Change your diet to manage high blood glucose during cancer treatment Princess Margaret

For patients with high blood glucose caused by cancer treatment

Read this resource to learn:

• What is blood glucose

• How cancer treatment affects blood glucose

• What kind of diet (food and drink) can help manage high blood glucose

• What foods I should eat if my appetite is poor

• What foods I should eat if my appetite is good

• Where to get more information

Please visit the UHN Patient Education website for more health information: www.uhnpatienteducation.ca © 2015 University Health Network. All rights reserved. This information is to be used for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis or treatment. Please consult your health care provider for advice about a specific medical condition. A single copy of these materials may be reprinted for non-commercial personal use only.

Author: Princess Margaret Oncology Dietitians Created: 01/2016 Form: D-8588 What is blood glucose?

Glucose is a type of sugar that is found in your blood. Your blood glucose levels can go up or down based on your medications or diet (the foods you eat).

Treatment for cancer may raise your blood glucose levels. High blood glucose levels are not good for your health or well-being.

Keep reading to find out more about what foods are safe to eat and drink during cancer treatment, and how to adjust your diet to manage high blood glucose levels.

How can cancer treatment affect my blood glucose levels?

People getting treatment for cancer can sometimes get high blood glucose. In these cases, high blood glucose may be due to some cancer drugs (for example, prednisone or decadron).

Having high blood glucose during cancer treatment does not mean you have diabetes (a disease that affects how well your body uses glucose). But having high blood glucose can make you feel tired and sick, and can cause blurred vision.

Your family doctor or oncologist (cancer doctor) will tell you if your blood glucose level is too high and if you need to make changes to your diet to help lower it.

How can I manage high blood glucose?

;; Plan your day so you do not go longer than 4-6 hours without eating a meal or snack

;; Try to balance your meals with a carbohydrate food, protein and vegetables

2 What are carbohydrates and should I eat them?

Carbohydrates give you energy. They are the part of your diet that can raise blood glucose. They can be split into 2 groups:

1. Simple carbohydrates (sugars)

2. Complex carbohydrates (for example, fibre and starch)

Many foods that have a lot of simple carbohydrates give you very little nutrition other than calories. If you have high blood glucose, try to avoid eating or drinking these foods that have a lot of sugar:

• Soda drinks • Popsicles or freezies • Drinks with artificial • Commercial (not real) fruit (store-bought) iced flavour tea • Fruit juice • White sugar or • Candy (for example, brown sugar licorice, jelly beans) • Maple syrup • Cookies • Agave syrup

It is okay to have small amounts of these items if:

• You have nausea (feeling of having to throw-up) or you are vomiting (throwing up) • You are eating and drinking poorly.

Complex carbohydrates (or starches) are foods that give you fibre, vitamins and minerals. Complex carbohydrates help make you feel full for a longer time.

Complex carbohydrates include whole grains, such as:

• Whole wheat breads • Pastas and cereals • Brown rice • Corn • Legumes

3 What is protein and should I eat it?

Protein helps your body heal, keep muscle mass and builds your immune system to fight infections. When you are having treatment for cancer, your body needs more protein.

Foods that have protein include:

• Chicken and other meats • Fish • Tofu • Cheese • Eggs • Legumes (for example, lentils and chick peas) • Nuts and seeds

Protein foods will not affect your blood glucose levels. However, because legumes give you both carbohydrates and protein, limit legumes to half a cup at one time to control the amount of carbohydrate.

What is fat, and when should I eat it?

Fat plays a role in keeping the cells in your body healthy. Foods that have fat include:

• Avocado • Oil • Butter or margarine • Salad dressing • Mayonnaise • Gravy

Fat alone will not affect your blood glucose levels. But some foods are a mix of carbohydrate, protein and fat and can raise your blood glucose.

This includes foods like:

• Battered chicken • French fries • Pizza • Hamburgers

4 To help control blood glucose levels from rising too high, eat these foods no more than once per week.

Which is better for my blood glucose levels, juicing or blending?

Blending is often better for your blood glucose levels than juicing since it adds more fibre to your diet. Fibre is good for you since it will slow the rise of your blood glucose.

• Juices are made by removing the liquid from fruits and vegetables. When this is done most of the fibre is lost.

• Blended drinks are made by pureeing (blending) fruits and vegetables. When this is done all of the fibre is kept in the drink. You can blend fruits and vegetables with or without added fluids.

• If you are going to make juices or blended drinks, use a half (½) cup of vegetables and a half (½) cup of fruit. If you are using dark leafy greens like kale, spinach or bok choy, you can use up to 2 cups.

Can I take nutritional supplements with high blood glucose?

Yes. Nutritional supplements are drinks that provide nutrition when you are not able to eat well. It is safe to take nutritional supplements with high blood glucose. • If you use supplements such as Glucerna®, Boost® Diabetic and Resource Diabetic®, you can take 1 container at one time. • If you take supplements such as Ensure Plus Calories®, Boost® Plus Calories, Resource 2.0® and Boost® Fruit-Flavoured Beverage, take one- third (⅓) to half (½) of a container at one time. • Talk to your registered dietitian if you are using nutritional supplements for all of your nutrition. If you do not have a registered dietitian, ask a member of your health care team to refer you to one.

5 Can I use non-nutritive sweeteners?

Non-nutritive sweeteners are artificial (not real) sweeteners that add sweetness to foods.

You can use them in food and drinks since they do not affect your blood glucose levels.

Non-nutritive sweeteners can be used to sweeten things like tea, coffee and cereals. They include sweeteners like Splenda®, Equal®, Sweet’N Low® and Stevia®.

What foods should I eat if my appetite is poor?

A poor appetite means you do not feel hungry and you may not feel like eating. If your appetite is poor, you may not have to limit carbohydrates as much because your portions may be smaller. When you are eating less, your food may not cause your blood glucose to rise.

Grains, starches and starchy vegetables. There is no limit on the amount you should eat.

You can eat things like: • Mashed potatoes • Plain pasta noodles • White or basmati rice • Plain toast (white or whole wheat) • Couscous • Quinoa

6 Fruit. There is no limit on the amount you should eat. You should have:

• Any fruit you choose and can tolerate (you are able to eat and keep down) • Any fruit juice you choose and can tolerate (you are able to eat and keep down)

Milk and yogurt. There is no limit on the amount you should have. You should have:

• Milk with more than 1% milk fat • Yogurt with more than 1% milk fat • Cheese added to your diet when your appetite is poor. Cheese will not affect your blood glucose levels

Protein. Protein is a good way to keep up strength.

• Animal sources of protein (for example, meats, eggs, fish, shellfish) will not affect your blood glucose • Try to have protein with at least 3 of your meals each day • Nuts and seeds give you protein and healthy fat. You can add a handful of nuts and seeds to your meals, or eat as a snack

Vegetables. There is no limit on the amount you should eat.

• Vegetables are low in calories • Try to eat them with healthy fats (for example, olive oil and avocado) or other toppings to get more calories

Fats and oils. They will not affect your blood glucose.

• Add fats and oils to meals, snacks and cooking to get more calories • Examples include olive oil, canola oil, butter, and avocado • Nuts and seeds also give you protein and fat

7 Nutritional supplements.

• Take a half (½) container of regular supplements at a time • You can take a full container of diabetic supplements at one time

What foods should I eat if my appetite is good?

A good appetite means you feel hungry and feel like eating. Below is a list of food and drinks you should have to manage high blood glucose if your appetite is good (you eat and drink a good amount).

Grains, starches and starchy vegetables. Have a half (1/2) cup to one-and-a-half (1½) cups at meals. You should not have more than a half cup at snacks. You can eat:

• Whole grain bread • Rye bread (1-2 (1-2 slices) slices) • Sweet potato • Corn • Whole wheat pasta • Brown rice • Quinoa • Barley

Fruit. Have a half (½) cup or one (1) medium size fruit at each meal or snack.

• Try to have 2-3 servings of fruit per day

• Limit tropical fruits to one serving per day (for example, mango, papaya, pineapple)

Milk and yogurt. Have one (1) cup of milk or three quarters (¾) of a cup of yogurt at one time.

• Try to have 1.5-2 ounces of cheese at one time (about the size of 1.5-2 ice cubes)

8 Protein. Protein is a good way to keep up your strength.

• A portion of protein is about 2.5-3 ounces, or about the size and thickness of a deck of cards • Try to have protein with at least 3 of your meals each day • Nuts and seeds are high in fat. Limit these to a quarter (¼) cup at one time, no more than 2 times per day

Vegetables. Eat your vegetables.

Fats and oils. They add calories, so if you are gaining weight, keep amounts small.

• Examples include olive oil, canola oil, butter and avocado • Nuts and seeds give you protein and fat

Nutritional supplements. If you have a good appetite and can eat solid foods, try to limit your use of supplements and choose foods instead.

Where can I get more information?

To speak with a registered dietitian, ask a member of your health care team for a referral.

The development of patient education resources is supported by the Princess Margaret Cancer Foundation.

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