With esophageal cancer, there are many dietary appropriateness and contraindications. For example, after surgery, you have to eat a semi-liquid diet for a period of time, with soft noodles and rice porridge as the mainstay. The first time I saw this, I was able to get to the bottom of it.
So, what is the best way to eat during treatment for people with esophageal cancer combined with high blood sugar is the question we will discuss in this article.
Glucose management goals for oncology patients
High blood glucose not only affects anti-tumor therapy and post-operative wound healing, but may also increase the risk of complications such as infection and affect your long-term recovery. Therefore, you should pay appropriate attention to blood glucose control issues.
Long-term goals for diabetes management vary from person to person. A better blood glucose level is generally defined as a fasting blood glucose of 4.4 to 6 mmo/L and a 2-hour postprandial blood glucose of 4.4 to 7.8 mmol/L. However, during oncology treatment, blood glucose may fluctuate due to the effects of surgery, radiotherapy, hormone therapy, and other factors such as changes in eating habits and food intake. Therefore, the glycemic control goals and the use of glucose-lowering drugs in oncology patients need to be individualized, and constantly monitored and adjusted.
For older patients with unstable blood glucose and short life expectancy, glycemic control standards need to be relaxed to 5-8 mmo/L for fasting blood glucose and 5-12 mmol/L or higher for 2-hour postprandial blood glucose.
Postoperative dietary principles for patients with hyperglycemia
- Choose low glycemic index carbohydrates: Just because your blood sugar is high doesn’t mean you can’t eat staple foods at all. You can choose staple foods based on coarse grains, such as tortillas, oats, buckwheat noodle buns, red beans and rice, which have a low glycemic index (GI) and are less likely to cause blood glucose fluctuations. Eat less refined white rice, refined white noodles and other foods with high glycemic index. The GI index is lower than the glycemic index (GI) and is less likely to cause fluctuations in blood sugar.
- Eat high-protein blended foods: Eating staple foods and high-protein foods at the same time is beneficial for lowering postprandial blood glucose. It is recommended to have high quality protein-rich eggs, milk, lean meat and soy products at every meal. Meat is mostly low-fat, especially low-saturated fat white meat, such as fish and poultry.
- Foods high in fiber and vitamins: Eat more of a variety of fresh vegetables such as spinach, kale, rape, bok choy, lentils, mushrooms, and other foods that supplement antioxidant vitamins along with a variety of dietary fiber.
- Cooking methods: steam, boil, braise, stew, mix, quick stir-fry, microwave heating, less frying, grilling, etc.
- Regular diet: Chemotherapy drugs, glucocorticoids (dexamethasone), and other drugs commonly used in oncology treatment can cause large swings in blood sugar. At this time, you will need to monitor your blood glucose more frequently. If your blood sugar is too high, you will need to adjust your dosage of glucose-lowering medications such as insulin to avoid acute complications of diabetes.
- Regular exercise: Whether you are a patient on chemotherapy or in recovery, moderate daily activity is not only good for lowering blood glucose, but can also improve fatigue, sleep, and immunity.
Prevention and management of hypoglycemia
In addition to controlling hyperglycemia, oncology patients (especially those who are malnourished) need to pay attention to the prevention of hypoglycemia.
Esophageal cancer patients with inadequate dietary intake who are already malnourished should not only not restrict their diet, but also increase their nutritional intake. You can supplement the energy gap with oral “diabetic enteral nutrition preparations” or with intravenous glucose infusions.
The general recommendation is to take 100 to 200 ml of diabetic enteral nutrition 3 to 6 times a day, or to change your meal plan to a carbohydrate-containing liquid diet with 15 g of carbohydrate per hour, such as 3/4 cup (about 175 ml) of fruit juice and 1 cup (about 250 ml) of sour milk. Since the main problem you are facing is severe under-eating, there is no need to worry about the amount of sugar in the above foods.
If a blood glucose test shows that your blood glucose is below 72 mg/dl (4 mmol/L), you should rush to eat sugars that can be absorbed quickly, such as glucose and chocolate. Be careful, however, not to eat too much. Usually, 1 tablespoon (15 g) of sugar, 3 cubes of sugar, 1 tablespoon (15 ml) of honey, and 3/4 cup (about 175 ml) of fruit juice are enough to bring your blood sugar up.
After eating sugar, take a break for 10 to 15 minutes and then check your blood glucose again. If it is still below 72 mg/dl, take another 15 g of fast-acting glucose and wait 10 to 15 minutes before testing again.
For patients with poor appetite or inadequate dietary intake due to chemotherapy, adjust the dosage of glucose-lowering drugs or insulin according to the amount of diet and test blood glucose more frequently to try to prevent hypoglycemia.
Multidisciplinary consultation for diabetes
If your blood sugar is too high or fluctuates widely, you may need to fight the disease with two medical teams: one dedicated to oncology care and the other to diabetes management. You will usually monitor and record your blood glucose levels and glucose-lowering treatment plan regularly, and make sure that you let your care team know clearly, each time you meet with them, about any changes in your treatment plan. You can also talk to your supervising physician and ask for a joint multidisciplinary consultation to agree on the best treatment plan.