing treatment.

“We have to understand the complex interplay of all of these things, and match the regimen to what’s going on with each individual patient,” Shariff says. “Are they eating or not? Are they on steroids as part of their cancer treatment? Are they taking pancreatic enzyme supplements?”

Taking Control of Your Diabetes

Such complexity can be overwhelming. Luckily, there are tools to help patients understand what’s going on in their bodies at any given moment, and to help them maintain control of their health.

For most patients, the best way to mimic the body’s natural insulin balance is through a combination of long- and short-acting insulin. The former provides a consistent level of insulin to maintain the body’s baseline blood sugar levels, and the latter provides quick bursts to handle the glucose that is released each time we eat. In order to help patients manage this regimen, Shariff recommends a continuous glucose monitor. “The benefits of these devices are threefold: safety, dosing, and learning,” she explains. Shariff is the director of the Duke Onco-Endocrinology Program and the co-founder for a virtual cancer support clinic called Citrus Oncology.

Safety: If blood sugar levels fall below 70 mg/dL, the device will beep to warn its wearer, and wake them up if necessary. The patient should then consume fast-acting carbohydrates like glucose tablets, fruit juice, or candy to raise blood sugar levels, and avoid driving and other potentially hazardous activities until balance is restored. 

Dosing: Once given blood sugar level guardrails by their physician, provider, or diabetes educator, patients can determine how and when to administer and titrate their insulin doses.

Learning: Patients can see exactly how their body responds to what they eat, such as how different types of carbs affect their blood sugar levels. They can monitor both minute-to-minute changes as well as trends over time, and adjust their food choices and/or portion control accordingly.

“I don’t like to tell patients that there are foods they absolutely cannot eat. A low carb diet is a great diet for blood sugar levels, but it’s not a practical approach for most ethnic groups, especially those where bread and rice are staple parts of the diet,” Shariff says. “They may be able to adjust their portion sizes, or how often they have certain foods.”

Technology has changed the game in diabetes management, she continues. “It’s a better time to have diabetes than it was 10 years ago. You no longer have to prick your finger six to seven times a day, which is a very barbaric way to take care of diabetes,” she adds. “It also lessens the anxiety that comes with low blood sugar levels, and has enhanced the quality of life overall for diabetes patients.”

Shariff also encourages patients to focus on the big picture. “Your diabetes control is not going to be perfect every day. But as long as you’re coloring within the lines most of the time, you are going to be okay.”

Consult your physician/provider about the diabetes control method that is best for you. You can also learn more about continuous glucose monitors from a Cleveland Clinic article.