American Diabetes Month: Navigating the Journey With Joseph Kalis, PharmD, BCOP
Expert Perspectives · Keira Smith · 2024-11-27
November marks American Diabetes Month, a time for healthcare professionals to amplify awareness and enhance care strategies for diabetes—a condition affecting approximately 38 million Americans. In this article, Dr. Joseph Kalis, a board-certified oncology pharmacist who has type 1 diabetes, offers insights into diabetes management, particularly for patients navigating the dual challenge of diabetes and cancer.
Understanding the Two Faces of Diabetes
Dr. Kalis draws attention to the distinct challenges of type 1 and type 2 diabetes. Type 1 diabetes, which Dr. Kalis has had since age 10, arises from the immune system attacking insulin-producing pancreatic cells. Patients rely on external insulin sources, including continuous glucose monitors and pumps, for life-sustaining management.
Type 2 diabetes involves insulin resistance, where the body produces insulin but cells fail to respond effectively. Lifestyle modifications like diet and exercise form the cornerstone of management, supplemented by oral and injectable medications like GLP-1 receptor agonists.
Understanding these distinctions is critical for personalizing treatment approaches to meet the unique needs of patients.
Managing Diabetes in Oncology Patients
Oncology clinicians often encounter patients managing diabetes alongside cancer. Unique considerations arise due to cancer treatments like steroids, which can significantly raise blood sugar levels. For example, if a patient who is either a type 1 or type 2 diabetic receives 10 mg of dexamethasone intravenously (IV) as part of their anti-nausea regimen, they can experience blood glucose levels for up to three days after.
To address these risks, Dr. Kalis stresses the importance of proactive counseling and collaboration with endocrinologists or primary care physicians. Adjusting diabetes management strategies during treatment cycles can help mitigate the impacts of hyperglycemia on overall health and cancer care.
The Role of Nutrition
For patients managing both diabetes and cancer, nutritional guidance plays a pivotal role. Dr. Kalis recommends a balanced diet rich in fiber, protein, and whole foods, tailored to maintain stable blood sugar levels and support muscle mass.
Referring patients to a nutritionist ensures an individualized approach. By addressing dietary needs holistically, clinicians can support better outcomes for patients managing these concurrent conditions.
Multidisciplinary Collaboration: A Key to Success
Dr. Kalis advocates for a team-based approach to diabetes management, especially for oncology patients. Collaboration with endocrinologists, primary care physicians, and nutritionists can optimize treatment and improve patient care.
“Depending on a patient’s situation and the complexity of their diabetes case, they may be working with an endocrinologist—someone specializing in diabetes or other endocrine disorders—or they may be able to be managed through their general primary care physician,” Dr. Kalis notes. “I find that team approach with the interdisciplinary management to be a critical component.”
Insights for Healthcare Professionals
Dr. Kalis urges healthcare providers to broaden their understanding of diabetes’ multifaceted nature. Beyond common cases, he highlights rare instances of cancer treatments triggering autoimmune type 1 diabetes.
“We’ve seen some rare cases where immunotherapy has been linked to directly causing autoimmune conditions like type 1 diabetes,” Dr. Kalis advises. “Keep that open mind. The diabetes that a patient may have could be due to a variety of different factors and could require a variety of different medications for the best management.”
Moreover, Dr. Kalis encourages patients to remember that diabetes is a journey. “With diabetes being the condition that it is, even if you’re doing everything right, sometimes the body just doesn’t cooperate. It’s important to give ourselves that grace to say, ‘okay, maybe today wasn’t my day, but tomorrow’s a fresh day.’”
Moving Forward: A Shared Responsibility
As diabetes prevalence continues to rise, American Diabetes Month serves as a reminder for healthcare professionals to lead the charge in education, prevention, and care. Whether through adopting a multidisciplinary approach, tailoring treatment strategies, or fostering patient resilience, clinicians play a pivotal role in improving outcomes for those with diabetes.
About Dr. Kalis
Joseph Kalis, PharmD, BCOP, is an Ambulatory Oncology Clinical Pharmacy Specialist at the University of Colorado Health. In this position, he educates patients about their chemotherapy and immunotherapy treatments, reviews treatment plans and dose adjustments, and assists with supportive care. Dr. Kalis’ professional interests include multiple myeloma and hematologic malignancies. He enjoys teaching learners from all walks of life. Dr. Kalis has spoken extensively for continuing education programs, along with various peer-reviewed papers on oncology and pharmacy.