Diabetes – Chemotherapy Steroid Induced Diabetes

In late April 2014 I was undergoing a Chemotherapy called ABVD for Stage 4 Hodgkin’s lymphoma my oncologist called an early PET Scan to see how well the therapy was doing (if you look through my pages you will find ABVD and PET scans fully explained).

The night before the scan, when I should have been fasting I ate two bars of chocolate and drank about 2ltrs of fizzy orange or more. I could hardly sleep and I was very thirsty. So I arrived at the radiology unit at 9.30am still parched. For PET scans they do a blood sugar/glucose test. This is basically a tiny needle into the top of a finger to draw blood which is dabbed onto a strip. The reading comes up on the screen in seconds. Last time I had one of these was prior to my first PET scan in March 2014, that read was 5.6 – very average. So the nurse preforms the procedure and looks at the screen 33.5 – she looked me and said “this unit must be faulty I’m going to get another” she arrives back with a slightly bigger unit and a radiologist. They redo the test 33.5 again. Like most people who have never experienced diabetes I had no idea what this meant, I knew however that it sounded high. The radiologist left the room to make a few calls. This radiology unit is not in the same location or the same hospital that takes care of my chemotherapy. The radiologist returns a few minutes later and tells me they can’t do the PET as the likelihood that my body would go into shock during the scan and cause a coma was high. He asked if I had a lift home and I said yes. I could see him considering options but he told me to go home and expect an urgent call from the oncology unit. So off I went home. And as we do I went onto the internet and consulted Dr Google. To be honest here I was getting more and more confused. There were so many different types, stages, ages, causes and explanations it was impossible to really understand. I was home about an hour

Then the mobile rang – it was the oncologist

“Get in here right now” okay this felt bad

Casually walked into the ward and was placed in bed, blood sugar/glucose test immediately 33.3 I looked at the nurse and said “it’s dropped” “What do you mean?” I told her it was 33.5. She then asked had I any idea how high it was and I said Nope. It was actually the highest she had ever seen. Enters the oncologist who proceeded to explain that I had Chemotherapy Steroid induced diabetes…. it appeared that the level of steroids used in ABVD therapy had a negative effect on me. I was classed as Type 1 insulin dependent diabetic. Now we have to add to that as the cause is more medical than physical so the diagnoses is actually Chemotherapy Steroid Induced Type 1 insulin dependent diabetic

Generally I do go into a level of medical terminology but in this case I will keep it very simple. I have never had an issue with blood sugar, like most people in their 50’s I was a little overweight but nothing serious, for my height and age iI was about 5kgs over. Prior to the commencement of Chemo I had put on weight intentionally but started to loose some of this during treatment. But this had in no way influenced the current situation. So I was admitted to hospital and getting insulin injections to regulate my sugar levels, I have added some explanations about Blood Sugar/Glucose, Insulin and Chemotherapy Steroids at the end of the article.    

And an addition to my medical team now included an Endocrinologist A diabetes specialist is called an endocrinologist. Endocrinologists specialize in the glands of the endocrine (hormone) system. … The pancreas produces insulin, and problems with insulin are what managing your diabetes is about.

The first day was really about regulating my insulin levels. And they achieved this quiet fast. But I had a dietician in to see me an occupational therapist and of course my oncologist. The oncologist felt that they needed to continue with the same level of steroids and the endocrinologist made the necessary adjustments to the dosage. At this point they went from injections to an insulin pen. Insulin pen’s are easy to use and just take getting used to them. By the following morning I was self injecting. By mid day the team were happy that I was able to do this myself and let me go home. I had a book that I needed to fill in daily and appointments to see the endocrinologist every week for the next 3 months.

My Diet did not change that much but I removed sugar from my Tea and replaced it with Canderel. Towards the end of this page I will be discussing diets a little and you may find it controversial but all I will be doing is explaining my Diet.

Leaping on a little here to August 2014 when I finished Chemotherapy. We had the blood sugar levels well under control but the finishing of the chemotherapy meant the end of steroids. Following each ABVD day I would take from 10mgs a day reducing to 1mg a day over two weeks. Therefore I would be completely off steroids by September. The endocrinologist started to monitor my bloods twice a week in September but unfortunately nothing changed. I was still classed as Type 1 Insulin dependent. The hope was that the pancreas would kick back in and it didn’t. The endocrinologist felt that the damaged caused was not reversible as he had expected some improvement following the end of Chemo.

During radiotherapy in Nov/Dec 2014 the levels started to rise again. I had to go on special diabetic food supplements as the normal one’s are very high in sugar. Managing over Christmas 2014 had its share of difficulties but I survived.

By Feb 2015 things started changing. It appeared that I had started to produce insulin but in tiny quantities. So the team decide to switch me to a drug called Metformin Metformin (Metformin hydrochloride) is a type of medicine known as a biguanide. This works to lower the amount of sugar in the blood of people with diabetes. It does this by lowering the amount of sugar produced in the liver, and also increasing the sensitivity of muscle cells to insulin. I was initially on 2000mgs per day but I was stopped taking the insulin pen. At this point they change me from Chemotherapy Steroid Induced Type 1 insulin dependent diabetic to the lesser dependency as Type 2 Diabetic (Type 2 diabetes occurs when not enough insulin is produced by the body for it to function properly, or when the body’s cells do not react to insulin. This is called insulin resistance. Type 2 diabetes is far more common than type 1 diabetes, which occurs when the body does not produce any insulin at all) Yes I was still on metformin but to see this dropping was great. By July 2015 I had the metformin reduced again to 1000mgs – one table in the morning anf one in the afternoon.

I went for a full blood screen in Oct 2015 – one of the test included an A1C The A1C test is a blood test that provides information about your average levels of blood glucose, also called blood sugar, over the past 3 months. The A1C test can be used to diagnose type 2 diabetes and prediabetes. The A1C test is also the primary test used for diabetes management.

 

Over the following years I kept a close eye on my sugar levels, when I was re diagnosed with Stage 4 NHL in 2017 the medical team kept a very close eye on me. The levels of steroids used in ICE are not as high as ABVD so even though the blood sugar levels went up they did not go beyond 9.5 so no need for intervention. During BEAM and the stem cell transplant they did jump up to between 15 and 18 but the team again did not consider intervention mostly likely because there were more serious issues to deal with.

So as I write this it is actually Dec 2019. Even now I do a self test at least once a week. I can average between 4.8 and 8. Generally speaking I know myself when its going to be too high or low. I am sure anyone suffering from diabetics would agree with me on this, you get used to the signs that most people would ignore. Our bodies are incredible and sometimes we need to stop and listen to ourselves.

Where this page started was about a member of my team in work and her reaction to what a doctor had told her. At lunch hour I had entered our operations office and was chatting to one of my team about an upcoming proceedure she was due to have, this lady had no real idea about my medical history apart from the fact that I was a cancer survivor. As I am trained in psychology I could see that she was very concerned about something. She then told me that her doctor had preformed a blood sugar test the previous week and that she had been told the reading was placing her in an “orange” zone and that she was borderline diabetic. I asked her if the doctor had told her what the read was and she said no, I then asked how the doctor was following this up “the doctor will address it in the New Year”. However it turns out that this lady had cut out sugar immediately, not some but as much as she possibly could. Her body obviously reacted to this and she then had a massive craving for fizzy drinks. Unfortunately I did not have my testing kit with me as I had accidentally left it at home. I explained to her that if this was dangerous the doctor would have sent her straight to hospital, I suggest that she re introduced a lower level of sugar to her died immediately and that we would do a test the next day.

Sometimes people listen and sometimes they don’t. She listened and agreed with my thoughts. By lunch time the next day she looked better. I explained in greater detail about my own experience and she asked me to do the test. 6.5 – nothing to alarm anyone. I will do the chart that I done for her shortly. She explained that she had a normal meal the night before and a light breakfast. We done the same test the next day and got the same read. by the third day we decided against doing any test as she seemed great and felt a lot better.

I am very much aware that some medical people will view anything over 6.5mmol/l as been iffy, In reality anything up to 7.5 is fine, there are so many things that come into play here, like how much water is the person drinking, how long since their last meal etc etc. If they are concerned then the doctor needs to refer the person to a specialist not scare the crap out of them. At least tell the person the reading so they can compare in the future.

Normal values

Many factors affect a person’s blood sugar level. … The global mean fasting plasma blood glucose level in humans is about 5.5 mmol/L (100 mg/dL); however, this level fluctuates throughout the day. Blood sugar levels for those without diabetes and who are not fasting should be below 6.9 mmol/L (125 mg/dL)

 They are the European values

And this is the testing kit

First photo shows the complete kit

You set up a strip into the unit and it begins flashing

Using the pen, the pen has a cartridge that holds 6 needles these are rotated from the side of the pen and are disposable. The depth of the needle is gaged as well, I use 3 to 4. Just like a pen the top has a presser this is used to trigger the needle which automatically retracts.

You clean the tip of any finger hold the pen and press onto your finger. Press the trigger and pull the pen back – a drop of blood is all you need.

Pick up the unit, place the bottom of the strip on the finger and scoop up the blood. Within seconds the value will appear

Please keep in mind this is my experience and my way of taking a test. They are also the way I view values. The images shown are from today as you can see from the screen

Diet

This is a big subject and the causes of many disagreements over the years. I will be quiet direct in what I am about to say and this is really “My Diet” it’s not advice or any form of guideline. Please keep in mind I was born and raised in Ireland.

We have heard for years about healthy eating and reducing red meat in our diets. We also heard the many benefits of eating more fish, which they have recently advised against. Then the are the organic products (most of them overpriced and tasteless) and on and on it goes…

I was born in Dublin in 1962. My parents both worked, they had to as there wasn’t much social welfare back then. We were raised on milk, eggs, potato’s and meat. Everything was cooked in or on an oven. All food was fresh, meat was bought in a butchers, vegetables were delivered by a man in a van, milk was delivered to the front door by the milkman and there was a local shop that sold bread etc. There were no supermarkets, tiny freezers. It didn’t matter if you were poor or rich back then. This is how we lived.

Milk would be in a bottle, reusable and not plastic. The top of the milk was about an inch of pure cream, you had to shake the bottle to mix it. If you wanted 4 pints of milk, you left out 4 empty bottles. The milk would go off within two days. Hard to picture this. Sometimes I look at the water down over processed milk we use now in a 2 ltr plastic holder with a date on it the would last more than a week. I actually can’t remember the last time I drank a glass of milk.

Meat. We had two ways of getting meat. First was from the local butcher ( My life long friend Dave Courtney dad worked in the local butchers) butchers back when I was growing up were more for red meat, pork and bacon. Then we would have a man, his name was Dan who would call to the house every week. Dan would have things like eggs, rashers and sausages. Our meat was not injected with whatever they do now and was wrapped in paper not plastic

Vegetables – We had a back garden and most of it at one time was used to grow spuds carrots and cabbage. But there was also a green grocer who would arrive on the road ever couple of days. People went over and bought what they needed.Nothing was sprayed with a shit load of chemicals or grown faster than nature allowed. The main spray back then was to prevent greenfly

Local shop. Not much different from the local shops that still survive today. But they tended to carry essentials like vegetables, potatoes milk and eggs.

It was about 1970 when the first supermarkets began to appear and they didn’t really start to take off till the early 1980’s. It would be impossible to properly explain this to people born in the 90’s or after 2000.

My Mum worked in one of the local shops. She made her way to work on a bike. My Dad was gone from early morning till late evenings and spent his weekends tending the vegetables in the garden. He had a car which out of about 200 houses on the road there were properly 30 with cars, they were the people who needed them for work as against a luxury. The same road in 2018 when my Mum passed away and we sold the home every single house had at least 2 cars.

But we were healthy. We walked to school and as we got older we had bikes. TV was black and white for years with four channels that you had to get off your arse and press to change. Nice days were spent on the road playing games with other children.

The local shop owner had a name that we all knew. The delivery guys would give you credit if you didn’t have enough money. And money was real not plastic credit cards

Water. Came from a tap or a spring. It did not come in a plastic bottle

Readers born before 1970 will really appreciate the above and like myself they will be smiling.

So our modern world of today, we have a massive plastic problem, we have pollution, we have year round vegetables that are over sprayed. We go to supermarkets with plastic bags, to but processed food in plastic containers, we buy long life milk in plastic containers, we buy frozen food, fast food and of course takeaways. The list is endless.

This is how we were raised and I do miss so much of this. I still use a butchers when I can, but modern lifestyle and the unbalanced work/life style demands processed food during the week- over the past few years I have reverted back to cooking during the week. Anita however has a habit of eating fast food i.e. microwave meals that take 4 minutes to cook!!!!!

So what does this have to do with diabetes? Really everything. Diabetes pre 1970’s was rare. Sugar was not a part of everything we eat. But we are now told how to eat. It is seen that people who live in a warm climate eat healthier- and those who live in cold countries like Ireland and England are encouraged to eat like those living in warm climates…it doesn’t work. I lived in the Canary Islands for over 4 years. It took me months to adjust both to the climate and food. The climate in the Canaries is warm 10 months of the year, climate in Ireland is damp 10 months of the year. Our bodies need hot food like it or lump it.

My own appetite during the first chemotherapy was not effected however post stem cell I have had serious appetite issue. It’s getting better but slowly.

I changed my eating habits in 2015 when I was diagnosed with diabetes. But against going with nearly all veg and salads I reverted back to the way I was raised. More home cooked meals, less fizzy drinks, I cut out sugar in my tea. I started walking more and I honestly feel this helped. I had started to make home made soups and home made brown bread. It’s now taken me over two years to get my eating habits back properly and I reckon it could take another year to resolve.

But one thing I really do agree with is the idea of eating more regularly like a good breakfast, a good lunch and a smaller dinner. I agree with it but personally I am still a creature of habit and my work lifestyle pushes me towards one meal a day. It is something I intend to address in the very near future. But right now I’m about to cook a couple of T-Bone stake. And since I’m properly pissing a lot of people off so far I’mgoing to pick the healthy option and have a pint of Guinness with it

Since I’m on a rant I might as well finish this off with a topic that does not relate to Diabetes

Technology

I was born in a generation that did not have smartphones or internet. I grew up without social media. A friend was someone you actually spoke to. If you wanted to talk to someone you either called them on a landline or knock on their door, there were no texting or emails.. I did have a mobile in the late 80’s but even when I lived in Spain up to 2004 they was little if any emails, social media etc. I’m not going to criticise modern technology too much as we rely so heavily on it, without the internet this site would not be happening and the level of awareness would only be within my own circle, but I am glad that my youth did not involve any modern technology, if it did I’m sure I’d be arrested by now. I do wonder if emissions from all this technology could be devastating to our general health

Taken a while to actually finish this article, I had started writing this in 2017 and scrapped it more than once. Basically because it such a broad topic. However I decided to go ahead following a resent medical problem with a member of my team in work, I will go into details about this later but for now I’d like to explain in greater detail my own experience with Diabetes. I update the article over the years but I reset this to fall in line with the diagnosis in 2014