How to Manage Diabetes With Another Life-Changing Condition
Wayne Bottlick was discussing lunch plans with coworkers on a warm spring day in 2008 when he started to feel ill. Bottlick, who has lived with type 1 diabetes for 51 years, thought he might be having a low. A quick finger stick revealed that his blood glucose was normal. A few minutes later, Bottlick had a seizure—the first sign of a condition that took two years to diagnose: brain cancer.
“While type 1 diabetes was certainly a life-changing and challenging event that altered the course of my life, it did not stop my life. Brain cancer, on the other hand, has … been far more emotionally debilitating than type 1 ever was,” says Bottlick, 62, who underwent surgery to remove the tumor in 2010.
Researchers are still untangling the connection between diabetes and conditions such as cancer and Alzheimer’s disease. When it comes to heart disease, research has shown that diabetes raises the risk, but more research is needed to understand why. While discoveries are ongoing, here’s what to know about living with a double diagnosis.
Diabetes is scary in itself. When life hits you with another curveball, and you’re diagnosed with a serious medical condition such as cancer, Alzheimer’s, or heart disease, it’s natural to experience a range of emotions. “It’s absolutely normal to cry, to be angry, to be upset, scared, and worried—all of those emotions and many combined at once,” says Alicia McAuliffe-Fogarty, PhD, CPsychol, vice president of lifestyle management at the American Diabetes Association.
Research shows that taking an active role in your health care decisions can improve your outcome. That can mean educating yourself about your treatment options, getting a second opinion to make sure the diagnosis is accurate, asking your doctor questions, and researching specialists and treatment centers.
Also important is encouragement from family, friends, health providers, and support groups. Having someone to talk to when you’re upset, or to help you out if you’re not feeling well, is comforting. “We know that when people have support, they have better health and mental health outcomes,” McAuliffe-Fogarty says.
With hearing the word “cancer,” a set of worries, questions, and uncertainties come into focus. You may also wonder how you’ll manage your diabetes with this new diagnosis: Will cancer treatments affect your glucose management? What are the possible side effects? Will your medications be affected? Your health care team will guide you in balancing your diabetes needs with your cancer treatments.
How diabetes responds to cancer drugs is unpredictable. Your doctor’s holistic approach to your care is key, says Deena Adimoolam, MD, assistant professor of diabetes, endocrinology, and bone disease at the Icahn School of Medicine at Mount Sinai in New York. “It’s important that they’re addressing all of the side effects of these medications and how they can disrupt glycemic control,” she says. Treatments known to raise glucose levels include:
Nausea, vomiting, decreased appetite, and weight loss are all common side effects of chemotherapy that could require adjustments to your insulin and other diabetes medications, says Adimoolam. “Different medications, chemotherapy, and radiation therapy are huge stressors on the body that can also cause hyperglycemia,” she says. If your glucose is trending higher or lower than normal, discuss medication adjustments with your doctor.
Chemotherapy regimens often include steroids to bring down inflammation or help alleviate side effects such as nausea, says Dawn Hershman, MD, professor of medicine and epidemiology at Columbia University Medical Center. But steroids can drive up blood glucose. Depending on the circumstances, you may need a higher insulin dose.
Newer Anti-Cancer Agents
Targeted cancer drugs, such as P13 kinase inihibitors, tacrolimus, sirolimus, and everolimus, interfere with the growth process in specific cancer cells, says James Flory, MD, an endocrinologist at Memorial Sloan Kettering Cancer Center in New York. Rather than kill healthy cells and cancer cells alike, these drugs target functions specific to the cancer cells and promote cell death. As with steroids, people taking these agents can see higher blood glucose levels.
Diagnosis: Alzheimer's Disease
When Brian Van Buren, 66, learned he had Alzheimer’s disease two years ago, he felt overwhelmed and stopped taking care of his type 2 diabetes. “I found that as my blood sugar levels rose, my cognitive ability decreased really significantly,” he says. Over time, he was simply forgetting to take his medication, including metformin and basal insulin. After his A1C shot up to 9.6 percent, he devised a system. He uses phone alerts to remind him to take his meds, and puts a week’s worth of pills in a plastic organizer.
Managing diabetes and Alzheimer’s disease can be tough, particularly as the dementia progresses, but one good thing to know is that Alzheimer’s medications do not typically interfere with glucose management or diabetes medications, says Luca Giliberto, MD, PhD, assistant professor of neurology at Northwell Health in Manhasset, New York. But medication side effects such as nausea, vomiting, and diarrhea may require that your doctor adjust your insulin dose or other diabetes drugs, he says. Also of note: A class of Alzheimer’s drug called cholinesterase inhibitors may decrease your heart rate, masking symptoms of hypoglycemia.
In the early stages of dementia, you may be able to set up a system, like Van Buren has, for remembering to take your diabetes meds. “This works until a certain point,” Giliberto says. “Eventually you will need somebody from the family to be there to administer the medications, or you will need a health aide to care for the person.”
Van Buren, meanwhile, is managing well. He’s lost 25 pounds by switching to a plant-based Mediterranean eating plan, and he’s training for a marathon. He also has his diabetes well managed. “I’m a lot calmer, and I seem to be able to focus much better than before,” he says.
Diagnosis: Heart Attack
It was shaping up to be a typical day for Ruby Hope, 57, when she stepped out for a walk around her neighborhood in St. Petersburg, Florida. Hope, who has type 1 diabetes, suddenly found that she had trouble walking even a block from her house. “I had a pain in my wrist, a little bit of shortness of breath, and an overwhelming feeling of doom,” she says. The next day, she went to see her primary care doctor, who immediately sent her to the emergency room. “Come to find out I had [had] a heart attack,” says Hope, who now works to raise awareness around heart attack and stroke risks in women.
Your doctor will want to find the right mix of medications for you. Darren McGuire, MD, MHSc, a member of the National Cardiovascular Data Registry and Diabetes Collaborative Registry executive steering committee, says researchers involved in large clinical trials have learned that some type 2 diabetes drugs protect against cardiovascular events, including the SGLT-2 inhibitor empagliflozin and GLP-1 agonists liraglutide and semaglutide. In one study of patients with prediabetes, pioglitazone, a drug in the thiazolidinedione class, reduced heart attacks in people with stroke.
Certain drugs used for cardiovascular health may have an effect on glucose management. Statins, for instance, bring down high cholesterol, but they’ve been shown to increase blood glucose, McGuire says. Usually the heart benefits make taking statins worth it—you and your doctor can adjust your diabetes medications, if needed.
Medications used for high blood pressure, such as thiazide diuretics and select beta blockers, can raise blood glucose, while ACE inhibitors, also used for blood pressure, may create an insulin-sensitizing effect. Your doctor will work with you to find a medication and lifestyle regimen that keeps your heart healthy and your glucose in target range.
Day By Day
It’s natural to feel overwhelmed with a new diagnosis. Give yourself time to adjust and process,” says McAuliffe-Fogarty.
As for Wayne Bottlick, he’s now cancer free. He has short-term memory loss, though, which has affected his ability to work and manage his diabetes. He’s lost the knack for quick calculations when counting carbs and dosing insulin, but he has learned a few tricks to overcome this: He records every meal, insulin dose, and glucose check to help guide his decisions. “I go over the logs for the last two weeks before deciding how much [insulin] I should use,” he says. This system works well for Bottick, who says he’s learned to take one day at a time. “You just keep moving forward,” he says.
5 Ways to Cope
When you’re in a dark place, it can be hard to see the light. Alicia McAuliffe-Fogarty, PhD, CPsychol, has a few ideas to get you started:
- Exercise. It relieves stress, helps clear your mind, and aids diabetes management.
- Get support. Enlist family, friends, support group members, or a therapist to help you cope.
- Spend quality time with family. Slow down and enjoy your loved ones.
- Disconnect from the electronic world. Engage in the real world instead.
- Meditate. This may help you to calm your mind.