Diabetes Management Guide

This information explains why it’s important to control your blood glucose (blood sugar) during cancer treatment at MSK. It also has information about the basic skills you’ll need to manage your blood glucose at home. Controlling your blood glucose will help you feel better and help prevent problems during treatment.

About hyperglycemia during cancer treatment

You’re getting this booklet because you have hyperglycemia (high blood sugar) and are getting cancer treatment. Hyperglycemia (HY-per-gly-SEE-mee-uh) means you have more glucose (sugar) than normal in your blood.

You may have diabetes, or short-term hyperglycemia. Short-term hyperglycemia may be related to your treatment plan and is common. About 3 out of every 10 of people with cancer will have hyperglycemia during treatment.

Hyperglycemia during cancer treatment can raise your risk of:

• Infection
• Poor healing after surgery
• Fatigue (feeling more tired than usual)
• Neuropathy (tingling or losing feeling in your fingers and toes)
• Pain
• Long-term problems related to diabetes

During cancer treatment, it’s important to manage chronic health conditions such as diabetes, high blood pressure, and high cholesterol. These can cause long-term health problems even after you finish treatment.

For some treatments, your blood sugar must be within a target range. A target range is when your glucose is not too high or too low.

We may need to stop your treatment if your blood glucose goes very high and stays high. This depends on the type of treatment you’re getting. Your healthcare provider will give you more information.

Diet and physical activity are the best ways to manage blood glucose levels. You may also need medicine. Your diabetes healthcare provider will work with you on a plan to manage your blood sugar at home.

During treatment, it’s common to have less energy and a poor appetite (not feeling hungry). This can make it harder to manage your blood glucose levels with diet and activity. We’re here to support and help you.

What are diabetes survival skills?

There’s a lot of information to learn about diabetes. This resource provides basic information, also called diabetes survival skills, to start safely managing your blood glucose at home.

Your outpatient diabetes healthcare provider will follow-up and teach you more about these skills after discharge (leaving the hospital).

This resource has information about:

• Blood glucose monitoring
• Hyperglycemia
• Hypoglycemia
• Understanding your diabetes medicine
  • Insulin
  • Oral medicine
  • Non-insulin injectable medicine
• Nutrition
• Follow-up care

Common questions about diabetes

I have a lot going on with my cancer treatment and feel like I cannot handle it all. Is it OK to wait to start diabetes treatment?

It’s important to start diabetes treatment as soon as your diabetes healthcare provider prescribes it. Controlling your blood glucose can help you feel better and make it easier to get through treatment. It helps lower the risk of infection and other health problems caused by hyperglycemia, such as dehydration.

How can I prevent other health issues caused by diabetes?

There is no cure for diabetes. Keeping your body at a healthy weight can help it use insulin more easily. It also helps your body manage your blood glucose levels.

Controlling your blood glucose levels is the best way to prevent other health issues caused by diabetes. You can do this by taking your diabetes medicine as prescribed.

Knowing your blood glucose level is the first step to preventing hyperglycemia. Check your blood glucose regularly. Read About Hyperglycemia (High Blood Sugar) to learn more.

Keep a healthy lifestyle through diet and exercise. To learn more about eating a healthy diet, call 212-639-7312 to talk with a clinical dietitian-nutritionist.

Common terms about diabetes care

Blood glucose (BG) levels: Also called blood sugar (BS) or glucose levels. This is measured by fingerstick.

Blood glucose (BG) log: Used to track blood glucose over time.

Blood glucose meter (BGM): Also called BG meter, glucometer, or glucose machine. This is used to do a fingerstick blood glucose check.

Carbohydrates: Your body’s main source of glucose. These are also called carbs.

Continuous glucose monitor (CGM): A small device you place on your arm or stomach that reads your glucose levels every few minutes.

Endocrinologist (EN-doh-krih-NAH-loh-jist): A doctor with special training in endocrine problems, such as diabetes.

Glucose: The body’s main source of energy. Your body stores extra glucose in your muscles and liver for energy. It also stores extra glucose as fat.

Hemoglobin (HEE-moh-GLOH-bin) A1c (HbA1c): The measure of your average blood sugar level over the past 3 months.

Hour of sleep (HS): At bedtime, usually a set time of night before you go to bed.

Insulin: A hormone that moves glucose from the blood to the body’s cells. Insulin is also a medicine you can inject if your body does not make enough insulin on its own.

Insulin sliding scale: A scale healthcare providers use to decide how much insulin you need to take. This scale often is part of a blood glucose log.

Macronutrients: Major food groups, such as carbohydrates, protein, and fat.

NPO: Nothing by mouth. Instructions for when to stop eating and drinking.

Polydipsia (pah-lee-DIP-see-uh): Extreme thirst.

Polyuria (pah-lee-YOOR-ee-uh): Urinating (peeing) often.

Post-prandial: After a meal.

Pre-prandial: Before a meal.

Target range: When your blood glucose is not too high or too low.

Titration (tih-TRAY-shun): Adjusting your medicine over time by tapering (lowering) or escalating (raising) the dosage.

This information describes how to check your blood sugar level using a blood glucose meter. Blood sugar is also called blood glucose.

The steps in this resource are specific to the Contour^® Next One blood glucose meter and Microlet^® Next lancing device. If you’re using a different type of blood glucose meter or lancing device, follow the instructions that came with it. All blood glucose meters and lancing devices are slightly different.

About the Microlet Next lancing device

Your lancing device holds the lancet (needle) you’ll use to prick your finger. It has 6 main parts (see Figure 1).

Your Microlet Next lancing device works with Microlet lancets. Microlet Next lancets come in different colors, but there’s no difference between them.

About your Contour Next One blood glucose meter

A blood glucose meter measures the amount of sugar in your blood. It has 3 main parts (see Figure 2).

‌ You need to set up your meter before using it for the first time. You do this by accepting the blood glucose target range of 70-180 mg/dL and setting the time and date. Your meter will not work until you set it up.

Watch Contour® Next One Video: Doing Your First Test for instructions on how to set up your meter.

Do not put your glucose meter under water. If you notice it’s dirty, wipe it with a damp cloth or alcohol pad.

The Contour Diabetes app

The Contour Diabetes app works with your Contour Next One blood glucose meter. It lets you make notes, set reminders, see your results in a graph, and share your reports. If you want to use the app, you can download it from the Apple App Store^® or Google Play^™ store.

You do not need to download the Contour Diabetes app if you do not want to. The Contour Next One blood glucose meter works without the app.

The Contour Next One user guide

For more information about the Contour Next One blood glucose meter and Contour Diabetes app, read the Contour Next One user guide. You can read the copy that came with your meter or find it at www.contournextone.com/getting-started.

Instructions for checking your blood sugar

Your healthcare provider will tell you how often to check your blood sugar. They’ll also tell you what your blood sugar level should be. This is called your blood sugar target range. Your blood sugar target range is based on your overall health and current treatment plan.

When you’re ready to start, wash your hands with soap and water. Dry them very well. Touching a blood glucose test strip with damp hands can damage it or make your result less accurate.

Gather your supplies

Set up your supplies on a clean surface. It’s helpful to arrange them in the order you’ll use them (see Figure 3). 

You’ll need:

• Your lancing device.
• A new lancet.
• Your blood glucose meter.
• Your blood glucose test strips.
• An alcohol pad (if you do not have access to a sink to wash your hands).
• A dry tissue or gauze pad (if you do not have access to a sink to wash your hands).
• Your blood glucose log.
• A trash can.
• A solid container to throw away the used lancet, such as a heavy plastic laundry detergent bottle with a lid.
  • Read How to Store and Get Rid of Your Home Medical Sharps for more information about choosing a container.

When you take a blood glucose test strip out of the container, set it on top of your meter. This helps keep it clean and dry and makes it easier to pick up. Make sure to close the glucose test strip container tightly. Humidity from the air can damage the strips.

Your lancing device is now ready. Set it down. Pick up your blood glucose meter and test strip.

Get your blood glucose meter ready

Your meter should beep and turn on after you put the test strip in the port. If it does not:

• Make sure you pushed the test strip all the way into the port.
• Make sure the end of the test strip with the grey square is in the port.
• Make sure the printed side of the test strip is facing you.

Your blood glucose meter is now ready. It will stay on for 3 minutes after you put in the test strip. If you do not apply a drop of blood to the tip of the test strip in that time, it will beep and turn off. If this happens, pull the test strip out and put it back into the port.

Do not apply blood to the test strip before you put it into the meter or when the meter is off. If you do, that strip will be ruined. You’ll have to start over with a new one.

Prick your finger

a. Pull the white reset handle on your lancing device until you hear it click into place (see Figure 13).

b. Turn the endcap dial to increase the puncture depth by 1 level.

c. Make sure you have the lancing device pressed firmly against the side of your finger.

e. Look for a blood drop. You may need to massage your finger gently. If the blood drop is bigger than you needed, lower the puncture depth by 1 next time you use your lancing device. This means the lancet will not prick your finger as deeply.

Touch the blood glucose test strip to the blood drop

Write down your blood sugar level

Write your blood sugar level in your blood sugar log. Your result will stay on the screen until you take out the test strip or for 3 minutes.

Make sure your blood glucose meter is right-side up when you read it. To quickly check, make sure you can read the time and date.

Keeping track of your results

• Your healthcare provider will tell you how to keep track of your blood sugar levels and medication doses. Follow their instructions.
• Bring your blood sugar log to all your appointments. This information will help your healthcare provider decide if they should change your current treatment plan. If you have questions about checking your blood sugar, ask your healthcare provider.

Where to buy supplies

Talk with your diabetes healthcare provider to get a refill prescription for blood glucose test strips and lancets. You must get refills from your local pharmacy. MSK’s outpatient pharmacy does not carry these supplies.

If your blood glucose meter is battery-powered, make sure to always have extra batteries. The Contour Next One blood glucose meter uses 2 CR-2032 batteries. You can buy these batteries online or at your local electronics store, hardware store, or supermarket.

This information describes hyperglycemia (HY-per-gly-SEE-mee-uh), what causes it, and how to recognize, prevent and treat it. It also talks about different types of diabetes.

What is hyperglycemia?

Hyperglycemia is when too much glucose (sugar) builds up in your bloodstream. This can cause you to feel tired and run down or get sick.

There are 2 types of hyperglycemia:

• Acute hyperglycemia happens when a person’s blood glucose spikes suddenly over a period of days or weeks.
• Chronic hyperglycemia happens when a person’s blood glucose rises slowly over a long period of time.

Causes of hyperglycemia

Hyperglycemia can happen if your body doesn’t make enough insulin or can’t easily use the insulin it makes. Insulin is a hormone that lets glucose go from your bloodstream into your cells. If your body does not have enough insulin, glucose stays in your bloodstream and causes hyperglycemia.

Treatment-related hyperglycemia

Some cancer treatments can raise your blood glucose and cause hyperglycemia, including chemotherapy and steroid treatment. Getting nutrition from tube feedings or total parenteral nutrition (TPN) can also cause hyperglycemia.

You may need to keep your blood glucose within a certain range during certain treatments. Your diabetes healthcare provider may prescribe insulin or oral (by mouth) diabetes medicine to improve your glucose levels. They will also explain how to check your blood sugar and how often.

Treatment-related hyperglycemia usually goes away after treatment ends. If it doesn’t, you may have had blood glucose issues before treatment. Keep checking your blood glucose and taking your medicine until your diabetes healthcare provider tells you to stop.

Risk factors for hyperglycemia

Hyperglycemia is more likely to happen if you:

• Have type 1 or type 2 diabetes mellitus (DM) or pre-DM.
• Are not getting enough diabetes medicine to control your blood glucose levels.
• Are not injecting insulin correctly.
• Are using expired insulin or insulin that has gone bad. This can happen if insulin gets too hot or too cold.
• Have not been active enough.
• Eat too many carbohydrates. Read How To Improve Your Blood Sugar With Your Diet to learn more.
• Are getting nutrition from tube feedings or TPN.
• Are sick or have an infection.
• Have physical stress, such as an injury or surgery.
• Have emotional stress, such as from treatment or problems in your personal life.
• Have had all or part of your pancreas removed.
• Are taking certain medications. Examples include:
  • Steroids, such as prednisone or dexamethasone (Decadron®).
  • Immunosuppressants, such as tacrolimus and sirolimus.
  • Certain types of chemotherapy, targeted therapy, immunotherapy, or hormone therapy. Talk with your healthcare provider to learn more.

Signs and symptoms of hyperglycemia

Your body’s cells need glucose for energy to work as they’re supposed to. For example, if the cells in your muscles don’t have energy, you may feel tired and run down. If your white blood cells don’t have energy, your body can struggle to fight off infection.

The signs and symptoms of high blood sugar can vary from mild to severe (very bad). They may happen acutely (suddenly) if there is a specific trigger. These include developing type-1 diabetes mellitus (T1DM) or steroid-induced hyperglycemia (high blood sugar caused by steroids).

For people with type-2 diabetes mellitus (T2DM), symptoms usually start out mildly and develop slowly over a long time. Mild signs and symptoms can be hard to recognize and may not feel the same to everyone. Because of this, it can take many years to notice or diagnose T2DM.

Acute hyperglycemia happens suddenly. Signs and symptoms of acute hyperglycemia include:

• Feeling very thirsty.
• Having a dry mouth.
• Feeling like you need to urinate (pee) often.
• Having dry skin.
• Feeling more hungry than usual.
• Having blurry vision.
• Feeling drowsy.

Severe hyperglycemia

Acute hyperglycemia can get worse if it is not treated. This can lead to a diabetes emergency, such as diabetic ketoacidosis (DKA).

DKA can be life-threatening. If you have DKA or think you have DKA, seek medical attention right away. Call your diabetes healthcare provider, go to your local emergency room, or call 911. Read Diabetic Ketoacidosis (DKA) and Ketone Urine Testing to learn more.

Signs and symptoms of DKA include:

• Feeling confused.
• Feeling shortness of breath.
• Having a dry mouth.
• Feeling weak.
• Having abdominal (belly) pain.
• Feeling nauseous (like you’re going to throw up) or vomiting (throwing up).
• Falling into a coma.

Chronic (long-term) hyperglycemia

Chronic hyperglycemia develops over a long time. Signs and symptoms of chronic hyperglycemia include:

• Having wounds that heal more slowly than usual.
• Getting worse infections or infections more often than usual.
• Having little to no energy.
• Neuropathy (tingling or losing feeling in your fingers and toes).
• Skin changes, such as acanthosis nigricans (AK-un-THOH-sis NI-gruh-KANZ). These are dark, thick areas of soft skin. They usually form on the back of the neck, armpits, or groin area.
• Gum disease. Signs of this include red, sore, irritated gums.
• Any or all of the signs and symptoms of acute hyperglycemia.

How to prevent hyperglycemia

Check your blood glucose

Knowing your blood glucose level is the first step to preventing hyperglycemia. Checking your blood glucose tells you if your glucose levels within your target range. The target range is when your glucose is not too high or too low.

Your diabetes healthcare provider or educator will:

• Tell you how often to check your blood glucose.
• Set your target range based on your health and treatment plan.
• Use your blood glucose readings to adjust your medications as needed.

What is a safe blood glucose range?

MSK’s target blood glucose range for people getting cancer care is usually 100 to 200 milligrams per deciliter (mg/dL). Your diabetes healthcare provider may have different recommendations for you.

How to check your blood glucose at home

You can check your blood glucose level at home using one of these devices:

• A blood glucose meter (or glucometer). You can buy a blood glucose meter at your local pharmacy with or without a prescription. Read How to Check Your Blood Sugar Using a Blood Glucose Meter to learn more.
• A continuous glucose monitor (CGM). Read About Your Continuous Glucose Monitor (CGM) to learn more.

Keep track of your blood glucose results and medicine

Keep track of your blood glucose results and doses of insulin on a blood glucose log. This will help your diabetes healthcare provider safely adjust your medications.

Practice a healthy and active lifestyle

The best way to prevent hyperglycemia and manage your blood glucose is to practice a healthy and active lifestyle. Use your blood glucose readings to guide lifestyle choices to reach your target range. Talk with your diabetes healthcare team about how to do this safely.

Here are some tips for managing your blood glucose levels at home:

Follow a healthy diet

Follow a healthy diet and stay on your meal plan. We recommend following a consistent carbohydrate meal plan, which means having a certain amount of carbohydrates for each meal. Read How To Improve Your Blood Sugar With Your Diet to learn more.

Stay well-hydrated

Drink enough liquids to stay hydrated. Follow your healthcare provider’s instructions for how much liquid to drink.

Drink sugar-free liquids

Drink sugar-free, flavored water, sparkling water (seltzer) or other zero-calorie drinks. Avoid regular soda and fruit juice made with real fruit. These usually have a lot of sugar and can raise your blood glucose.

Get enough physical activity

Physical activity can help keep your blood glucose at a healthy level. Follow your healthcare provider’s instructions on how much activity is safe for you.

Take your diabetes medicine as prescribed

Follow your diabetes healthcare provider’s instructions for taking your diabetes medicine. They will help you plan for what to do if you miss a dose of your medicine.

When to call your diabetes healthcare provider

MSK recommends talking with your diabetes healthcare provider within 10 days after leaving the hospital. Call them if:

• You have new hyperglycemia.
• You were just diagnosed with diabetes.
• Your diabetes medicines have changed.
• Your blood glucose has been above your target range most of the time over the past 2 to 3 days.

• Your blood glucose is lower than 70 mg/dL or higher than 400 mg/dL. These can be dangerous.
• You’re vomiting, or you have diarrhea more than 3 times in 24 hours (1 day).
• You have DKA or think you have DKA.
• You do not feel well and are unsure if you should take your diabetes medications.
• You have a fever of 101° F (38.3° C) or higher.

Go to your local emergency room or call 911 if you cannot contact your healthcare provider right away.

This information explains what hypoglycemia (HY-poh-gly-SEE-mee-uh) is and what signs to look for. It explains how to treat it and how to prevent it from happening.

What is hypoglycemia?

Hypoglycemia is when your blood glucose (blood sugar) level goes too low. This usually happens when your blood glucose goes below 70 milligrams per deciliter (mg/dL).

Your body uses glucose as its main source of energy. If there isn’t enough glucose in your bloodstream, you may have trouble thinking clearly and doing your usual tasks safely. This can happen if you have not eaten enough or are more active than usual.

It is important to treat hypoglycemia right away. If you take medication for diabetes, your healthcare provider may need to change the dosage. Contact the provider who prescribes your diabetes medication any time you have hypoglycemia.

Signs of hypoglycemia and what to look for

Some people show different warning signs when their blood glucose is low. Others may show no signs at all.

Check for hypoglycemia by measuring your blood glucose at home. Read How to Check Your Blood Sugar Using a Blood Glucose Meter for more information. You can also watch How To Check Your Blood Sugar Using a Blood Glucose Meter.

How to treat hypoglycemia

If your blood sugar is below 70 mg/dL and you’re awake and alert, follow the rule of 15/15.

Rule of 15/15

Choose one of these rapid-acting sugars in these amounts:

• Chew 4 large glucose tabs. You can buy these at your local pharmacy without a prescription.
• Drink 4 ounces of fruit juice or soda (not diet soda).
• Chew 5 to 6 gummy candies or hard candies, such as LifeSavers®.
• Have 1 tablespoon of honey or syrup (not sugar-free syrup).

Do not eat chocolate, cookies, or a regular meal or snack to treat low blood glucose. Your body does not absorb these items very quickly. These foods may make your blood glucose even lower at first, then too high 1 to 2 hours later.

Once your blood sugar is 70 mg/dL or higher, have your next meal or small snack within 1 hour. For example, a small snack may include one of the following:

• Peanut butter or cheese with 4 to 5 crackers.
• Half of a sandwich and 4 ounces of milk.
• A single-serve container of Greek yogurt.

What is severe hypoglycemia?

Hypoglycemia can get worse if you do not treat it quickly. Severe hypoglycemia happens when your blood glucose level goes below 54 mg/dL, or when you cannot take care of yourself.

Symptoms of severe hypoglycemia can include:

• Feeling very confused.
• Having trouble following directions or doing simple, routine tasks.
• Trouble speaking or slurred speech.
• Blurry vision or seeing double.
• Loss of balance or trouble walking.
• Suddenly feeling very weak or sleepy.

Talk with your family and friends about the signs of low blood sugar. Teach them what to do if you feel faint or become confused. If you become unconscious (pass out), someone must call 911 for an ambulance.

How to treat severe hypoglycemia

If your blood sugar is below 54 mg/dL, have 24 grams of simple, rapid-acting sugar instead of 15 grams. Choose one of these:

• Chew 6 large glucose tabs. You can buy these at your local pharmacy without a prescription.
• Drink 6 ounces of fruit juice or soda (not diet soda).
• Chew 8 to 9 gummy candies or hard candies, such as LifeSavers®.
• Take 1 ½ tablespoons of honey or syrup (not sugar-free syrup).

Wait 15 minutes, then re-test your blood glucose. Keep doing this until your blood glucose level is 70 mg/dL or higher.

• Peanut butter or cheese with 4 to 5 crackers.
• Half of a sandwich and 4 ounces of milk.
• A single-serve container of Greek yogurt.

Emergency glucagon treatments

An emergency glucagon treatment is a prescription medication used to treat severe hypoglycemia. Your healthcare provider may prescribe this if you are at a very high risk for severe hypoglycemia.

If your healthcare provider prescribed an emergency glucagon treatment, read About Emergency Glucagon Treatments for more information.

How to prevent hypoglycemia

It is always best to prevent hypoglycemia before it happens. You can usually do this by balancing your medications, what you eat, and your level of activity. Keeping this balance isn’t always easy. Your provider, diabetes educator, and dietitian can work with you to lower your risk of hypoglycemia.

• Check your blood sugar more often, especially if you have had hypoglycemia before.
• If you take diabetes medications, be sure to eat enough. Do not skip meals.
• Talk with your provider before:
  • Changing your medications.
  • Starting a new exercise routine. Exercise causes your body to use extra glucose.
  • Changing how much you eat.
• If you drink alcohol, talk with your healthcare provider about how to do so safely.

When to call your healthcare provider

Call your healthcare provider any time you have hypoglycemia. They may need to change your medication.

This resource explains what insulin is, how it works, and different types of insulin. It also explains what type 1 and type 2 diabetes are and how to manage them. It answers common questions about insulin and diabetes.

About insulin

Insulin is a hormone that lets glucose (sugar) go from your bloodstream into your cells. Your pancreas makes insulin and releases it into the bloodstream. Your cells need glucose for energy. If your body does not have enough insulin, glucose stays in your bloodstream. This causes hyperglycemia (high blood sugar).

Hyperglycemia can make you feel tired or sick. It can also make it harder for your body to fight off infection. Read About Hyperglycemia (High Blood Sugar) to learn more.

About type 1 and type 2 diabetes

Type 1 diabetes mellitus (T1DM) is when the pancreas does not make insulin at all.

Type 2 diabetes mellitus (T2DM) is when your pancreas does not make enough insulin. Your pancreas may make less insulin over time. You may also have insulin resistance. This means your cells do not respond to the insulin your body makes. This causes glucose to stay in your bloodstream instead of entering your cells.

How to manage type 1 and type 2 diabetes

People with T1DM must always take exogenous (ex-AH-jin-us) insulin. Exogenous insulin is medicine that you inject. It acts like insulin and replaces the insulin your body cannot make.

People with T2DM may need oral medicine to help manage blood glucose levels. As your pancreas makes less insulin over time you may also need exogenous insulin.

Some diabetes medicine makes your pancreas release more insulin. But these medicines will not work if your pancreas cannot make any more insulin. If so, you’ll need to use exogenous insulin to control your blood glucose levels. Talk with your diabetes healthcare provider about how to manage your blood glucose.

When to take insulin

It’s important to take insulin at the right time. Your diabetes healthcare provider will tell you how much to take and when to take it. Taking doses of insulin and other diabetes medicine too close together can raise your risk for hypoglycemia (low blood sugar). Read About Hypoglycemia (Low Blood Sugar) to learn more.

It helps to make a routine for taking insulin. If you miss a dose of insulin, wait until your next scheduled dose. Do not take a dose to make up for a missed dose unless your diabetes healthcare provider tells you to.

What to discuss with your diabetes healthcare provider

Share important health information with your diabetes healthcare provider.

• Had an allergic reaction to diabetes medicines in the past.
• Have liver or kidney problems.
• Have blurry vision or changes to your vision that make it hard to see clearly.
• Have a severe (very bad) infection.
• Are being treated for heart failure or recently had a heart attack.
• Have problems with your circulation (blood flow). This includes neuropathy (tingling or losing feeling in your fingers and toes).
• Have trouble breathing.
• Drink alcohol.

Types of insulin

Rapid-acting insulin

Rapid-acting insulin starts working within about 15 minutes to lower your blood glucose. It can be used to lower your blood glucose during meals. It can also be used to treat high blood glucose when you’re not eating.

A dose of rapid-acting insulin lasts for about 4 hours.

Examples of rapid-acting insulin include:

• Aspart (Novolog®, Fiasp®)
• Lispro (Humalog®, Lyumjev™)
• Glulisine (Apidra®)

Taking insulin doses too close together can cause hypoglycemia. Take doses of rapid-acting insulin at least 4 hours apart. If your diabetes healthcare provider gives you different instructions, follow their directions.

Mealtime insulin dose

When you eat, your blood glucose rises fast. Rapid-acting insulin is often called a mealtime insulin dose because it manages your blood glucose during meals. If you wait too long to eat after taking your mealtime insulin dose, this can cause hypoglycemia.

Take your mealtime insulin dose no more than 15 minutes before a meal. It’s best to wait until your meal is in front of you and you’re ready to eat. This helps prevent hypoglycemia.

Correctional insulin dose

A correctional insulin dose is when rapid-acting insulin is used to treat high blood glucose levels when you’re not eating. This dose is usually lower than a mealtime insulin dose.

Short-acting insulin

Short-acting insulin can take up to 1 hour to start working and lasts for 6 to 8 hours. If you’re taking it before a meal, take it 30 minutes before you eat. This gives the insulin enough time to start working.

Examples of short-acting insulin include regular human insulin (Humulin R and Novolin^® R).

Intermediate-acting insulin

Intermediate-acting insulin usually takes about 2 hours to start working. It lasts for about 12 hours. Intermediate-acting insulin is often used to manage steroid-induced hyperglycemia. This is hyperglycemia caused by steroids, such as prednisone or dexamethasone.

If you’re taking intermediate-acting insulin for steroid-induced hyperglycemia, take them both together. Do not take the insulin without taking the steroid unless your diabetes healthcare provider tells you to.

Tell your diabetes healthcare provider if your steroid dose changes, is held, or stopped suddenly. They may need to stop or adjust your insulin dose.

Examples of intermediate-acting insulin include Neutral Protamine Hagedorn insulin (Humulin N and Novolin^® N). Neutral Protamine Hagedorn is also called NPH.

Long-acting insulin

Long-acting insulin is also called basal insulin or background insulin. Long-acting insulin works slowly over a long period of time. It works to keep glucose levels stable when you’re not eating, such as between meals or while you sleep. Long-acting insulin is not used to control the quick rise in glucose caused by eating.

Long-acting insulin starts working in about 2 hours. Some insulin lasts 20 to 24 hours. These include glargine (Lantus^®, Basaglar^®, Semglee^®, and Rezvoglar^™). Other insulin, such as insulin glargine U-300 (Toujeo^®) and insulin degludec (Tresiba^®), lasts 36 to 42 hours.

Take long-acting insulin at the same time every day unless your diabetes healthcare provider gives you other instructions. It’s helpful to set an alarm or reminder on your smartphone.

Common questions about diabetes and insulin

Will I become addicted to or dependent on exogenous insulin?

No. Taking exogenous insulin injections (shots) does not cause your body to make less insulin. If your body makes insulin, it will keep making it just the way it did before.

You can use exogenous insulin for short periods of time, such as during treatment.

Certain medicine causes hyperglycemia, but only while you’re taking them. These include steroids and some chemotherapies. Once you finish the treatment with these medicines, your blood glucose goes back to what it was before.

Tell your diabetes healthcare provider if your dosage of steroids or chemotherapy changes. You may need to change how much insulin you take, too. Follow your diabetes healthcare provider’s instructions.

What are the side effects of exogenous insulin?

Exogenous insulin is very similar to the insulin your body makes. This means it does not have many side effects.

The most common side effect of exogenous insulin is hypoglycemia. You can prevent this by taking your insulin as prescribed, knowing your blood glucose levels, and not skipping meals.

Tell your healthcare provider if you develop a rash. This is rare but may be a sign of an allergy.

Why can’t I just take a pill?

Oral diabetes medicine will only help your body do the things it usually does better. It cannot make your body do something it cannot already do. For example, if your pancreas cannot make more insulin, you may need to take insulin injections. Read About Oral and Non-Insulin Injectable Diabetes Medicine to learn more.

Can taking exogenous insulin cause problems with my eyesight? Can it affect how well my kidneys work? Can it make me lose my fingers, toes, or legs?

Some people do not want to start insulin until they can no longer delay taking it. But waiting too long can cause other health problems. Uncontrolled high blood glucose over long periods of time can cause loss of eyesight. It can affect how well your kidneys work. You may lose your fingers, toes, and legs.

It’s best to manage your blood glucose right away, before other health problems start.

You may have changes in your vision as insulin brings your blood glucose under control. Tell your healthcare provider if this happens.

Is it my fault that I need to take insulin? Did I not take good enough care of myself?

Your genetics are one of the main causes of diabetes. Over time, diabetes lowers your body’s ability to make enough insulin. This is mostly out of your control. It is not your fault that your body loses cells that make insulin. Eating too much sugar does not cause you to have diabetes.

This resource explains what oral and non-insulin injectable diabetes medicines are and how they help prevent hyperglycemia (HY-per-gly-SEE-mee-uh). Hyperglycemia is also known as high blood glucose (sugar).

Oral medicine is medicine you swallow. Non-insulin injectable diabetes medicine is diabetes medicine other than insulin that you inject. This resource also answers common questions about types of diabetes medicine.

About non-insulin diabetes medicine

Non-insulin diabetes medicine helps your body manage blood glucose. It helps your body prevent hyperglycemia better than it already does.

For example, some medicine helps your pancreas release more insulin than usual. Other medicine helps your body make less sugar than usual. This helps prevent hyperglycemia.

This type of medicine will not make your body do something it cannot already do. It can improve how your body does some things. For example, if your pancreas cannot make more insulin, you may need to take insulin injections.

• Have had an allergic reaction to diabetes medicines in the past.
• Have liver or kidney problems.
• Have a severe infection.
• Are being treated for heart failure or have recently had a heart attack.
• Have severe problems with your circulation (blood flow) or trouble breathing.
• Drink alcohol.

Knowing these things will help them make a plan to control your blood glucose safely.

Hypoglycemia

Hypoglycemia (HY-poh-gly-SEE-mee-uh) is also known as low blood glucose. It’s one of the major side effects of medicine that lowers blood glucose. Read About Hypoglycemia (Low Blood Sugar) to learn more.

Hyperglycemia

Hyperglycemia is also known as high blood glucose. This happens when too much glucose (sugar) builds up in your bloodstream. Read About Hyperglycemia (High Blood Sugar) to learn more.

Types of diabetes medicine

Oral diabetes medicine

Most diabetes pills should be taken with the first meal of the day. This is when they work best. Taking them with food can also help prevent upset stomach, nausea (feeling like you’re going to throw up), and hypoglycemia.

The risk of hypoglycemia is often higher if you take more than one diabetes medicine.

Try to eat regular meals. Avoid skipping meals if you can. Follow your diabetes healthcare provider’s instructions.

Swallow your diabetes pills whole with a glass of water. Do not chew them.

Some pills have a score line in the middle of the tablet you can break them into 2 parts. If it’s hard for you to swallow a whole pill, break it into 2 parts and take both parts.

Try to take your diabetes medicine at the same time every day. If you miss a dose of diabetes medicine, plan to take it at the next scheduled time. Do not take a double dose to make up for a missed dose. Talk with your diabetes healthcare provider to make a plan for what to do if you miss a dose.

Biguanides

Biguanides (bi-GWA-nidez) help your body use insulin better. They also lower the amount of sugar your liver releases into your bloodstream.

Biguanides have a lower risk for causing hypoglycemia. The risk for hypoglycemia is higher if you take them with other diabetes medicine.

Examples of biguanides include metformin (Glucophage^®, Glucophage XR, Glumetza^®, Fortamet^®, and Riomet^®). These can be used with most other diabetes medicine.

Upset stomach is the most common side effect when you first start taking metformin. This includes symptoms such as nausea, diarrhea (loose or watery poop), vomiting (throwing up), and gas. Tell your diabetes healthcare provider if you have an upset stomach. They may prescribe a lower dose so your body gets used to it, then slowly raise it over time.

If you’re having a test with intravenous (IV) contrast, you may need to stop taking metformin for 2 days after the test. Tell the doctor who ordered the test and the person doing the exam you’re taking metformin. Talk with your diabetes healthcare provider. They may give you another medicine to take during this time.

Sulfonylureas

Sulfonylureas (suhl-fuh-nuhl-YUR-ee-uhz) help your pancreas release more insulin into your bloodstream. They will only work if your pancreas can already make insulin.

Sulfonylureas have a moderate to high risk for causing hypoglycemia.

Examples of sulfonylureas include:

• Glipizide (Glucotrol®, Glucotrol XL)
• Glimepiride (Amaryl®)
• Glyburide (DiaBeta®, Glynase® PresTab®, Micronase®)

Tell your diabetes healthcare provider if you’re told to not eat or drink to prepare for a procedure or surgery. Also tell them if you’re sick or have nausea and vomiting that keeps you from eating or drinking. This can lower your blood glucose too much and raise your risk for hypoglycemia. They may tell you to stop taking sulfonylureas.

SGLT2 Inhibitors

SGLT2 inhibitors help control your blood glucose. They let your body get rid of more sugar when you urinate (pee).

SGLT2 inhibitors have a lower risk for causing hypoglycemia. The risk for hypoglycemia rises if you take them with other diabetes medicine.

Examples include:

• Canagliflozin (Invokana®)
• Empagliflozin (Jardiance®)
• Dapagliflozin (Farxiga®)
• Ertugliflozin (Steglatro®)
• Bexagliflozin (Brenzavvy®)

SGLT2 inhibitors can cause urinary tract infection (UTI) and yeast infection. Practice good personal hygiene to lower your risk of getting UTI and yeast infections. This includes keeping your genital area clean and dry. You should also wear cotton undergarments that fit properly and are not too tight.

SGLT2 inhibitors can cause dehydration and low blood pressure. Drink lots of fluids to prevent dehydration while taking SGLT2 inhibitors.

Tell your diabetes healthcare provider if you’re told to not eat or drink to get ready for a procedure or surgery. They may tell you to stop taking SGLT2 inhibitors a few days before.

Tell your diabetes healthcare provider right away and do not take your next dose of SGLT2 inhibitors if:

• You’re sick or have nausea and vomiting that keeps you from eating or drinking.
• Are dehydrated.
• Are sick such as with an infection or the flu.
• Have physical stress such as surgery.

These things can cause euglycemic diabetic ketoacidosis (DKA). Euglycemic DKA is when your body has DKA but your blood glucose is normal or near normal. This is a medical emergency that must be treated right away. Read Diabetic Ketoacidosis (DKA) and Ketone Urine Testing to learn more.

DPP-4 Inhibitors

DPP-4 inhibitors help your pancreas release more insulin into your bloodstream when needed, such as after you eat. They slow down digestion, which helps lower your appetite. They also lower the amount of sugar your liver makes.

DPP-4 inhibitors have a lower risk for causing hypoglycemia. The risk for hypoglycemia rises if you take them with other diabetes medicine.

Examples of DPP-4 inhibitors include:

• Sitagliptin (Januvia®)
• Saxagliptin (Onglyza™)
• Alogliptin (Nesina®)
• Linagliptin (Tradjenta®)

Side effects of DPP-4 inhibitors can include headaches, joint pain, and upper respiratory tract infection. DPP-4 inhibitors can also cause acute pancreatitis, but this is rare. This is when your pancreas gets irritated or inflamed over a short period of time.

Thiazolidinediones (TZDs)

Thiazolidinediones (tie-uh-ZOW-luh-deen-dai-ownz) lower insulin resistance. This means they help your cells better use the insulin your pancreas makes. They also make your liver release less sugar into your bloodstream.

TZDs have a lower risk for causing hypoglycemia. The risk for hypoglycemia rises if you take them with other diabetes medicine.

Examples of TZDs include pioglitazone (Actos^®) and rosiglitazone (Avandia^®).

TZDs work slowly when you first take them. It can take up to 2 to 3 months for them to work fully. It is safe to take TZDs with or without food.

A side effect of TZDs can include fluid retention. This is when your body holds on to extra fluid, causing swelling. Fluid retention can raise your risk for cardiovascular disease (CVD), such as congestive heart failure (CHF).

Meglitinides

Meglitinides (muh-GLI-tuh-nidez) help your pancreas release more insulin into your bloodstream.

Meglitinides have a moderate to high risk for causing hypoglycemia.

Examples of meglitinides include repaglinide (Prandin^®) and nateglinide (Starlix^®).

This medicine works very fast. Take it 15 minutes before you eat. Waiting too long to eat after you take the medicine raises the risk of hypoglycemia.

Side effects of meglitinides can include headaches and mild cold-like symptoms.

Non-insulin injectable diabetes medicine

GLP-1 agonists and Dual GIP agonists

GLP-1 agonists help your pancreas release more insulin into your bloodstream when needed, such as after you eat. They lower the amount of sugar your liver makes. They also make your stomach empty more slowly. This helps you feel less hungry, which may help you eat less.

GLP-1 agonists have a lower risk for causing hypoglycemia. The risk for hypoglycemia rises if you take them with other diabetes medicine.

Examples of GLP-1 agonists include:

• Dulaglutide (Trulicity®)
• Exenatide ER (Bydureon)
• Semaglutide (Ozempic®)
• Liraglutide (Victoza®)
• Lixisenatide (Adlyxin™)
• Exenatide (Byetta™)

Side effects of these medicines can include nausea, vomiting, and diarrhea. GLP-1 agonists can also cause acute pancreatitis, but this is rare. This is when your pancreas gets irritated or inflamed over a short period of time.

If you’re taking GLP-1 agonists, tell your surgery team before you schedule a surgery or procedure with anesthesia. You may need to stop taking this medicine up to a week before getting anesthesia. This is because GLP-1 agonists can cause aspiration. This is when food or liquid goes into your airway instead of your esophagus (food pipe). Talk with your surgeon about steps to take before your surgery or procedure.

Tell your diabetes healthcare provider if you or a family member has ever had medullary thyroid cancer or multiple endocrine neoplasia (MEN). If so, they may prescribe a different medicine.

This information explains how to improve your blood sugar (glucose) with your diet. It also explains how to manage treatment side effects and control your blood sugar at the same time.

How to control your blood sugar with your diet

Many things can affect your blood sugar, such as:

• Stress.
• Medications.
• Changes to your diet.
• Physical activity and exercise.

Some cancer treatments and their side effects can also make your blood sugar levels go up or down. Managing your blood sugar is an important part of your cancer care, and we’re here to help.

A big part of controlling your blood sugar is understanding what to eat. This can feel overwhelming. You might hear different kinds of advice. The best diet for any individual is personal. Your ideal diet is based on your health, treatment plan, and personal preferences. It is different for everyone.

That’s why the American Diabetes Association has general guidelines. They can help you control your blood sugar, stay at a healthy weight, and lower your risk for heart disease. It’s also important to try to follow a well-balanced diet that gives you the nutrients your body needs.

To learn more, talk with a clinical dietitian nutritionist. They will base their recommendations on your health and health goals.

About carbohydrates

There are 3 main types of nutrients:

• Carbohydrates, also called carbs.
• Fats.
• Proteins.

These main nutrients are sometimes called macronutrients or macros. While each one has a different purpose, they work together to give you energy. Many foods have all three of these nutrients.

Before food can give you energy, your body needs to break it down into a sugar called glucose. While all nutrients can be turned into glucose, the process is much easier with carbohydrates. That’s why your body prefers to use carbohydrates as its main source of energy.

How carbohydrates affect your blood sugar

While carbohydrates give your body energy, they also affect your blood sugar levels. If you eat too many carbohydrates, you may have a higher risk for blood sugar problems.

Not all carbohydrates raise your blood sugar the same way. Some raise your blood sugar levels very quickly, while others raise them more slowly (see Figure 1). This can make it hard to control your blood sugar. It’s important to keep your blood sugar from getting too high (hyperglycemia) or too low (hypoglycemia).

Your healthcare provider or diabetes educator will set your blood sugar target numbers. Keeping your blood sugar near those target numbers is an important part of your treatment.

How to choose your carbs wisely

Since carbohydrates are a good source of energy and nutrition, it’s important to include some in your diet. During your treatment, you may be asked to keep track of or change the amount of carbohydrates you eat. This is to help control your blood sugar levels.

This section gives general tips on how to control your blood sugar through your diet. To learn more, talk with your clinical dietitian nutritionist or diabetes educator.

Choose foods with the right amount of carbohydrates

The following table has examples of foods with carbohydrates. It includes foods with fewer carbohydrates that still have the nutrition you need.

When you’re managing your blood sugar, you may need to eat less carbohydrates. Choose foods with fewer carbohydrates when your blood sugar is high.

How to control your blood sugar with fiber

Another way to control your blood sugar is to choose carbohydrates that have more fiber and less sugar. Fiber helps control blood sugar levels by slowing down the absorption of sugar into your body. Choose foods with more than 3 grams (g) of fiber per serving.

You can find the amount of fiber in packaged foods by reading the Nutrition Facts label. The Nutrition Facts label has information about the amount of certain nutrients in the food or drink. The amount of fiber is listed in the “Dietary Fiber” row (see Figure 2).

Soluble fiber

Soluble fiber helps control blood sugar levels by slowing down how fast your body uses carbohydrates. It breaks down in water to form a gel and is easier for your body to digest. Soluble fiber is found in foods such as oats, peas, beans, apples, citrus foods, and barley.

It’s important to eat high-fiber foods that have soluble fiber, such as:

• ¾ cup to 1 cup serving of multi-grain cereal.
• ½ cup of cooked beans or lentils.
• 3 cups of air popped popcorn.
• 1 medium potato, regular or sweet potato.

It can be hard to only eat carbohydrates that are high in fiber. Try to switch out low-fiber foods with high-fiber foods as often as you can.

Limit the amount of carbohydrates in your meals, when needed

If your blood sugar is high, having meals with fewer carbohydrates can help bring it back to your target range. Never stop eating all carbohydrates, especially if you take insulin. This can make your blood sugar go too low. Talk with your healthcare provider for more information.

Here are some ways to have less carbohydrates in your meals:

• Have 1 main source of carbohydrate in your meal instead of 2. For example, have either whole grain rice or beans instead of both.
• Add spices such as cinnamon or ginger to cereals instead of fruit.
• Drink sugar-free, flavored water and sparkling water instead of fruit juice. Fruit juice made with real fruit usually has a lot of sugar.
• Add vegetables and proteins to carbohydrate-rich meals. For example, have a salad and chicken with your pasta instead of just pasta.
• Substitute or add more protein, such as an egg, to your breakfast instead of having more bread or fruit.

How to count carbohydrates to control your blood sugar

Carbohydrate counting is when you plan and track meals that have a certain number of grams of carbohydrates per meal. Carbohydrate counting helps you control your blood sugar levels with the food you eat. This type of meal plan is commonly recommended for people taking insulin.

When you’re carbohydrate counting, use the number in the “Total Carbohydrate” row in the Nutrition Facts label (see Figure 2). Aim for 45 to 50 grams total carbohydrate at each meal, or the amount of carbohydrates your care team recommends.

Steps to carbohydrate counting

Step 1: Talk with your care team to decide the amount of carbohydrates you should have at each meal.

Step 2: Learn to choose the foods and food groups that add the right amount of carbohydrates to your diet. Talk with a clinical dietitian nutritionist or diabetes educator for more information.

Step 3: Calculate the grams of carbohydrates (per serving) for the food you’re eating. Use the Nutrition Facts label listed on the food package to do this.

Step 4: Measure your foods to the serving size on the food label (see Figure 3). You can use a measuring cup or a kitchen scale. It’s important to measure your food initially so that you get used to what the serving size is. But after you become used to what the serving size looks like, it’s OK to estimate your measurements. They don’t need to be exact. Talk with your clinical dietitian nutritionist for more information about measuring your serving sizes.

Carbohydrate counting example

Use the Nutrition Facts labels to practice calculating the amount of carbohydrates in a meal. Calculate the amount of carbohydrates for 1 serving of Cheerios^™ and 1 serving of milk (see Figures 3 and 4).

Total carbohydrates in Cheerios: 29 g
Total carbohydrates in 1% low fat milk: 12 g
29 g + 12 g = 41 g

Your breakfast of Cheerios and 1% low fat milk has a total of 41 g of carbohydrates. This is for a serving size of 1 ½ cups (32 g) of Cheerios and 1 cup of 1% milk. Remember to measure this amount of Cheerios and milk when serving yourself a bowl.

Difference between grams listed on Nutrition Facts labels

Sometimes both the serving size and the amount of carbohydrates in a serving can be measured in grams. But they are not the same.

• Grams (g) listed next to the “Serving Size” tells you the weight of the food item in grams. If you are using a food scale, you can use this information to measure the serving size (see Figure 5).
• Grams (g) listed next to “Total Carbohydrate” tells you the amount of carbohydrate in one serving of the food (see Figure 5).

What to do when you do not have a Nutrition Facts label

If a food does not have a Nutrition Facts label or you’re eating out, look up the carbohydrate information online. Some websites, such as www.CalorieKing.com and www.MyFitnessPal.com, also have mobile applications (apps) for your smartphone or tablet. Talk with a clinical dietitian nutritionist for more resources.

How to manage nutrition during cancer treatment

During cancer treatment, side effects can limit your ability to eat well. Side effects can include nausea (feeling like you’re going to throw up), taste changes, or appetite loss (not wanting to eat).

Being unable to eat can raise your risk for weight loss. It also raises your risk for malnutrition (when your body does not get all the nutrients it needs).

Read Eating Well During Your Cancer Treatment to learn more about general nutrition guidelines during cancer care.

If you’re having a hard time eating during treatment, talk with your healthcare providers and clinical dietitian nutritionist. You may need to change your diet to get the nutrients you need. Sometimes, they may want you to focus less on carbohydrate counting.

Eating small meals more often can make it easier to meet your nutrition goals. Your clinical dietitian nutritionist can help set your carbohydrate goals for each smaller meal. Focus on eating more protein and healthy fats. This will help you get the nutrients you need while controlling your blood sugar.

• Nuts and nut butters.
• Seeds, such as pumpkin seeds or flax seeds.
• Avocados.
• Unsweetened (plain) yogurt and cheese.
• Lean protein, such as fish, chicken, eggs, and tofu.
• Olive oil and canola oil.

Diet changes can help. But you still may need medication to manage side effects better. If you’re prescribed medications, be sure to follow your care team’s instructions for taking them.

Tips for managing side effects of treatment and high blood sugar

Here are some tips on what you can eat to manage side effects of treatment while controlling your blood sugar.

How to manage nausea during your treatment

Nausea is often caused by radiation therapy, chemotherapy, and surgery. It can also be caused by pain, medication, and infection. To manage nausea, try to:

• Eat starchy, bland foods, such as dry toast or crackers.
• Eat plain or vanilla yogurt.
• Eat ice chips.
• Have a low-sugar carbonated (fizzy) drink.
• Avoid foods that have a strong smell.
• Drink ginger tea.

For more tips, read Managing Nausea and Vomiting or talk with a clinical dietitian nutritionist or diabetes educator.

How to manage taste changes during your treatment

Treatment can affect your sense of taste. Taste changes are different from person to person. The most common changes are having bitter and metallic tastes in your mouth. Sometimes, food may not taste like anything. These changes may make you want to eat more carbohydrates.

Before making a meal with a larger carbohydrate portion, try:

• Using fresh and strong herbs and spices.
• Choosing and making foods that look and smell good to you.
• Eating sour and tart foods. They can help stimulate your taste. You can also squeeze some lemon on your food.
• Adding water or salt to foods that are too sweet.
• Eating with plastic or wooden utensils instead of metal ones if food has a metallic taste.

For more tips, read Managing Taste Changes During Chemotherapy or talk with a clinical dietitian nutritionist.

How to manage loss of appetite during your treatment

Appetite loss means you have less of a desire to eat. It’s a very common side effect of treatment. When you lose your appetite, you may want to eat comfort foods to feel better. This can make it harder to eat a well-balanced diet and control blood sugar levels.

• Add more protein to your diet, such as chicken, fish, eggs, or tofu.
• Have a protein shake or nutritional supplement that’s high in protein and low in carbohydrates. Some are high-calorie, ready-made drinks that have vitamins and minerals added to them. Others are powders that you can mix into other foods or drinks. Most are also lactose-free. That means you can have them even if you’re lactose intolerant (have trouble digesting milk products). Talk with a clinical dietitian nutritionist for suggestions.
• Talk with your healthcare provider about your symptoms. They may give you a prescription for a medication to help with your appetite.

It’s hard to manage your blood sugar while going through cancer treatment. Sometimes you need more than the right diet and exercise routine. If you’re having trouble controlling your blood sugar, talk with your care team.

Follow-up care

Within 1 week after discharge

It’s important to share your blood glucose readings with your outpatient diabetes healthcare provider within 7 days after you’re discharged. You may need to talk to them sooner if:

• You were just diagnosed with diabetes or hyperglycemia.
• You were discharged with a feeding tube.
• You’re tapering off steroids.
• You’re trying to get your blood glucose to a target range to continue treatment.
• Your medicine regimen (the medicines you take) has changed.
• Your blood glucose levels are not within your target range.

Some of your healthcare providers often do not manage blood glucose levels or adjust diabetes medicine. This can include your oncologist (cancer doctor), surgery team, or radiation oncologist.

Follow up with your primary healthcare provider or diabetes healthcare provider to manage your blood glucose levels after you’re discharged. If you do not have a primary healthcare provider or endocrinologist, tell a member of your care team. They can help set up follow-up care.

Routine follow-up

Certain appointments and testing are recommended as routine care for people with diabetes. It’s how we check for problems caused by diabetes early, when they’re easier to treat.

You can use the logs at the end of this resource to help keep you on track during your care.

Educational resources

This section lists the MSK educational resources mentioned in this guide.

• Contour® Next One Video: Doing Your First Test
• www.contournextone.com/getting-started
• How to Store and Get Rid of Your Home Medical Sharps
• Diabetic Ketoacidosis (DKA) and Ketone Urine Testing
• How To Check Your Blood Sugar Using a Blood Glucose Meter
• About Your Continuous Glucose Monitor (CGM)
• About Emergency Glucagon Treatments
• Managing Nausea and Vomiting
• Managing Taste Changes During Chemotherapy
• www.CalorieKing.com
• www.MyFitnessPal.com
• Using Your Insulin Pump or Continuous Glucose Monitor (CGM) Safely While You’re at MSK

More diabetes resources

American Diabetes Association (ADA)
www.diabetes.org

The ADA has helpful tips for diabetes self-care, diet, and recipes with nutrition information.

Joslin Diabetes Center
www.joslin.org/diabetes-information