[bhardwajanirudh]

Multiple myeloma, diabetes, and weight loss

by bhardwajanirudh on Tue Aug 02, 2016 1:50 am

Hi,

I always start my posts with a big thank you to this website and this community for the amount of compassion and information it provides to fellow multiple myeloma patients. It's really a great help to me so far, and I'm really thankful to all the contributors.

My father is a Type 2 diabetic for 15 years now and ever since had his diabetes in control. He was a bit overweight, all of which is said to have a considerable role to play in the onset of multiple myeloma.

My question is that, he's been losing a lot of weight since his diagnosis, actually 2 months before that. He was diagnosed with multiple myeloma in March and had been losing weight since January. So far he's lost 18 kg (40 pounds).

The oncologist suggests we try to keep his weight steady because he's scheduled for an autologous stem cell transplant in about 2 months from now, and constant weight loss can hamper the transplant results. But so far we've been unable to do that. He eats healthy, but can't eat sugar and high carbohydrates because of his diabetes, but still there's no decrease in his regular diet since the last 15-16 years, i.e. from the onset of his diabetes.

Does the diabetes have any role to play with the weight loss, or should we be searching for the problem somewhere else?

His diabetes has been very controlled forever but due to the Velcade and Zometa it has started fluctuating now. It goes between 70-250 but gets back to normal after a day or two. And the current endocrinologist has given him an insulin pen to treat the fluctuations.

We are scheduled to meet a better known endocrinologist a few days later, but this really is worrying me now.

Can anyone shed some light in dealing with multiple myeloma with diabetes and any reasons for the weight loss?

Thanks again for this forum and good health to all

PS: I'd like to mention that his treatment regimen has been Velcade with cyclophosphamide (Cytoxan, Endoxan) and dexamethasone.

[rick]

Re: Multiple myeloma, diabetes, and weight loss

by rick on Tue Aug 02, 2016 7:44 pm

Hi Anirudh.

It would be helpful to know your father's current body mass index (BMI) and his HgbA1c, or glycosylated hemoglobin. If the latter is higher than 8, the weight loss may be related to diabetes control.

Additionally, the likely chemo culprit is not the Velcade or the Zometa, but the co-administered dexamethasone. Any steroid can worsen diabetes. I have had non-myeloma patients (I'm an internist) with drug-induced or worsened diabetes after asthma care, allergic reactions, and even after using OTC pain meds from non-U.S. countries that contained steroids.
Your father may need better insulin dosing that takes his steroid days into account.

If his BMI is over 25, the next marker for general health is likely his albumin, as his total protein with be low due to the myeloma treatment's effect on his antibodies and globulin. If his albumin is normal, than he is still more nutritionally OK than the weight loss might suggest.

As for maintaining weight and recommendation: their is a poster who writes often on ketogenic diets (high fat and moderate protein) and myeloma.

Healthy fats (unsaturated and rich in omega 3 and omega 6 fatty acids) – avocados, nuts, cold water fish, coconut milk and oil, olive oil – might help as they will not require or affect insulin needs and are calorie dense and anti-inflammatory. Use full fat yogurt and kefir.

My husband lost 20 lbs from diagnosis into treatment, then it leveled off. He went to a BMI of 25 (pretty ideal, actually, but something neither of us thought he'd see again and with a good deal of muscle loss) and never had a low albumin except for a single day during his autologous stem cell transplant. In his case the issue was and remains what Revlimid did to his GI tract and the pulsed steroids which did cause heartburn and hiccups.

We found if he eats all day in small amounts and uses herbs and vegetables that help with indigestion – fennel, ginger, thyme, dill, apple cider vinegar, some cumin and turmeric, fiber and leafy greens, lentils, papaya seeds and fruit, pineapple, manuka honey – he got more relief than the prescription options (and he tried them all).

i hope this helps and wishing you the best.

[bhardwajanirudh]

Re: Multiple myeloma, diabetes, and weight loss

by bhardwajanirudh on Thu Aug 04, 2016 6:31 am

Hi Rick,

My father's current BMI is 20.7 and his HgA1c came out to be 6.5, so I'm guessing it's most prob­ably because of the dexa­metha­sone. I'm just concerned if it's because of something else, since the doctors also said people generally don't lose this much weight this fast.

We'll keep an eye if it goes down further and see if he gains some when his cycles end next month.

Thanks for the info though. It really came in handy.

[rick]

Re: Multiple myeloma, diabetes, and weight loss

by rick on Thu Aug 04, 2016 10:41 am

Hi Anirudh.

6.5 is an average sugar of about 125 (each point in the glycosylated hemoglobin is about 30 points in average sugar with 7 = ~155). His current control is pretty ideal for a diabetic on AVERAGE. If his sugar runs high with meals or dexamethasone, he may need some rapid acting insulin, but his current DM doses are clearly pretty good given his current intake.

So it appears there is another cause. and it's worth looking for it.

His BMI is at the low end of ideal (20-24), which is pretty uncommon in the US. So I can understand your doctor's concerns as you want to stay over 20 if you can.

Is he having problems with diarrhea or nausea/vomiting? The prior might indicate mal­ab­sorp­tion (particularly if he has oily stools) or an infection, the latter gastroparesis or dys­motility that some diabetics get (and which chemotherapy that worsens neuropathy could certainly ag­gra­vate). Dys­motility is more difficult to treat, but there are medications to try.

Since you say he is eating his regular diet, it is time to change it up. His prior diabetes diet is not ideal for his current care plan. I'd still recommend the food in my prior post and add well cooked eggs. We use hard boiled for ease, but any cooking method will do. I also add almond butter to soups and sauces and spread it on bread like any other condiment.

I do my share of weight loss work ups and am often left without a good answer (which some­times means depression is involved, but also means medicine doesn't know all that it should).
It is worth asking his doctors to look further.

Again, wishing you both the best.