Diagnosed on day of cancer surgery

[Nicki70]

I had a bit of a day yesterday!

I have been having chemo for metastatic breast cancer since October 2021. Was due to have my surgery yesterday. On the ward and ready at 7am but my blood pressure has been high since part way through chemo. Despite this no one intervened with medication. This came to a head yesterday morning as blood pressure was so high they could not do surgery. Then they decided to do a bit more of an MOT and did a finger prick test. Blood glucose was 22 and I had ketones.


Surgery has been rescheduled for 31 March but in the meantime I’ve been put on blood pressure meds but from a diabetic perspective I’ve been put on insulin. Have to say Diabetic Nurse was amazing and spent lots of time with me at the hospital yesterday. I was give two lots of insulin at the hospital and monitored and they eventually said I could go home late afternoon. In addition to insulin (at least for the next two weeks) I have also been put on metformin.

I’m on Lantus insulin (8 clicks), metformin 500mg modified slow release. I have chemo induced peripheral neuropathy in each of my fingers. That happened in mid January towards the end of chemo and it is improving but finger pricking is painful so I’ve got a Freestyle Libre for two weeks to help and have to say it’s an amazing bit of technology and very easy to use.


My BG reading at 6.30am before breakfast was 4.4 which is a huge drop down, is this normal to happen overnight. Nurse is ringing me today to see what my numbers are doing after 24 hours on insulin, and up to surgery on 31 March they are keeping in touch with me every other day including weekends which is brilliant.

 

[Antje77]

Hi @Nicki70 , welcome to the forum.

I'm so sorry, that sounds like rather a lot of bad luck to deal with. Sounds like you're taking it in your stride in a remarkable way though!
Glad the surgery has been rescheduled so quickly, I hope everything goes as well as can be.

My BG reading at 6.30am before breakfast was 4.4 which is a huge drop down, is this normal to happen overnight. Nurse is ringing me today to see what my numbers are doing after 24 hours on insulin

Insulin is a relatively short acting medication, Lantus lasts for about a day, so yes, it can work that quickly.
Your 4.4 is on the low side though, not too low but rather close to 4, and you don't want to be below that.
Do you carry some glucose (tabs, sweets, sweetened drinks, whatever has your preference) wherever you go to treat a hypo should you go below 4?
This is very important! Navigating the stairs is not something you want to do when having hypo symptoms!

I expect your nurse will want to have you lower your dose a little so your blood glucose stays a bit higher than the 4's, but it sounds like you're getting excellent care!

Wish you all the best, keep us updated on how you're doing!

 

[Outlier]

I'm sorry you are having such a rubbish time. I really feel for you.

Sometimes Fate calls a rescheduling that brings benefits hidden at the time. You might end up with a better surgeon, or the same surgeon having a better day. I'm pleased your DN was so helpful.

 

[Nicki70]

Hi @Nicki70 , welcome to the forum.

I'm so sorry, that sounds like rather a lot of bad luck to deal with. Sounds like you're taking it in your stride in a remarkable way though!
Glad the surgery has been rescheduled so quickly, I hope everything goes as well as can be.

Insulin is a relatively short acting medication, Lantus lasts for about a day, so yes, it can work that quickly.
Your 4.4 is on the low side though, not too low but rather close to 4, and you don't want to be below that.
Do you carry some glucose (tabs, sweets, sweetened drinks, whatever has your preference) wherever you go to treat a hypo should you go below 4?
This is very important! Navigating the stairs is not something you want to do when having hypo symptoms!

I expect your nurse will want to have you lower your dose a little so your blood glucose stays a bit higher than the 4's, but it sounds like you're getting excellent care!

Wish you all the best, keep us updated on how you're doing!

The diabetes nurse rang me at 8.30 this morning and I gave her my figures. You are right she did reduce my dose of insulin. I have set the overnight alarm to on for the Libra as well. I checked on the graph and it had not gone below 4 overnight. We picked up some glucose tablets from the supermarket on the way home from the hospital yesterday so I had them to hand.

Before chemo flattened me I was really active. I walk the dog for at least 2 x 1 hour walks each day and was a Park Run runner on a Saturday and did at least one or two 5k runs mid week. At points during the last five months chemo has put me in bed for weeks at a time, with no appetite (I have a BMI of 26) so a little in the overweight category but will definitely be working on that once I have recovered from surgery. Ideally I think they would like six weeks between yesterday and surgery but from an oncology point of view they have guidelines to remove tumours no later than 8 weeks after the end of chemo. This is week 6, hence rescheduling for two weeks time and using insulin to get BG down quickly.

 

[Nicki70]

I'm sorry you are having such a rubbish time. I really feel for you.

Sometimes Fate calls a rescheduling that brings benefits hidden at the time. You might end up with a better surgeon, or the same surgeon having a better day. I'm pleased your DN was so helpful.

 

[Nicki70]

I was quite resigned to it yesterday. All you can do is take that if they think it’s unsafe then it’s unsafe. I was looked after very well. Whilst I feel generally much better over the last four weeks recovering from chemo, it’s very difficult to say I had diabetes symptoms because many of them are also symptoms or side effects of chemo. I did not feel “unwell” as such and if you saw my bald head etc you might think that’s an odd statement but considering how bad I was in chemo I now feel well. However the numbers don’t lie both with the BG and blood pressure.

 

[Rokaab]

Then they decided to do a bit more of an MOT and did a finger prick test. Blood glucose was 22 and I had ketones.

Given that they found ketones I would make sure they are going to do the tests to see which type of diabetes you have, I would try and chase them up on that when you can - obviously you're going through a lot of stuff at the moment anyway and on insulin anyway so it's probably not as urgent to find out

 

[Nicki70]

Given that they found ketones I would make sure they are going to do the tests to see which type of diabetes you have, I would try and chase them up on that when you can - obviously you're going through a lot of stuff at the moment anyway and on insulin anyway so it's probably not as urgent to find out

Thank you. Yes I will have follow up appointments after surgery is out of the way. They said yesterday their immediate aim was to get my BG down so surgery can go ahead on 31 March and thereafter they will do more in-depth investigations. I was diagnosed with PCOS 12 years ago so they indicated that may have caused insulin resistance, but in addition I’ve had a lot of steroids, dexamethasone during chemo as part of what keeps you safe and not in hospital with the toxic chemo drugs. There are various red flags there and she said it was a shame that the chemo unit had not thought to finger prick test me at some point given the high dose of steroids that I needed. I’m not going to moan. I’ve got complex medical history(this is a reoccurrence of cancer for me after first being diagnosed with years ago) and I get that sometimes it’s not always obvious what’s going on with symptoms. At least now it’s been picked up, but was just dreadful timing when you’ve got yourself all psyched up to have surgery that day. I feel like at least now it’s been identified then I can do whatever I need to manage it.

 

[Nicki70]

Just an update. I had surgery on 31 March and had all three tumours successfully removed.

I spiked my BG whilst under anaesthetic and was giving nova rapid and then used quite a lot of insulin on a sliding scale for several days post surgery. It kept me in hospital for four days. My insulin was changed and I am now on Humulin M3. Found that adjusting to that twice a day and before food was something to get my head around but four weeks on and I feel that it is all not so daunting. My BG have been good and I average anywhere between 5.8-6.2 with fasting BG at 6.5-7.0. I have been slowly reducing the teatime dose of Humulin and also the morning dose but not so much of a reduction on this as the teatime dose.

The aim was (or for me is) to get off insulin eventually. I’ve changed diet, no longer on any steroids for cancer treatment which has helped hugely. I am getting back to being more active but not allowed to start running for another 4 weeks whilst healing from surgery. However, I have been warned that some of the cancer drugs, one in particular, that they want to keep me on for up to 10 years is known to push glucose levels up and DN was very much of the opinion that I would never come off insulin because of that. This made me feel quite down for a week or so, but stayed fixed on good diet, and picking up more activity each day and feel determined to give it my best go at getting off insulin or at the best getting it reduced to very low levels. I was confirmed as type 2 and have PCOS.

I am reading lots on the forum and finding it great for information.

 

[VashtiB]

Hi @Nicki70

I am glad to hear you are doing so well. Your positive attitude is both wonderful and inspiring. You have done so well.

I am also glad that you are finding this forum helpful. I am also so grateful to have found a place full of such amazing people and the level of knowledge of some is amazing!

Good luck and let us know how you are going!