Letters From Cancerland: New Occasions, New Duties
High on the front façade of the former high school in our town are two engraved sayings. The one pertinent in my life right now? “New occasions teach new duties.”
I’ll say.
In mid-July, I was diagnosed with type 2 diabetes. For the record, it runs in my family on both sides. Further, for the record, my personal physician and I had been watching for it. So it was not a surprise when my HbA1C level, a key test for diabetes, came back high for a second time.
Just because it wasn’t a surprise doesn’t mean it didn’t take me aback.
My doctor and I held a huddle. She knew I was headed to see my myeloma specialist soon for my quarterly check-in. Because of that trip, she did not want me to start taking the prescribed metformin until after the specialist appointment. Why? Because the drug can interfere with contrast tests in case any were ordered. But she did want me to start checking my blood sugar twice a day.
New occasions teach new duties. New duties bring new equipment. I can check my blood in under a minute now, but that first time? A lot of frustration, a lot of stress, a lot of I-don’t-know-how-to-put-the-test-strip-in swearing, some angry tears, and a ridiculously long time figuring out that the end cap needed to be removed from the lancing device before I could insert a lancet for the finger prick.
Letting others know I have diabetes was a whole different ballgame from telling people when I was diagnosed with multiple myeloma. One of the stunning differences? I have not been told by friends, family, friends of friends, and complete strangers how to treat the disease, why I need to take this or do that, how they know someone who had a totally unrelated disease and survived, or how the last person they knew with diabetes died in a matter of days.
New occasions, fewer know-it-alls coming out of the woodwork?
On the other hand, many responses seemed entirely out of proportion to the announcement. “Oh, I am so very sorry,” said one, lowering his head and folding his hands. “Oh, dear, what terrible news,” in a hushed voice usually reserved for a funeral home, was another.
I have lived with multiple myeloma for almost 14 years. I have been in continuous treatment for most of the last six. Compared to myeloma, diabetes is a cakewalk. So I have to watch my diet. So I have to take a pill and check my blood twice a day. That’s nothing. I much preferred the reaction of my baby brother when I told him: “So you have another chronic, incurable, progressive disease on top of a chronic, incurable, progressive disease. Dang.”
The biggest hurdle I have faced so far is that the diabetes treatment inadvertently triggered a post-traumatic stress disorder reaction in me. Why? Because the metformin sped up my metabolism so much that I was dropping weight fast. Really fast. Three pounds in two days fast. That reminded me so much of the weeks leading up to my myeloma diagnosis, when I dropped weight so rapidly that my husband Warren had to reassure me that all my labs were stable and there was no indication that the myeloma had turned on me. “But it can get very aggressive,” I said. “But you just met with your myeloma specialist and everything is fine,” he patiently replied. When my physician cut the metformin dose in half and ordered me to add fat to my diet, the weight loss slowed and then turned around.
New occasions, old trauma? Hey, I’m breathing easier.
With a little more than a month of being officially diabetic under my belt, I have settled into the routine of it: the testing, the lifestyle changes, the monitoring. I sleep more heavily now, an unexpected benefit of the medication. I am more conscientious about what I eat and when. There are times I don’t feel well that I ascribe to the new medication. I am relieved to discover that the unwell feeling from that is very different from the extremely distinct unwell feeling I have always had with the myeloma. The former comes and goes, sometimes quickly. The latter increasingly comes and stays.
I am in and out of that old high school often in my line of work with the courts. I drive by it at least once a week. I have taken to glancing up, whether on foot or behind the wheel, when I am nearby.
“New occasions teach new duties.”
I’ll say they do.
April Nelson is a multiple myeloma patient and columnist at The Myeloma Beacon. You can view a list of her previously published columns here.
If you are interested in writing a regular column for The Myeloma Beacon, please contact the Beacon team at .
Wow April! Another chronic, incurable, progressive disease! It sounds as though you have come to grips with the news and that you are adjusting your schedule to accommodate the diet, the testing, and taking yet another medication. While being diagnosed with type 2 diabetes is not pleasant, it is at least a manageable condition, like high blood pressure or high cholesterol. There are lifestyle changes that need to be made, but once you have adjusted, it becomes your new normal. It sounds like you have a great support system with your husband, your myeloma specialist, and your primary care physician. Thanks for sharing your initial experience with the metformin and weight loss as well as the post-traumatic stress disorder. By sharing that information, you are helping the rest of us to recognize and understand the side effects of this popular drug. We hope you continue to successfully manage your myeloma and now your diabetes.
Dear April, I am sorry to hear that you have diabetes. Not great to add that into the mix of symptoms and treatments. I hope that you manage to control it well. I could really identify with your stress when you started to drop weight so quickly and this reminded you of the time of your myeloma diagnosis. I also react this way to changes in my health and I hate it. On a lighter side, your comments about the way in which people react to a diagnosis took me back to your previous column about wheatgrass juice and I found myself laughing! That column is the funniest I’ve ever read. Thanks, April, for your lovely humour which you are happy to share.
Sorry to hear about the Type 2 diabetes, April! It seems like you have had a lot of health issues to deal with, let alone having a new disease. You mention that this runs in your family, but are you also taking dexamethasone as part of your treatments? From what I read, dex can cause spikes in blood sugar. So if the dex dosage were lowered in a patient, would that help with the diabetes? I am sure that you would have discussed this with the myeloma specialists already, but wondered if there could be any adjustment to that. Wishing you the best in coping with this new problem.
Nancy: I get dex once every 4 weeks with my infusion. My personal physician acknowledges that it is a factor in spiking my sugar on infusion day, but we both feel strongly it is not the culprit, especially since my sugar levels return to "normal" the next day. Mayo oncologist felt the same: dex is something to work around, but not the cause.
Patty, I have a wonderful support system, starting with my husband, which is why I did not pass out when I saw the weight come off. I recently read an article that said "resilience" (mentally) can be a factor in treatment outcomes (if nothing else, the placebo effect), and I would say "resilience AND support."
Marjorie, so glad you loved the wheatgrass juice story! One of my all time favorites. Second favorite was the local store owner taking me aside several years ago and telling me in a hush hush serious voice that there is a cure for cancer (apparently all cancers) and has been for years but the White House (this was during the George W Bush administration) was keeping it top secret. Proof? No president ever died of cancer. I looked at her and said "so are you telling me I need to run for the presidency?"
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