Dr. Farooki notes that especially for patients whose cancer is advanced, controlling glycemic levels to the very strict levels aimed for in patients without cancer does not always need to be prioritized. “For these patients, the primary and immediate focus is on treating the cancer,” he says.
“You don’t want to deprive them of a potentially life-sustaining drug because you are concerned about their blood sugar being marginally high. However, we want to avoid very high blood sugars that can predispose to immediate symptoms such as frequent urination, dehydration, unintentional weight loss, and infection,” he adds. “But the long-term effects of high blood sugar are of lesser concern. With advanced cancer, we’ve got bigger fish to fry.”
Some research raises the possibility that using insulin itself to correct hyperglycemia may curtail cancer growth and progression. “Both diabetes and cancer are considered inflammatory diseases, and involve inflammation at the cellular level,” he says. “It’s possible that preventing hyperglycemia with insulin may have antiinflammatory and antiangiogenic properties.”
Inflammation has long been associated with the development of cancer; blocking angiogenesis, the process by which tumors increase their blood supply in order to grow and spread, is a current focus of many cancer researchers.
On the other hand, since insulin is a growth factor, it has long been debated whether large doses of insulin could stimulate cancer growth.
In addition, some studies have indicated that metformin, an oral drug commonly used to treat diabetes, may provide oncologic benefits. “There’s a lot of interest right now in studying this,” he says.