Co-Managing Patients with Type 1 Diabetes and Cancer

Abstract

The life expectancy of people with type 1 diabetes is improving and now approaches that of those without diabetes. As this population ages, a growing number will be diagnosed with and treated for cancer. Cancer treatments can drastically affect insulin requirement and glycemic control through multiple mechanisms including high doses of glucocorticoids and targeted therapies that directly interfere with cellular pathways involved in the action of insulin. Patients with cancer frequently also have alterations in gastrointestinal motility or appetite and require supplemental enteral or parenteral nutrition. Few studies have evaluated these patients directly, but data on patients with and without diabetes suggest that glycemic control may play a larger role in cancer outcomes than is often recognized. Collaboration between the treating oncologist and diabetologist allows people with diabetes to receive the most effective therapies for their cancers without undue risk of hypoglycemia or adverse outcomes due to hyperglycemia.

A Practical Guide for the Management of Steroid Induced Hyperglycaemia in the Hospital

“…GCs are a well-known trigger for diabetic ketoacidosis in patients with deficiency or absence of endogenous insulin secretion, thus proper insulin dose adjustments to the GC therapy are recommended and transient hyperglycaemia should not be trivialized in these patients. Clinical evidence for insulin dose adjustments for patients with T1DM on GC therapy both, in the inpatient or in the outpatient setting, is largely lacking and not described in detail in any treatment guideline [ 62 ]. Moreover, the present article discusses SIHG in the hospital setting where besides GC therapy, numerous other factors such as acute disease and altered daily routine additionally influence glucose control.…”