Diabetes Technology Helps Manage Insulin Resistance for Patients Undergoing Cancer Treatment

Innovations in Diabetes & Metabolic Care | Summer 2024

Patients undergoing cancer treatment can find themselves in overwhelming and uncharted territory. Their care journey may involve multiple specialists, surgeries and oncological therapeutics, including chemotherapy, hormonal agents and steroids. While the goal of these complex protocols is to eradicate cancer cells, adverse effects of treatment may need to be addressed.

Natalie Bellini, DNP

One frequent challenge is steroid-induced insulin resistance. "Steroids can be prescribed during chemotherapy because they reduce pain, inflammation and allergic reactions and offer immunosuppressive properties," says Natalie Bellini, DNP, an Endocrine Nurse Practitioner and Program Director of Diabetes Technology at University Hospitals Cleveland Medical Center. “We treat large numbers of patients — with and without a prior history of diabetes mellitus (DM) — who experience rising glucose levels resulting from the high steroid doses they receive during cancer treatment.”

At the University Hospitals Diabetes and Metabolic Care Center, expert endocrinologists, advanced practice providers, diabetes educators, dieticians and pharmacists can provide interdisciplinary care for University Hospitals Seidman Cancer Center patients. They understand that each patient’s journey is unique and offer personalized treatment plans to help safely manage glucose levels based on each individual’s type and stage of cancer, comorbidities and health goals. A crucial component of that care involves best practices utilization of diabetes technology, and can include continuous glucose monitors (CGMs) and automated insulin delivery (AID) systems.

“At University Hospitals, we treat a lot of cancer — and when treating cancer, often with it, we use steroids,” Bellini says. “We utilize diabetes technology to closely monitor and manage rising glucose levels during and in the days following chemotherapy cycles.”

CGM Devices

CGM monitors measure the body’s glucose levels in real time by sensing the glucose in interstitial fluid. “CGMs enable us to reduce glucose fluctuations by adjusting medication through insulin injections or insulin pumps,” Bellini says.

There are several brands on the market, and selection for the system is chosen by features and benefits, as well as insurance coverage, for the patient. 

AID Systems

AID systems are insulin pumps that work or “talk” with a CGM. They deliver insulin in response to real-time glucose levels without the need for manual injections. The devices are used to administer basal (background) and bolus (mealtime) insulin, but still require interaction from the patient, including announcing meals and treating hyperglycemia, with the goal of increasing time in target ranges. 

“AID systems adjust insulin based on the predicted glucose value for the next 30 to 60 minutes, depending on the system the patient is using,” Bellini says. “When people receiving chemotherapy use an AID system, we can set the insulin pump to help combat the predicted high glucose levels on chemotherapy days and the days following because steroids can take time to flush through the body.”

According to the American Diabetes Association, all people with Type 1 DM and many with Type 2 DM should use an AID system. Patient selection of brand is based on insulin requirements and insurance coverage, as well as patient preference. 

Anticipated advancements will bring additional hybridization to the market, allowing CGMs and AIDs from different manufacturers to integrate seamlessly, Bellini says. “Ultimately, our goal as clinicians is for a person to be able to mix and match the brand CGM and brand AID that best suit their preference, insurance and affordability.” 

Bellini and her colleagues also monitor hemoglobin A1C levels and utilize CGMs to determine whether blood sugar spikes are limited to steroid dosing for people without diabetes or are affecting pre-existing DM. For patients who already have DM and begin cancer treatment, steroids can raise glucose exponentially.  

Cloud-based Technology Enables Flexible Scheduling

Patients receiving chemotherapy can experience fatigue, nausea or malaise, making it challenging to travel for medical appointments. They may also have weakened immune systems that require limiting exposure to others. UH Diabetes and Metabolic Care Center specialists can monitor patients’ progress remotely and offer telehealth visits because they pull glucose data electronically through cloud-based apps linked to patients’ CGMs and/or AID systems. They are also available through MyChart messaging and a direct phone line. 

“We like to have patients come in for their first visit, meet our team and link their continuous glucose sensor or insulin pump to our practice,” Bellini says. “If they are too sick or prefer telehealth appointments, we can make exceptions to this protocol. Follow-ups are offered as video visits, and then we can monitor their progress remotely.”

Circle of Health

During cancer treatment, diabetes is often not the central health concern, Bellini notes. However, keeping glucose levels in check is essential to improving safety and well-being. At UH, patients receive individualized metabolic care during their inpatient stays, discharge and beyond.

“Sometimes, we use diabetes technology during the hospice phase of cancer and set the pump to a higher target and reduce risks of hypoglycemia while improving patients’ comfort,” she says. “We want to keep patients’ goals and needs our priority and offer appropriate care for each stage of life.” 

For more information, email Natalie.Bellini@UHhospitals.org.

Contributing Expert:
Natalie Bellini, DNP, FNP-BC, BC-ADM, CDCES
Endocrine Nurse Practitioner and Program Director of Diabetes Technology
University Hospitals Diabetes and Metabolic Care Center
University Hospitals Cleveland Medical Center
Assistant Professor of Medicine
Case Western Reserve University School of Medicine