Reduce Insulin or Gliclazide?

[Jennet]

I’d really appreciate some advice from those of you who’ve been managing your diabetes for longer than me. I was diagnosed with breast cancer in June. When blood tests were done before I started chemotherapy my Blood Glucose was 25. This was news to me - I’d not had any diabetes symptoms although I’m overweight and not very fit.
I’m taking insulin injections twice a day (15 units in the morning and 12 in the evening) and I was taking 320mg of gliclazide a day. However my bg seems to be manageable just on the insulin so my Diabetic Specialist Nurse has said to keep on with the injections and stop the gliclazide.
I’m gaining weight but the nurse isn’t worried about that (joking that she’d be more concerned if I was losing weight because of the cancer) but I’m worried.
I’m trying to follow a low carb diet but chemo makes everything taste horrible so trying to find something I can eat is a challenge. Porridge and soup and cheese, with sourdough bread at the moment. The steroids spike my blood sugar so I have to inject more insulin when I’m taking those (every 3 weeks).
Ive just developed an infected toe and the nail is loose. That seems to be because of the chemo but the practice nurse panicked me with talk of amputation and gangrene.
My question is should I stay on the gliclazide and reduce the insulin- is it the insulin that’s causing me to put on weight? Is gangrene likely when I was only discovered to have high blood sugar four months ago? Is it okay to try to get to the end of chemo and then figure out what to do about the diabetes?
Is it alright to have a pudding sometimes because I feel so miserable on chemo and that cheers me up?
Any thoughts and advice would be so helpful!

 

[EllieM]

Hi @Jennet. I'm so sorry you're having such a difficult time at the moment. Getting diabetes doesn't exactly fill anyone with joy but getting it on top of cancer sounds to me like it's adding insult to injury. Do you actually have a T1 or T2 diagnosis, or have you just been told diabetes?

I'm not convinced that it's the insulin in itself that's causing you to gain weight. I'd argue that it is the high circulating insulin (part injected and part whatever you produce) plus high blood sugars that are doing it. Typically new T2s produce lots of insulin, because you are insulin resistant and the insulin doesn't work as well as it should. And taking gliclazide just pushes your pancreas to make more insulin, so I'm not sure that there is that much difference between the two. (And if you are T1 and not T2 then insulin is the way to go, because your pancreas isn't up to producing much insulin at all.)

Forum rules put me in a spot here, because we're not allowed to advise on medication doses and I think recommending gliclazide over insulin (or vice versa) pushes quite close to the edge. Moreover, I genuinely don't know what is best, though I would tend to do what my nurse says unless I had good reason not to. But I would urge you to try to keep your blood sugars under control, as high levels will both make you feel worse and give your body a harder time. If it were me, I would prioritise blood sugar control over any possible weight gain.

Porridge and soup and cheese, with sourdough bread at the moment.

They are all fairly high carb unfortunately, so I can well believe that you are having to inject for them.

The steroids spike my blood sugar so I have to inject more insulin when I’m taking those (every 3 weeks).

Steroids can actually cause diabetes on their own, so this is not at all surprising.

Is it alright to have a pudding sometimes because I feel so miserable on chemo and that cheers me up?

What kind of insulin are you injecting? Most of the insulin users here actually inject insulin according to what we eat, so we inject more if we have a pudding. You look like you are on fixed doses at the moment, which have less flexibility, but you could ask your nurse if you can adjust them to allow for a pudding.

Maybe some of the other posters can suggest things that you might like that are a bit lower carb. Full fat Greek yoghurt with berries??? 90% or 95% dark chocolate?

Lots of virtual hugs.

 

[Lakeslover]

If you have the energy to make your own soup, or a good friend to make it for you you can make it low carb. I had cauliflower and blue cheese soup this week which was lovely. If you like fish try fish pie with swede mash, or a mix of swede, butternut squash and carrot. Both can be batch cooked and frozen when you feel well enough between chemos. Easy to eat as it just slides down. Pineapple sugar free squash with a meal can help improve the taste of things…not sure why but it does!

I haven’t tried to make this yet but a low carb lemon curd might be good to taste (as long as you don’t have mouth ulcers)

These make a good substitute for bread. They are a cross between a scone and a roll (Americans call them biscuits). I add herbs and grated cheese for extra flavour and spread them with cream cheese.
https://healthyrecipesblogs.com/almond-flour-biscuits/

 

[Ddz]

You can buy packets of low carb bread that you can make in the oven. Any other bread is high carb. Anything you over 10 carbs is too much. You should check out Deboarah Murtagh on Facebook. Shes brilliant telling you what to eat, support group, live webinars, dietician you can ask questions to. It's all low carb. The group have plenty diabetics, some share their experiences with cancer and many diseases. I'm on insulin and have now halved how much I need and my tyrosine.
I hope your journey with diabetes and cancer improves.