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Chemo & Type 1 Diabetes

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LP212 View Drop Down
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    Posted: Apr 01 2018 at 2:44pm
I was just diagnosed with TNBC--I believe Stage IIb.  I start Chemo on Tuesday.  I have also had type 1 diabetes for 25 years and have an insulin pump to deliver insulin.  I am wondering if anyone else is Type 1 and could tell me how the chemo has affected their blood sugars/diabetes treatments?

Thanks,
Lisa
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Libber View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Libber Quote  Post ReplyReply Direct Link To This Post Posted: Apr 01 2018 at 5:20pm
Hello Lisa. I know this is a scary diagnosis and treatment protocol when T1. I am T1 as well. 37 yrs now and use a pump. You can do this. Here is how I handled it. When I did A/C chemo my onc agreed to not give me steroids. Steroids will increase BS about 1 1/2 Days for me. When I moved on to Taxol steroids were required. So I closely monitored BS using my Dexcom and was able to adjust basal dose to keep it under control.
On days where my appetite was low, again adjusted to less basal to avoid lows.
Steroids and no appetite are the two challenges. It’s completely doable with close monitoring and adjustments to pump settings.
It’s been 2 years this month since mastectomies and reconstruction In fact I wore my pump during the 2 surgeries as well.
You can do this. Feel free to reach out again if you need encouragement.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote LP212 Quote  Post ReplyReply Direct Link To This Post Posted: Apr 12 2018 at 11:25am
Thank you!  This helped me feel better, especially for the port placement procedure b/c I never had to fast and was so worried about dropping blood sugars overnight.  It was fine (and they told me if I had to drink apple juice at 4am it wouldn't be that big of a worry).  I didn't have to.

My first round had steroids for the three days after.  I got by with only one vomiting incident and a little bit of nausea.  My sugars were higher than normal for about 6 days after but didn't go much over 300, which I consider lucky.  I had to increase my insulin-carb ratio by about 40% to get it this far.  Maybe I go more next round.  

I did land in the hospital 1 week out from chemo--a very slight fever put everyone on alert b/c my normal white blood cell count for my whole life has been 2.5-3.5, so it was expected I would bottom out and I did with absolutely 0 neutrophils and wbc count of 0.5.(even with the injection the day after chemo).  My personal doctors were not as worried as all of the doctors at the hospital were b/c they know my body operates low and always pulls through.  I hope this is the case moving forward and they were just extra cautious for my first round.  7 rounds to go.....

Very appreciate of this forum.  Thanks for sharing with me.
Lisa
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Kellyless Quote  Post ReplyReply Direct Link To This Post Posted: Apr 12 2018 at 5:11pm
HWelcome Lisa, so sorry you are going thru this! A couple of things popped in my head when I read this post:
You should never actually vomit - the vast majority of the time they can change your meds and find one that will prevent it, even with the chemo we do. Everyone is different, and each of the meds works a little differently, so actually vomiting means you should try another. Zofran, Emend, Kytril are 3 that come to mind, adding Ativan for sure if it doesn't mess with BS, and Compazine or one of the others that works like it as well. My first go round Zofran and Compazine kept the vomiting at bay. Not this time, I ended up on Emend and Ativan (and edibles from Colorado...) When the Zofran didn't work I started vomiting, ended up with a fever and in the hospital. The med changes did the trick. I hate the steroids, rarely used them either time in pill form.
Did they give you a Neulasta shot for your WBC? I don't have diabetes, I don't know how Neulasta is with it, but worth asking if you've not been offered it yet.
Let us know how round two goes!
Kelly
IDC, 2.2 cm, Stage IIb,lumpectomy 1/30/09 ACx4,Tx4 36 rads
6/1/17 Local recurrence same breast, same spot 1.8cm Carb.4x every 3 wks, Taxol 12x once wk. Dbl Mast. PCR!! Reconstruction fail, NED!
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Post Options Post Options   Thanks (0) Thanks(0)   Quote LP212 Quote  Post ReplyReply Direct Link To This Post Posted: Apr 14 2018 at 9:03pm
I know we will definitely be considering different options for nausea drugs this week.  The problem is, my stomach is so sensitive to start with, anything that goes into it makes me nauseous.  Most antibiotics and even vitamins with iron make me throw up.  In addition, high blood sugars will do it -- and one of the "better anti nausea meds" is a steroid which raises them.  

I have a feeling it will be a bit of trial and error with the nausea meds, but hopefully we get the correct ones soon.  When I was in the hospital, the antibiotics they gave made me nauseous and Zofran worked great. I have compazine...and dexa something (that's the steroid I think).  However, the hospital told me insurances are hesitant to cover Zofran as out patient.  I'll see what kind of magic my doctors can roll out for me!

I did have the Neolasta shot.  I don't think there was ever a second thought about that one....BUT...my body recovered after it dropped to zero, the same way it always does, so I'm hopeful it will continue to bounce back against all of this and future hospital trips will be minimal, even if all doctors are freaked by my low counts Tongue.  They are moving forward with the chemo schedule as planned and may reduce my dose by a slight % to see if that helps my body also stay stronger.

It looks like I'm getting similar treatment you had for chemo in your first round.  AC x4, T x 4. similar size, 2.5 cm. with lumpectomy planned after, though not sure which you had first.  
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Libber Quote  Post ReplyReply Direct Link To This Post Posted: Apr 14 2018 at 10:14pm
Lisa. So sorry you had these issues with your first chemo. I never got sick during chemo. No nausea or vomiting. The nurse gave me amend IV. And I took Ativan and an anti-nausea Med several days after each infusion. Also did Neulasta after each treatment. My WBC counts remained normal thru the whole treatment. Again the only impact on BS was due to steroids. Ask you oncologist if you can skip those through A/C. I had to have them with Taxol due to additional risks with that drug. I even consulted with one of my pharmacy clinical friends and he said must do with Taxol. . High BS may contribute to nausea and other issues so if you can avoid them you may feel better.

You will get through this. It sucks but doable. I am 2yrs out now from bilateral masectomy. Chemo prior to masectomy. Reconstruction and radiation. My body has recovered thank goodness.

Are you using a glucose monitor like a Dexcom? That really helps keeping a close eye on glucose values. Sucks that one can’t take Tylenol tho while using. I used oxy for pain. Neulasta causes bone pain. That was the most challenging for me.

Also. Focus on nutrition. High protein. Your body needs protein to heal. I made sure I had at least 80mg protein each day. Ensure, eggs, chicken, fish, nuts, pb. Whatever you feel like eating. Chemo takes your appetite away but when you eat get lots of protein. Low carbs high protein.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Kellyless Quote  Post ReplyReply Direct Link To This Post Posted: Apr 15 2018 at 9:49am
That is exactly the chemo I did the first time and I was completely cured! My 2nd time was a rare, brand new tumor. An insurance that doesn't cover zofran???? If you are taking A.C. they just have too! Emend is way more expensive, I don't know about Kytril. These drugs aren't "stomach meds" they somehow magically work on the receptors in your brain to keep you from vomiting. It's just manditory! If you want to share your state And insurance carrier we'll crowd search some info for ya real quick :) And you can take zofran in suppositories, may be easier on your system? I'd think all of these come in an alternative method since there's times we can't keep anything down and need them. Especially with your diabetes, vomiting is going really mess up your BS, Zofran is waaaay cheaper than hospital stays, even the crappiest insurance providers know that. Your treating facility should know what's covered by your insurance and what's not, but calling yourself is often a must. Tell them your whole situation, Cancer, Diabetes, AC, hospitalized 1st dose, etc, they truly have to cover this class of drugs for you.
Hang in there! Kelly
IDC, 2.2 cm, Stage IIb,lumpectomy 1/30/09 ACx4,Tx4 36 rads
6/1/17 Local recurrence same breast, same spot 1.8cm Carb.4x every 3 wks, Taxol 12x once wk. Dbl Mast. PCR!! Reconstruction fail, NED!
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