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The management of diabetes in patients with advanced cancer |
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| Authors: | Jane Poulson CM MSc MDCM FRCPC |
| Affiliation: | aDepartment of Medicine, Division of General Internal Medicine, University of Toronto,Toronto, Ontario Canada bPalliative Care Service, The Toronto Hospital, Toronto, Ontario Canada cPalliative Care Service, Salvation Army TorontoGrace Hospital, Toronto, Ontario Canada |
| Abstract: | The management of diabetes mellitus is often complicated in patients with advanced cancer.Anorexia and nausea or vomiting make caloric intake erratic. The use of diabetogenic medications such as glucocorticoids can produce profound hyperglycemia. Many malignant tumors cause derangement in intermediary metabolism and abnormal glucose tolerance in up to one-third of patients. Both hyperglycemia and hypoglycemia impair the quality of life of dying patients. Swings in blood sugar should be avoided wherever possible, but aggressive blood sugar monitoring also impairs quality of life. This paper discusses issues in the management of diabetes in patients with advanced cancer and suggests guidelines for maintaining glycemic control without excessive interventions. |
| Keywords: | Diabetes mellitus terminal illness hyperglycemia hypoglycemia glucocorticoids insulin dietaryrestrictions cancer |
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