Colorectal Cancer and Diabetes

A higher risk

| Apr 1, 2006

While people with diabetes know that they face a long list of possible complications, it looks as if there’s one more to worry about: We now know that diabetics also face a higher risk of colon cancer. However, there is some consolation in knowing that colon cancer can often be prevented with proper testing.

First, the bad news. A recent study of 200,000 Americans released in November 2005 by Donald Garrow, MD, a clinical research fellow at the Medical University of South Carolina, concluded that diabetics are 1.4 times more likely to be diagnosed with colon cancer than nondiabetics. Cancers of the colon and rectum are the second most common cause of cancer death in the United States.

Protect Yourself

The good news is that diabetics can do a lot to protect themselves from developing colon cancer. Eating a diet that is high in fruits and vegetables and low in red and processed meat, being physically active, and maintaining a healthy weight can reduce the risk of colon cancer.

Begin Getting Screened at 50

The American Cancer Society does not list diabetes as a primary risk factor for developing colon cancer. Age is considered the primary risk factor, which is why the Society’s colorectal cancer testing guidelines recommend that individuals aged 50 and older begin having colorectal cancer screening. People with a family or personal history of colon cancer or polyps, or who have a personal history of inflammatory bowel disease, are at a higher risk.

Early detection of colon cancer is critical. There are several screening options, including fecal occult blood test, flexible sigmoidoscopy and colonoscopy. Based upon various determinants, a physician will decide what makes the most sense for each patient.

A colonoscopy allows a doctor to closely inspect the inside of the entire colon for signs of cancer and polyps that can eventually become cancerous, according to Len Lichtenfeld, MD, deputy chief medical officer of the American Cancer Society. The procedure requires the insertion of a slender, flexible tube that sends images to a monitor. The exam takes 15 to 30 minutes, and the patient is asleep during the procedure.

“The procedure is not painful or embarrassing,” Lichtenfeld says.

Colonoscopies and sigmoidosocopies are always done in a private room. Doctors and nurse specialists are careful to respect the patient’s privacy. A colonoscopy may be done in a hospital outpatient department, in a clinic, an ambulatory surgery center or in the doctor’s office. The procedure is usually done by a gastroenterologist or a surgeon. Studies have shown that a well-trained clinical nurse specialist, nurse practitioner or physician’s assistant can also perform these procedures effectively.

Follow-Up Care

Patients should ask their doctors whether they will need to miss work after the colonoscopy or sigmoidoscopy. Most people feel fine after a colonoscopy. Even so, they may feel a bit woozy, Lichtenfeld says. They will be observed and given fluids after the procedure as they awaken from the anesthesia. They may have some gas, which causes mild discomfort. The patient should have someone drive them home after the procedure.

Most diabetics understand the seriousness of their disease, Schuster says. As a result, they may be better prepared that most people to understand that prevention and early detection are the best ways to avoid colon cancer.


Steps Diabetics Should Take Before a Colonoscopy

While all patients should follow the preparation procedures for a colonoscopy carefully to ensure accurate test results, diabetics need to take extra precautions.

  • First, preparation for the colonoscopy requires a special liquid diet the day before the exam; no solid foods are permitted. This could cause problems for diabetics who follow a particular dietary routine.
  • Second, the patient has to drink a strong laxative in order to clean out the colon so that the images will be clear. If the diabetic patient is not careful, the laxative effect can lead to dehydration, causing low blood glucose or possible fainting. Patients are also advised not to eat a heavy meal the day before taking the laxative to ease the burden on their digestive system.
  • People with diabetes need to test their blood glucose more frequently the day before the test and possibly for the next few days, according to Dara Schuster, MD, associate professor in the Division of Endocrinology, Diabetes and Metabolism at Ohio State University. She also advises scheduling the colonoscopy early in the day, since the test requires fasting.
  • Most diabetics do not have to worry about the caloric content of the laxative. There are ways to lessen the laxative mixture’s unpleasant taste. The night before, it is a good idea to refrigerate it. Also, to overcome the bitter taste, try to drink it quickly.
  • Insulin users will need to consider whether to reduce their insulin intake during the preparation phase and the day of the test. Their endocrinologist or family practitioner may advise using less insulin during these two days. Schuster says that insulin pump users will very likely reduce their basal units.

The Diabetes–Colon Cancer Connection
By Daniel Trecroci

In a study of 2,395,935 participants that was published in the November 16, 2005, issue of the Journal of the National Cancer Institute, it was found that “diabetes was associated with an increased risk of colorectal cancer, compared with no diabetes.” This association did not differ between men and women.

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Categories: Blood Glucose, Diabetes, Diabetes, Food, Hospital Care, Insulin, Insulin Pumps, Losing weight, Type 1 Issues


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