Any advice? How to reduce blood sugar after chemo

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Pookie

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Type 2
I'm an underweight T2 diabetic being treated for ovarian cancer. I've had 2 lots of chemo so far and my Libre2 shows blood sugar very high (mostly 14-20) no matter what I eat. I still take my one metformin a day but also, and hopefully temporarily, 8 x 40mg Glicklazide per day. Even at say 3am this morning it was 12.7. Its day 10 and still so high. I also feel incredibly tired, light-headed, emotional and just not myself. And I pee a lot and my eyes are stinging and watering. I did not have these effects after the first chemo. I'm worried I could have kidney damage if I don't get the blood sugar levels down soon. I also wonder if I need insulin to get the levels down if the Glicklazide isn't working. Or maybe I've become T1 diabetic.
Has anyone experienced anything similar? Or does anyone have any advice or reassurance?
 
Pookie said:
I'm an underweight T2 diabetic being treated for ovarian cancer. I've had 2 lots of chemo so far and my Libre2 shows blood sugar very high (mostly 14-20) no matter what I eat. I still take my one metformin a day but also, and hopefully temporarily, 8 x 40mg Glicklazide per day. Even at say 3am this morning it was 12.7. Its day 10 and still so high. I also feel incredibly tired, light-headed, emotional and just not myself. And I pee a lot and my eyes are stinging and watering. I did not have these effects after the first chemo. I'm worried I could have kidney damage if I don't get the blood sugar levels down soon. I also wonder if I need insulin to get the levels down if the Glicklazide isn't working. Or maybe I've become T1 diabetic.
Has anyone experienced anything similar? Or does anyone have any advice or reassurance?
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Hi Pookie

I had chemotherapy after pancreatic cancer but fortunately had access to insulin.
Premeds such as Dexamethasone can put your glucose into orbit, I think mine hit 21 if I remember rightly.
Please don’t panic, you just need support. Do you have access to diabetes specialist nurses; if so they can guide you.
I suspect your current meds are insufficient to cope with these large glucose fluctuations.
If you do not have access to DSN then oncologist can refer you to them or to a specialist dietitian, I assume you have a contact number for oncology ward so ask them , they usually respond promptly.
If all else fails then contact GP who will refer to the above as they will be out of their depth normally.
I found my glucose soared for 48 hours after chemotherapy then calmed down.
If yours is worse than this then seek support as stated above.
Don’t be afraid to ask and remember it usually takes prolonged raised levels of glucose to cause significant damage to kidneys etc not a couple of weeks.
You’re bound to be upset and feeling rubbish after cancer diagnosis and chemotherapy. I told myself glucose control is secondary to cancer and chemotherapy so don’t stress about it, focus on staying positive and getting well.
I wish you well , you can do this
 
Thank you for your help Chris88. The community on here is so supportive. I won’t panic, I’ll speak to the diabetic dept on Monday. It is just scary seeing my blood sugar so high on top of everything else when I thought it was one thing I had taped. My HbA1c went from 47 pre first Chemo to 62 now.
 
Hope you get some insulin, even if it is just on a temporary basis to help you lower your levels whilst going through chemo. Do be quite assertive that you would like insulin as the medication you are taking is obviously not working and you feel rough with the high BG levels. Sometimes you have to be a bit pushy to get what you need, but getting those levels lower will also assist you in beating cancer, so it is important to be able to bring them down when you need to.
 
My Hba1c went up also but not to the extent yours has . I think Barbara is correct, you might need insulin , at least in the short term and once your glycemic control improves hopefully you will feel better. Chemotherapy does make you feel awful and those long hours thinking about things seem to make things worse. Keep your chin up!
Chris
 
Chris88 said:
My Hba1c went up also but not to the extent yours has . I think Barbara is correct, you might need insulin , at least in the short term and once your glycemic control improves hopefully you will feel better. Chemotherapy does make you feel awful and those long hours thinking about things seem to make things worse. Keep your chin up!
Chris
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Thanks for that. Blood tests and insulin on Wednesday. Then I'm going to have to inject myself with insulin in the stomach each day. Quite a frightening prospect! But hey, if it stops the symptoms of high blood glucose then I'm IN! Hopefully it will only be short term. Fingers crossed!
 
rebrascora said:
Hope you get some insulin, even if it is just on a temporary basis to help you lower your levels whilst going through chemo. Do be quite assertive that you would like insulin as the medication you are taking is obviously not working and you feel rough with the high BG levels. Sometimes you have to be a bit pushy to get what you need, but getting those levels lower will also assist you in beating cancer, so it is important to be able to bring them down when you need to.
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Thank you for replying. They are going to give me insulin on Wednesday after I see the oncologist, and also test to see if I have become T1. Maybe they will cut out the steroids after the next chemo as they think that is what causes the blood sugar to shoot up. At any event the oncology consultant will be in touch with the diabetes dept. Thank you!
 
Really, I can assure you it is nothing in comparison to what you expect. The needles are really, really tiny.... less than a quarter of an inch long and only slightly wider than a human hair and the pens are so easy to use and the forum is here to support you if you have any questions. So pleased that you are getting insulin because getting those high levels down will help your body fight the cancer more effectively as well as making you feel better physically and emotionally. You don't realise how rough you feel with high BG until they come down. Hopefully they will start you off with conservative doses and gradually increase them as needed. Finding the right dose for each person is trial and improvement, so it will take a few weeks to bring you slowly and steadily down into range.... or at least I hope so. Sudden drops in BG are not good for the body either.

Do you know which insulin(s) you are getting? And will you be getting a Constant Glucose Monitor, usually a Libre. If it hasn't been mentioned, do ask as it will make monitoring your levels easier. If they don't prescribe them, you can apply for a free 14 day trial from the manufacturer, so ask and we will post a link.
 
Thank you Barbara, that is quite reassuring. I was imagining sometjing huge. I'm seeing the Diabetes dept in the hospital on Wednesday afternoon to start me off. I'm wearing a Libre2 now as they said I should be testing when they saw how high my HbA1c was as I started the second lot of chemo. It was never mentioned before then although they knew I was a T2 diabetic. I don't normally test at all. Should I ask for anything in particular re insulin/needles/monitors?
I'm so grateful to you for the reassurance.
 
Libre isn't normally available on prescription for Type 2 diabetics unless they are on multiple injections of insulin a day and even then they often have to really push to get it. Type 1s get it offered as standard now as they use multiple daily injections of insulin or insulin pumps, some of which link to the sensor to provide what is called a hybrid closed loop system.... not relevant to you in your current situation.... Hopefully you will continue to have Libre prescribed now you are going onto insulin.

They will fix you up with needles and a Sharpsafe box for their disposal and your insulin pens. Do be aware that Libre or other CGM isn't totally reliable and there are times when you still need to do finger prick tests, so hopefully you have a BG meter and test strips too on prescription and lancets?
 
The nurse should be in regular contact with you maybe once or possibly twice a week in the first few weeks to see how you are getting on with the insulin and adjust the dose according to your readings. If you have Libre they should be able to view your data and make decisions based on that, so a short telephone call should suffice, but the forum is here any time you have any questions or need reassurance, so don't feel like you are alone with it. We all know it can be really daunting at first but you will soon get the hang of it and find a routine and it just becomes second nature. I can inject insulin and then a few minutes later I can't remember whether I actually injected it or not, because it has become so automatic. Thankfully the pens I have are reusable and they record each dose and how long ago I injected it, so I can easily check. You will likely be on disposable pens so you won't have that feature but with it being new to you, I am sure you will remember for a while at least.

It will be interesting to see what sort of insulin they give you. I have no idea if your levels will settle a bit between chemo treatments which would make a long acting (basal) insulin difficult as it would need regular adjustment up and down and a similarly issue with mixed insulin which is a combination of fast acting (bolus/meal time) insulin and long acting (basal) insulin. Do let us know what they decide on and of course how you get on with it and please shout up if you need any reassurance or advice.
 
Hello @Pookie, sorry you need to be asking these questions but the Forum is a helpful place to be right now.

Is your chemo frequency mapped out for you? I was scheduled for fortnightly sessions, but they sometimes became 3 weekly if the blood tests taken on the day before a scheduled session revealed my cell count was too low. I was on Levermir as my basal and NovoRapid as my bolus and my Levermir was increased by c.20% for chemo day and the 3 days following. But I did not have CGM at that time, so I was sending my DSN a photo of my log book once a fortnight. Presumably you have been given a code that allows you to share your Libre readings with the Hospital Diabetes Team and then they can help (guide) you for insulin adjustments and corrections.

I was on fixed NovoRapid bolus doses for meals and only started carb counting after my chemo finished. In hindsight it would have been better if I'd been gently encouraged to get on with carb counting and steadily learnt not just how to do that but started to get a feel for the process and see how I could make my own decisions on bolus doses and adjust these surprisingly easily when I wanted a food treat!

Your libre phone app allows you to record insulin taken, carbs in meals eaten and miscellaneous notes about bad chemo days or upset tummy days; such notes should greatly help the diabetes team guide you with dose adjustments.

One thing to discuss with both your Oncology and diabetes teams is diet. In theory taking insulin can allow you to eat higher carb meals than you would normally plan on eating as a T2 with just oral meds to help. However, as you might have already have found, the chemo sessions and steroids can quite fundamentally change your appetite and desire for food. It certainly did for me in 3 or 4 day blocks straight after chemo. I was already at a good weight before starting chemo and then lost a lot more and needed high protein supplements to help me through the chemo phase. It was all rather muddled from my perception and I needed the help of a MacMillan dietician to find a way through this period; but the Hospital Diabetes Team already had their own dietician and there was briefly a minor territorial battleground between the 2 dieticians. I asked the MacMillan dietician to take the lead; partly because she worked in the Oncology wing and took the trouble to come and find me during a chemo session, then asked what felt like the right questions and certainly understood how the chemo was mucking up my appetite. Whereas the diabetes dietician was cocooned in her nursing station, and had only indirect contact with me. This might not become an issue for you, but if it does you are at least now forewarned about this sort of potential challenge.

Anyway good luck with all of this. You may get lousy days; don't be shy about sharing these with us (a problem shared .... etc) and certainly ask questions, no matter how stupid they might seem. This chemo phase was pretty confusing and unsettling I found.
 
When I had chemo and steroids, I found I had to quadruple, yes quadruple, my basal insulin dose for the whole period of the treatment. Was nice to finish, but took a few more weeks to revert to normal afterwards.
 
Thank you everyone for advice and reassurance. I saw my oncologist yesterday and the diabetic nurse too. Strangely the BG readings have come down a bit so they are waiting one more day to see if I need to start the insulin. It is brilliant that the hospital can see my Libre2 readings direct. But I've been shown how to test and inject and now have the insulin in my fridge. I feel a little better I think, though still very dry mouth and lips and eyes. I am definitely less emotional, probably because I feel the hospital is more aware of these symptoms before my next chemo on tuesday. I'm guessing the BG readings will shoot up again then so maybe that's when I will have to start with the insulin. Everything seems so unpredictable, and every new chemo session has different side effects.
Thank goodness for this Forum as thats where I get most of the answers!
Fingers crossed for tuesday and hoping I don't have to start insulin before then...
 
So pleased you now have insulin on hand to use if you need it. Which insulin have they given you?
Hope chemo on Tuesday goes as smoothly as possible and the effects are not too unbearable and are short lived. Let us know if you have to start insulin before then and how you get on.
Wishing you all the very best through this horrid phase of treatment and of course a successful outcome to your battle with cancer. Sending (((HUGS)))
 
You are lovely! Thank you so much. It's insulin in a pen and its called Glargine (Abasaglar Kwik pen).
I've been in green range most of the day apart from after meals. But the highest so far today is actually only 11.9 which is so much better. I guess I won't have to start the insulin until after the chemo/steroid pushes it right up again.
Thank you for your good wishes. They help!
 
This all sounds reassuring: a useful meeting with your Oncology team, you now know for sure they can see your BG as it happens and meanwhile you've got insulin ready to go if needed. You might need to gently tell them if you feel your BG is racing away; it's probably not realistic to expect that they are directly monitoring, minute by minute. But my experience was that a phone call in to the chemo ward was always answered directly and any issue I had was taken note of and someone always got back to me straightaway. They never let me feel anything was a trouble or difficulty for them.

I also had quite different side effects after each chemo session. They gave me a logbook to complete after each session and I tried to be honest about how I felt. Every single one of the nurses at the chemo "dispensing" stations were truly wonderful, which in itself was most helpful for me. Wishing you well for next Tuesday.
 
Glad you have the support you need.
Onwards and upwards!
Hope the next course of chemotherapy goes well, you know your glucose will spike but at least you have a chance of controlling it and professional advice at hand should you need it.
Good luck, keep going
Chris
 
Proud to be erratic said:
This all sounds reassuring: a useful meeting with your Oncology team, you now know for sure they can see your BG as it happens and meanwhile you've got insulin ready to go if needed. You might need to gently tell them if you feel your BG is racing away; it's probably not realistic to expect that they are directly monitoring, minute by minute. But my experience was that a phone call in to the chemo ward was always answered directly and any issue I had was taken note of and someone always got back to me straightaway. They never let me feel anything was a trouble or difficulty for them.

I also had quite different side effects after each chemo session. They gave me a logbook to complete after each session and I tried to be honest about how I felt. Every single one of the nurses at the chemo "dispensing" stations were truly wonderful, which in itself was most helpful for me. Wishing you well for next Tuesday.
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Thank you! The support from forum members has been really encouraging!
 
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