High Blood Sugar and Insulin Resistance

Repeated high blood sugar levels can create imbalances leading to insulin resistance. Chronically high levels of blood sugar and insulin can create conditions favorable to cancer growth and spread.

High blood sugar and insulin resistance at a glance

High blood sugar (glucose) levels may come from eating foods with a high glycemic indexan indication of the ability of a food to raise blood sugar, in a value from zero (not at all) to 100 (pure glucose); high-GI foods are digested quickly and release glucose rapidly into the bloodstream, while low-GI foods release glucose slowly and steadily into the bloodstream: sugary, high-calorie foods with little fiber. Too much sitting (sedentary) time, sleep disruption, unmanaged stress, and some medications, such as steroids, can also contribute to high blood sugar. Repeated high blood sugar levels can create imbalances leading to insulin resistance, a condition in which cells in your muscles, fat, and liver don’t respond well to insulin and can’t efficiently take up glucose from your blood for energy. 

When cells don’t take in blood glucose due to insulin resistance, the pancreas produces more insulin, leading to insulin levels that are too high. Chronically high levels of blood sugar and insulin can create conditions favorable to cancer growth and spread and are markers of diabetes, which is a risk factor for several types of cancer.1Yin M, Zhou J, Gorak EJ, Quddus F. Metformin is associated with survival benefit in cancer patients with concurrent type 2 diabetes: a systematic review and meta-analysis. Oncologist. 2013 Dec;18(12):1248-1255.

Cancer types with modest or good evidence of a link to high blood sugar and insulin resistance:

Cancer as a whole

Brain cancer

Breast cancer

Colorectal cancer

Gynecological cancer

Head and neck cancers

Kidney cancer

Lung cancer

Ovarian cancer

Pancreatic cancer

Prostate cancer

Thyroid cancer

Top practices and therapies for managing high blood sugar and insulin resistance

Therapies and practices we have reviewed

The effects of these practices and therapies are described below on this page. Full details of evidence are on the therapy reviews, accessible through the image links below.

Further therapies

Therapies recommended in clinical practice guidelines but that we haven’t yet reviewed; see belowUse your browser's Back button to return to this location. for guidelines ›

Aloe vera (oral)

Alpha-lipoic acid

A specific Ayurveda formulation of six herbs

Berberine

Citrullus colocynthis

Coccinia cordifolia

Fenugreek (Trigonella foenum graecum)

Ginger

Gynostemma pentaphyllum

Hintonia latiflora

Lichen genus Cladonia BAFS “Yagel-Detox”

Marine collagen peptides

Milk thistle ›

Nettle

Omega-3 fatty acid eicosapentaenoic acid ›

Pterocarpus marsupium (vijayasar)

Salacia reticulata 

Scoparia dulcis porridge

Soybean-derived pinitol extract

Touchi soybean extract

Traditional Chinese medicine herbs:

  • Fructus mume
  • Gegen Qinlian Decoction (GQD)
  • Jianyutangkang (JYTK) with metformin
  • Jinlida with metformin
  • Sancaijiangtang
  • Shen-Qi-Formula (SQF) with insulin
  • Tang-Min-Ling-Wan (TM81)
  • Xiaoke (contains glyburide)
  • Zishentongluo (ZSTL)

Other therapies

Several other therapies have some evidence of benefit for managing high blood sugar and insulin resistance. The benefit may be meaningful or even substantial, but our reviews show the evidence so far is preliminary.

Acupressure

Acupuncture

Cannabis or cannabinoids

Non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs)

Vitamin D in combination with other therapies

On this page

What are high blood sugar and insulin resistance?

The food you eat is converted into glucose to feed your cells. Insulin facilitates the absorption of glucose into your cells.2Pancreas Hormones. Endocrine Society. January 24, 2022. Viewed December 7, 2022. Without insulin or insulin-like growth factors, the glucose is not transported to cells to provide the fuel they need. Blood glucose and insulin levels normally rise and fall throughout the day as you eat, fast, and are physically active. 

High blood sugar—hyperglycemia—is a condition in the body indicating an abnormally high amount of glucose in the blood. High blood sugar can be caused by any of these conditions:

  1. Too much glucose in the blood from eating foods that are turned into glucose too quickly, and insulin hasn’t yet been able to transport all this new glucose into cells
  2. Too little insulin in the blood, usually because the pancreas isn’t producing insulin; this can happen either because the pancreas isn’t functioning to produce insulin, as in type 1 diabetes, or because in the long term the pancreas cannot maintain insulin production needed to respond to high blood glucose levels, as in insulin-dependent type 2 diabetes
  3. Too much glucose in the blood because cells have become resistant to insulin, and the available insulin cannot facilitate transporting the glucose to cells

Insulin resistance is a condition in which cells in your muscles, fat, and liver don’t respond to insulin’s attempts to facilitate glucose absorption by cells. Metabolic syndrome includes a cluster of conditions including obesity, high blood pressure, high cholesterol, and type 2 diabetes.3Dansinger M. Insulin Resistance. Web MD. June 23, 2021. Viewed August 12, 2022.

Chronic levels of high blood glucose may lead to chronically high levels of insulin in your blood (hyperinsulinemia). While insulin and its related insulin-like growth factors (IGFs) play a crucial role in normal growth and development, they may also create an environment favorable to cancer growth.4Brahmkhatri VP, Prasanna C, Atreya HS. Insulin-like growth factor system in cancer: novel targeted therapies. Biomed Research International. 2015;2015:538019. If blood sugar and insulin are consistently high over a long time, normal (nonmalignant) cells can become resistant to insulin’s attempts to transport glucose into the cells.

What is the role of insulin-like growth factors?

Insulin-like growth factors including IGF-1 and IGF-2 have many functions. These IGFs regulate cell division, development/specialization, and normal cell death (apoptosis). IGF-1 may also be necessary for normal insulin sensitivity,5Clemmons DR. Role of insulin-like growth factor in maintaining normal glucose homeostasis. Hormone Research. 2004;62 Suppl 1:77-82. but high levels of IGF-1 are linked to cancer growth.6Sax AT, Jenkins DG et al. The insulin-like growth factor axis: a biological mechanism linking physical activity to colorectal cancer survival. Cancer Epidemiology. 2014 Aug;38(4):455-9.

When cells signal a need for glucose—normally during the process of dividing and functioning—insulin and IGFs operate to deliver the glucose. During a state of insulin resistance, some of the insulin receptors in nonmalignant cells are not receptive to insulin, and glucose isn’t delivered efficiently. However, because cancer cells in particular require a constant supply of glucose and IGFs to continually reproduce themselves, cancer cells have developed workarounds to insulin resistance. In fact, cancer takes advantage of a state of insulin resistance to create a favorable tumor microenvironment.7Alschuler LN, Gazella KA. The Definitive Guide to Thriving after Cancer: A Five-Step Integrative Plan to Reduce the Risk of Recurrence and Build Lifelong Health. Berkeley, California: Ten Speed Press. 2013. In a state of chronically high blood glucose, normal cells become resistant to the absorption of too much glucose, which is promoted by insulin. However at least some cancer cells continue to respond to insulin, absorbing both glucose and factors that stimulate cell growth, such IGF-1.

Insulin-like growth factor binding protein 3 (IGFBP-3) binds IGF-1, reducing the IGF-1’s ability to promote tumor progression.8Panasiti V, Naspi A et al. Correlation between insulin-like growth factor binding protein-3 serum level and melanoma progression. Journal of the American Academy of Dermatology. 2011; 64:865–872. Increasing levels of IGFBP-3 that reduce the activity of IGF-1 may be linked to less tumor growth and development.9Sax AT, Jenkins DG et al. The insulin-like growth factor axis: a biological mechanism linking physical activity to colorectal cancer survival. Cancer Epidemiology. 2014 Aug;38(4):455-9.

Diabetes

When levels of blood glucose become chronically high, diabetes can develop. Diabetes is actually a cluster of several diseases and conditions in which blood glucose levels are too high. In type 1 diabetes, the pancreas doesn’t make enough insulin, and so levels of blood glucose rise because insulin is not available to transport it into cells. Type 2 diabetes results when cells have become resistant to insulin, and so the glucose in blood is not transported into cells even when insulin is available.10Diabetes: An Overview. Cleveland Clinic. March 28, 2021. Viewed August 12, 2022. Diabetes indicates an out-of-balance body terrainthe internal conditions of your body, including nutritional status, fitness, blood sugar balance, hormone balance, inflammation and more and is a risk factor for several types of cancer.11Yin M, Zhou J, Gorak EJ, Quddus F. Metformin is associated with survival benefit in cancer patients with concurrent type 2 diabetes: a systematic review and meta-analysis. Oncologist. 2013 Dec;18(12):1248-1255.

Resources

What may contribute to high blood sugar and insulin resistance?

Lifestyle and behaviors

Diet

What you eat plays a big role in your blood sugar and insulin levels. Some foods are digested slowly, raising your blood glucose slowly and allowing insulin to transport glucose into your cells at an appropriate rate. Such foods include protein-rich foods, whole grains and other foods high in fiber. For most people, these are very beneficial foods for keeping blood sugar and insulin levels in balance. 

Other foods cause a rapid spike in blood glucose levels. These foods are high in simple carbohydrates that are converted to glucose quickly—sugar, honey, and other sweeteners; refined grain products such as white bread, pasta, cakes and cookies; sweetened drinks; fruit drinks without fiber; white potatoes, and white rice. Diets with high amounts of refined carbohydrates cause repetitive spikes in blood glucose and insulin and are said to have a high glycemic index. They also increase the risk of diabetes.12Cazzaniga M, Bonanni B. Relationship between metabolic disorders and breast cancer incidence and outcomes. Is there a preventive and therapeutic role for berberine? Anticancer Research. 2018 Aug;38(8):4393-4402. 

Ensuring that carbohydrates are eaten with protein and healthy fats will balance the meal’s overall impact on blood sugar. Selecting whole-food carbohydrates also slows the release of glucose:

  • Beans such as black beans, navy beans, and lentils
  • High-fiber vegetables and fruits
  • Nuts and seeds
  • Whole grains with sufficient fiber, such as quinoa or oats
Commentary

Chef and CancerChoices Senior Clinical Advisor Laura Pole: You can lower the glycemic load of the food you eat, such as by cooking pasta al dente or eating cooked potatoes cold, as in a potato salad. 

You can reduce the glycemic load of grains and increase the availability of their calcium: Soak whole grains for eight hours in water with a tablespoon of an acidic food such as vinegar, yogurt, or lemon juice. Drain off the water and rinse the grains, then cook using ¼ less water and ⅓ less cooking time than usual. You could also eat ready-made sprouted grain bread and other products in which the grains and other ingredients were not ground into a flour, but soaked and sprouted. 

Including healthy fats, such as olive oil, nuts, or avocadoes, with other foods low in fat—such as vegetables in a salad—also increases nutrient absorption.

In this cooking video I talk about adding chia seed and almond butter to add fiber, fat, and protein to this smoothie which contains carbohydrates from strawberries, bananas, and carob.

Sedentary time

More sitting time is linked to a worse insulin profile, independent of the total amount of physical activity.13León-Latre M, Moreno-Franco B et al; Aragon Workers’ Health Study investigators. Sedentary lifestyle and its relation to cardiovascular risk factors, insulin resistance and inflammatory profile. Revista Española de Cardiología (English Edition). 2014 Jun;67(6):449-55.

Sleep disruption

Shorter self-reported sleep duration is linked to an increased incidence of type 2 diabetes. Decreasing either the amount or quality of sleep decreases insulin sensitivity and decreases glucose tolerance.14Nedeltcheva AV, Scheer FA. Metabolic effects of sleep disruption, links to obesity and diabetes. Current Opinion in Endocrinology, Diabetes, and Obesity. 2014 Aug;21(4):293-8.

Stress

Stress can also make controlling blood sugar difficult. During times of stress, individuals with diabetes may have more difficulty controlling their blood sugars.15Diabetes Education Online. Blood Sugar & Stress. University of California, San Francisco. Viewed September 16, 2022.

Body weight

The connections among obesity, uncontrolled blood sugar, and insulin resistance are widely accepted in conventional medicine. Obesity-related processes such as immune cell infiltration, inflammation, and increased oxidative stressan imbalance between free radicals and antioxidants in your body in which antioxidant levels are lower than normal; this imbalance can cause harmful oxidation reactions in your body chemistry promote metabolic impairments in insulin-sensitive tissues, leading eventually to insulin resistance, organ failure, and premature aging.16Chobot A, Górowska-Kowolik K, Sokołowska M, Jarosz-Chobot P. Obesity and diabetes—not only a simple link between two epidemics. Diabetes/Metabolism Research and Reviews. 2018 Oct;34(7):e3042.

Hormone imbalance

High levels of progesterone, such as during polycystic ovarian syndrome or the period in pregnancy when progesterone is highest, are linked to higher risk for diabetes. We haven’t published our handbook on hormone imbalance. This statement is from our research so far.

Medical treatments

Some treatments, including some cancer therapies, can contribute to imbalances resulting in high blood sugar or insulin resistance.

  • Higher insulin resistance after 12 months of maintenance therapy among children with acute lymphoblastic leukemia compared to baseline in a small observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods study17Esbenshade AJ, Simmons JH, Koyama T, Lindell RB, Friedman DL. Obesity and insulin resistance in pediatric acute lymphoblastic leukemia worsens during maintenance therapy. Pediatric Blood & Cancer. 2013 Aug;60(8):1287-91.

Glucocorticoids (steroids), asparaginase, mTOR (mammalian target of rapamycin) inhibitors, tyrosine kinase inhibitors, targeted drugs such as PI3K inhibitors like alpelisib, and immune checkpoint inhibitors, plus chemotherapy among people with breast cancer, are linked to higher risk of high blood sugar (hyperglycemia) or insulin resistance.18Grimes A, Mohamed A, Sopfe J, Hill R, Lynch J. Hyperglycemia during childhood cancer therapy: incidence, implications, and impact on outcomes. Journal of the National Cancer Institute Monographs. 2019 Sep 1;2019(54):132-138; Bicakli DH, Varol U et al. Adjuvant chemotherapy may contribute to an increased risk for metabolic syndrome in patients with breast cancer. Journal of Oncology Pharmacy Practice. 2016 Feb;22(1):46-53.

Risk factors for diabetes

Some examples of medical conditions which are risk factors for type 2 diabetes:19Chobot A, Górowska-Kowolik K, Sokołowska M, Jarosz-Chobot P. Obesity and diabetes—not only a simple link between two epidemics. Diabetes/Metabolism Research and Reviews. 2018 Oct;34(7):e3042; Diabetes and Pancreatic Cancer. Pancreatic Cancer Action Network. Viewed December 7, 2022.

  • Acanthosis nigricans (dark discoloration of skin in body folds and creases)
  • Early (precocious) puberty
  • High blood pressure (hypertension)
  • Abnormally elevated blood cholesterol or fats (dyslipidemia)
  • Polycystic ovary syndrome
  • Pancreatic cancer

Some ethnic groups have higher risk of type 2 diabetes:20Chobot A, Górowska-Kowolik K, Sokołowska M, Jarosz-Chobot P. Obesity and diabetes—not only a simple link between two epidemics. Diabetes/Metabolism Research and Reviews. 2018 Oct;34(7):e3042.

  • African American
  • Hispanic
  • Asian/Pacific Islander
  • Japanese
  • Middle Eastern

Resources

How can I find out if high blood sugar and insulin resistance is an issue for me?

High blood sugar, insulin resistance, pre-diabetes, and type 2 diabetes may have no symptoms or only vague symptoms. Many people may not know they have these conditions: “More than 37 million people in the United States have diabetes, and 1 in 5 of them don’t know they have it. 96 million US adults—over a third—have prediabetes, and more than 8 in 10 of them don’t know they have it.”21Diabetes Fast Facts. Centers for Disease Control and Prevention. December 17, 2021. Viewed August 4, 2022.

To find out if you have any of these conditions, ask your doctor for an evaluation, which may involve one or more lab tests to identify if your blood sugar, insulin, and insulin sensitivity are out of balance. 

If you’ve been diagnosed with diabetes, chances are you’ve had—and continue to have—some of these tests. 

Resources

Why are high blood sugar and insulin resistance important?

Direct connections to cancer 

Chronically high blood sugar may accelerate cancer progression, invasion, and migration to other areas of the body. High blood sugar may also help cancer cells resist normal cell death and may promote resistance to chemotherapy. It prompts the body to produce substances that promote inflammation and may be linked to development of tumors.22Li W, Zhang X et al. Effects of hyperglycemia on the progression of tumor diseases. Journal of Experimental & Clinical Cancer Research. 2019 Jul 23;38(1):327. 

“Insulin increases cell production and reduces cell death”23Underferth D. Sugar, insulin resistance and cancer: What’s the link? MD Anderson Cancer Center. June 21, 2021. Viewed August 12, 2022.—two hallmarks of cancer. Relatively small but chronic rises in blood sugar or insulin may contribute to cancer growth.24Mulholland HG, Murray LJ, Cardwell CR, Cantwell MM. Dietary glycaemic index, glycaemic load and endometrial and ovarian cancer risk: a systematic review and meta-analysis. British Journal of Cancer. 2008 Aug 5;99(3):434-41. Chronic high levels of insulin are linked to diabetes and several types of cancer.25Yin M, Zhou J, Gorak EJ, Quddus F. Metformin is associated with survival benefit in cancer patients with concurrent type 2 diabetes: a systematic review and meta-analysis. Oncologist. 2013 Dec;18(12):1248-1255; Underferth D. Sugar, insulin resistance and cancer: What’s the link? MD Anderson Cancer Center. June 21, 2021. Viewed August 12, 2022.

Cancer as a whole

Good evidencesignificant effects in one large or several mid-sized and well-designed clinical studies (randomized controlled trials (RCTs) with an appropriate placebo or other strong comparison control or observational studies that control for confounds) (this is the CancerChoices definition; other researchers and studies may define this differently) of slightly higher mortality among people with solid tumors with diabetes

Modest evidencesignificant effects in at least three small but well-designed randomized controlled trials (RCTs), or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observational studies), or several small studies aggregated into a meta-analysis (this is the CancerChoices definition; other researchers and studies may define this differently) of higher risk of cancer as a whole, including invasive cancer, among people with diabetes

Good evidence of higher cancer-specific mortality among people without cancer at baseline with poorer markers of blood sugar balance and insulin sensitivity

Bladder cancer

Preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently) of higher rate of cancer progression among people with non-muscle invasive bladder cancer with diabetes with high blood sugar levels

Preliminary evidence of higher risk of cancer recurrence among people with non-muscle invasive bladder cancer with diabetes

Brain cancer

Modest evidence of lower overall survival among people with glioblastoma and with high blood sugar levels

Breast cancer

Modest evidence of worse survival among people with breast cancer with diabetes

Modest evidence of higher risk of breast cancer among women with diabetes, including gestational diabetes

Modest evidence of higher risk of breast cancer diagnosis, recurrence, and possibly mortality among people with higher levels of insulin-like growth factor 1

Colorectal cancer

Modest evidence of higher mortality among people with colorectal cancer with the highest insulin index or insulin load

Preliminary evidence of higher local tumor malignancy among people with colorectal cancer with higher blood glucose levels

Preliminary evidence of higher risk of recurrence among people with stage 3 colorectal cancer with high blood glucose

Preliminary evidence of higher risk of left-side colorectal adenoma among people with higher levels of insulin-like growth factor 1

Gastrointestinal cancer

Good evidence of higher risk of gallbladder cancer among people with type 2 diabetes

Preliminary evidence of worse survival after radiofrequency ablation among people with early hepatocellular carcinoma (HCC) with diabetes

Preliminary evidence of higher risk of recurrence of hepatocellular carcinoma after initial liver resection among people with diabetes and with HbA1c higher than 9%

Good evidence of higher risk of hepatocellular carcinoma among people with type 2 diabetes

Gynecological cancer

Good evidence of a link between type 2 diabetes or insulin resistancea condition in which cells in your muscles, fat, and liver don’t respond well to insulin and can’t efficiently take up glucose from your blood for energy and endometrial cancer

Modest evidence of higher risk of developing cancer in any organ with high levels of estrogen receptors—including breast, endometrium, and ovaries—among people with decreased levels of estrogen as a result of insulin resistance

Head and neck cancers

Modest evidence of higher overall and cancer-specific mortality among people with head and neck cancer and diabetes

Kidney cancer

Modest evidence of a link between insulin resistance and renal cell carcinoma

Good evidence of higher risk of kidney cancer among people with diabetes

Lung cancer

Modest evidence of slightly lower mortality among people with lung cancer with diabetes

Preliminary evidence of higher risk of lung cancer among people with higher insulin levels and resistance

Lymphoma

Weak evidenceone or more case studies, supported by animal evidence OR small treatment effects of limited clinical significance OR studies with no controls OR weak trends of effects (this is the CancerChoices definition; other researchers and studies may define this differently) of higher overall and lymphoma-specific mortality among people with diabetes

Melanoma and other skin cancers

Preliminary evidence of more progression of melanoma among people with lower levels of insulin-like growth factor binding protein; IGFBP-3 binds IGFs, reducing their ability to promote tumor progression

Preliminary evidence of lower risk of malignant melanoma among people without a history of non-melanoma skin cancer with higher levels of IGF-I, but higher risk among people with a history

Ovarian cancer

Modest evidence of higher risk of ovarian cancer among people with diabetes

Modest evidence of higher risk of developing cancer in any organ with high levels of estrogen receptors, including ovaries, among people with decreased levels of estrogen as a result of insulin resistance

Pancreatic cancer

Modest evidence of worse survival of pancreatic cancer among people with diabetes

Good evidence of higher risk of pancreatic cancer among people with diabetes

Prostate cancer

Modest evidence of higher mortality among people with prostate cancer with diabetes

Preliminary evidence of worse survival among people with advanced prostate cancer with higher levels of insulin-like growth factor-1 (IGF-1)

Modest evidence of higher risk of prostate cancer among people with high serum levels of insulin-like growth factor

Modest evidence of a link between higher fasting insulin levels and homeostasis model assessment of insulin resistance and prostate cancer

Thyroid cancer

Good evidence of a substantially higher risk of thyroid cancer among people with insulin resistance

Connections to body terrain factors

Hyperglycemia and insulin resistancea condition in which cells in your muscles, fat, and liver don’t respond well to insulin and can’t efficiently take up glucose from your blood for energy have links to all the other body terrainthe internal conditions of your body, including nutritional status, fitness, blood sugar balance, hormone balance, inflammation and more factors. Sometimes the cause and effect are seen in both directions (bidirectional). Sometimes an imbalance in one terrain factor causes a domino effect, toppling the balance of other terrain factors. Details of these connections follow, but first we want to emphasize the web of connections among factors that aren’t as apparent by looking at factors one at a time.

For instance, hyperglycemia and insulin resistance trigger a cascade of immune events that promote inflammation, which, along with oxidative stressan imbalance between free radicals and antioxidants in your body in which antioxidant levels are lower than normal; this imbalance can cause harmful oxidation reactions in your body chemistry can then damage the inside of blood vessels and lead to coagulation problems such as developing blood clots along the lining of these vessels. While the “fires of inflammation” are burning, other immune functions, such as protection against infection, may be hampered by uncontrolled hyperglycemia and insulin resistance. People with diabetes are at higher risk for infection. 

Obesity (high body weight) is linked to insulin resistance, often being cited as the cause, but more recently being proposed as a possible result of insulin resistance. The relationship is complex, and measures to control weight and reduce insulin resistance are important pieces in optimizing your terrain.86Diabesity: How Obesity Is Related to Diabetes. Cleveland Clinic. November 8, 2021. Viewed September 15, 2022.

Another two-way link is between hyperglycemia/insulin resistance and hormone imbalances. Diabetes itself is a hormone imbalance condition,87Are Diabetes and Hormonal Imbalances Linked? Matthews Internal Medicine. Viewed September 15, 2022. but other hormones besides insulin can be involved. For instance, low testosterone is common in men with diabetes and is linked to insulin resistance. Estrogen may increase insulin sensitivity, while progesterone may reduce that sensitivity.

When a person is under stress, the body increases its release of stress hormones (glucocorticoids) such as cortisol and epinephrine. These hormones can impair the effects of insulin and slow down glucose absorption,88Bauerle KT, Harris C. Glucocorticoids and diabetes. Missouri Medicine. 2016 Sep-Oct;113(5):378-383. ensuring enough glucose is in the blood to provide energy for the fight-or-flight response. If stress hormones remain high for a prolonged time, chronically high levels of glucose in the blood can develop. 

Stress hormones surge during acute stress, but are also released in a daily up and down rhythm based on the body’s internal clock. For instance, stress hormones are normally lower during sleep and rise after waking. If these daily (circadian) rhythms are disrupted, such as from inadequate sleep or reversed sleep-wake times, hormones that affect glucose control, insulin resistance and basic metabolism can also get out of rhythm. In people with diabetes, these hormonal release rhythms may be disrupted, dangerously affecting blood sugar levels in the early morning. 

Not only do stress hormones follow a daily rhythmic pattern, but other hormones as well, including hormones related to metabolism. “An intimate relationship between circadian clocks and endocrine systems exists. This relationship is clinically relevant since disruption of the circadian clock is linked to metabolic disease.”89Pillon NJ, Loos RJF, Marshall SM, Zierath JR. Metabolic consequences of obesity and type 2 diabetes: Balancing genes and environment for personalized care. Cell. 2021 Mar 18;184(6):1530-1544. Metabolic hormones such as leptin, insulin and others respond to fasting/feeding cycles. Eating late at night, when the body is normally expected to fast, is linked to overweight and poor glycemic control. 

Your microbiomethe collection of microbes living on and within your body also influences and is influenced by glucose. Because of its important metabolic function, your microbiome may influence the development of both obesity and diabetes. An imbalanced gut microbiota is linked to impaired glycemic control and development of type 2 diabetes in the host.90Gérard C, Vidal H. Impact of gut microbiota on host glycemic control. Frontiers in Endocrinology (Lausanne). 2019 Jan 30;10:29. Measures to improve the health of your microbiome, such as through a diet including foods that are fermented or high in fiber, may promote beneficial microorganisms and contribute to the health of your metabolism. Healthy fermented foods include yogurt, miso, tempeh, and fermented vegetables such as sauerkraut.

Bottom line: Insulin resistance and high blood glucose affect and/or are affected by all the other terrain factors. We recommend you work with your healthcare practitioner to determine which terrain imbalances you may have and what is driving those imbalances. Then you can make a plan to optimize your terrain in the most sensible way. For instance, if you have high blood sugar and insulin resistance as well as chronic sleep disruption, it may make sense not only to treat your blood sugar and insulin balance up front, but also to improve your sleep.

Bleeding and coagulation imbalance

Many cancer types increase risk of coagulation problems. Some types of cancer increase risk of blood clots, while others increase risk of bleeding. If you’re at higher risk of blood clots, diabetes could increase your risk further.

Preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently) of increased blood clotting and platelet activation among people with type 2 diabetes and cardiovascular disease

Body weight

Modest evidencesignificant effects in at least three small but well-designed randomized controlled trials (RCTs), or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observational studies), or several small studies aggregated into a meta-analysis (this is the CancerChoices definition; other researchers and studies may define this differently) of excessive fat accumulation among people after developing insulin resistance

Modest evidence of better blood sugar and insulin sensitivity among people losing weight

Preliminary evidence of more weight loss among obese people who reduced high blood sugar levels

Hormone imbalance

Links between changes in metabolic hormones such as glucagon and diabetes

Preliminary evidence of high rates of testosterone deficiency among men with type 2 diabetes

Preliminary evidence of a link between low testosterone levels and insulin resistance among men with either type 1 diabetes or type 2 diabetes

Immune function

Modest evidence of impaired immune function among people with diabetes or high blood sugar

Inflammation

Good evidencesignificant effects in one large or several mid-sized and well-designed clinical studies (randomized controlled trials (RCTs) with an appropriate placebo or other strong comparison control or observational studies that control for confounds) (this is the CancerChoices definition; other researchers and studies may define this differently) of higher inflammation among people with type 2 diabetes

Oxidative stress

Modest evidence of higher incidence of oxidative stress among people with type 2 diabetes

Your microbiome

Modest evidence of a bidirectional link between insulin sensitivity/diabetes and gut microbial composition and diversity

Connections to symptoms and side effects

Symptoms not specific to cancer

Modest evidencesignificant effects in at least three small but well-designed randomized controlled trials (RCTs), or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observational studies), or several small studies aggregated into a meta-analysis (this is the CancerChoices definition; other researchers and studies may define this differently) of higher levels of vascular injury and risk of cardiovascular disease, heart attack (myocardial infarction), stroke, and peripheral artery disease among people with type 2 diabetes

Modest evidence of higher risk of cognitive dysfunction among people with diabetes or increased insulin resistance

Good evidencesignificant effects in one large or several mid-sized and well-designed clinical studies (randomized controlled trials (RCTs) with an appropriate placebo or other strong comparison control or observational studies that control for confounds) (this is the CancerChoices definition; other researchers and studies may define this differently) of higher incidence of depression among people with higher levels of blood sugar or type 2 diabetes

Preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently) of a link between depression and high blood sugar, but no evidence specific to people with cancer

Modest evidence of slower progression of neuropathy among some people with type 2 diabetes or delay of the development of neuropathy among patients with type 1 diabetes practicing tight glycemic control

Modest evidence of higher risk of infection and other complications, including short-term mortality, after surgery among people with poor glycemic control and/or insulin resistance

Modest evidence of longer hospital and/or intensive care unit (ICU) stays after surgery among people with diabetes with poor glycemic control

Resources

What approaches can help you manage high blood sugar and insulin resistance?

Conventional, self-care, and complementary approaches are all available to help you control high blood sugar or correct insulin resistance. These almost always require monitoring and guidance from a health professional.

Conventional approaches

Many conventional approaches are available to control high blood sugar and diabetes.

Self-care practices

Evidence supporting these statements is detailed in the linked pages.

Eating Well: good to preliminary evidence

Better fasting blood glucose and insulin among people eating legumes such as dried beans, lentils, split peas and chickpeas (good evidence)

Better blood sugar balance, insulin levels, and markers of metabolism among people eating a low-carbohydrate diet (modest evidence)

Lower insulin resistance among people with type 2 diabetes eating a diet high in inositol hexaphosphate (IP-6, abundant in cereals, legumes, and nuts) (preliminary evidence)

Lower markers of insulin resistance or metabolic syndrome among people eating foods rich in carotenoids (carrots, squash, mango, cantaloupe, sweet potatoes and tomatoes) and especially lycopene (tomatoes, guava, watermelon, papaya, red oranges, and pink grapefruit), but not after only 4 weeks (preliminary evidence)

Lower markers of blood sugar and insulin resistance among a general population drinking green tea, but not among people with prediabetes or type 2 diabetes (modest evidence)

Lower levels of insulin-like growth factor-1 (IGF-1) among people eating 8 small meals per day compared to 3 (preliminary evidence)

Higher risk of high blood sugar among people eating at night (preliminary evidence)

Exercise is one of the best insulin sensitisers!

Moving More: good and strong evidence

Better insulin balance among people with cancer as a whole participating in physical activity (good evidence)

Some better markers of insulin balance and insulin-like growth factor (IGF) among people with breast cancer with higher levels of physical activity (strong evidence)

Better insulin balance among people with colorectal cancer with higher levels of physical activity (strong evidence)

Combining Eating Well and Moving More: preliminary and weak evidence

Better insulin sensitivity and higher incidence of reduced diabetes medication among people with type 2 diabetes eating a vegetarian diet and participating in physical exercise (preliminary evidence)

Lower markers of glycemic imbalance among men with prostate cancer participating in a diet and an exercise program (weak evidence)

Better markers of insulin growth factor among men participating in a diet and exercise program (weak evidence)

Better markers of blood sugar and insulin among people participating in both diet and exercise (weak evidence)

Managing Stress

In response to stress, the body acts to make glucose available in the bloodstream: insulin levels fall, glucagon and epinephrine (adrenaline) levels rise and more glucose is released from the liver. At the same time, growth hormone and cortisol levels rise, which causes body tissues (muscle and fat) to be less sensitive to insulin. 124Diabetes Education Online. Blood Sugar & Stress. University of California, San Francisco. Viewed September 16, 2022.

Sleeping Well: good and weak evidence

Higher risk of prediabetes or diabetes among people with either short (5–6 hours/day) or long (more than 8 hours/day) sleep durations (good evidence)

Better markers of blood sugar and insulin resistance among people with better reported sleep quality (weak evidence)

Creating a Healing Environment: good evidence

Higher risk of type 2 diabetes among people without cancer with the highest body levels of bisphenol A (BPA) (good evidence)

Manage your body weight

Better blood sugar and insulin sensitivity among people losing weight (modest evidence)

Complementary therapies

We present complementary therapies supported by evidence for managing high blood sugar and insulin resistancea condition in which cells in your muscles, fat, and liver don’t respond well to insulin and can’t efficiently take up glucose from your blood for energy. Those with the best evidence are presented first. Details of research evidence are on our reviews of each therapy.

A therapy may show a stronger effect or have more evidence in some situations than in others.

Good or modest evidence of benefit

Good evidencesignificant effects in one large or several mid-sized and well-designed clinical studies (randomized controlled trials (RCTs) with an appropriate placebo or other strong comparison control or observational studies that control for confounds) (this is the CancerChoices definition; other researchers and studies may define this differently) indicates a relatively high degree of confidence that the therapy is linked to the outcomes as noted. Modest evidencesignificant effects in at least three small but well-designed randomized controlled trials (RCTs), or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observational studies), or several small studies aggregated into a meta-analysis (this is the CancerChoices definition; other researchers and studies may define this differently) means several smaller or at least one large study have found the effect described.

Flaxseed: modest evidence

Better blood sugar control and insulin sensitivity among people eating whole flaxseed but no evidence of a change in blood sugar control and insulin sensitivity with use of flax supplements (modest evidence)

Ketogenic diet: strong and preliminary evidence

A ketogenic diet is one potential means to minimize dietary sources of carbohydrates and instead supply fats as the primary energy source. The goal is to alter the metabolism of cancer cells and their associated stromal cells by decreasing glucose and increasing ketones as available energy sources.

Better blood sugar and insulin levels among people with cancer following a ketogenic diet (preliminary evidence)

Better markers of metabolism during radiation therapy among women with breast cancer following a ketogenic diet (preliminary evidence)

Better blood sugar and insulin levels among people with diabetes following a ketogenic diet (strong evidence)

Mediterranean diet: mixed evidence

Better markers of glycemic control among people with type 2 diabetes or other diagnoses following a Mediterranean diet (good evidence)

Lower fasting insulin and homeostatic model assessment of insulin resistance (HOMA-IR) but not HbA1C among people following a Mediterranean diet (good evidence)

Inconsistent evidence of an effect on fasting glucose among people following a Mediterranean diet

Nutrition before surgery: good evidence

Lower insulin resistance after surgery among people treated with an oral carbohydrate before surgery (good evidence)

Tai chi or qigong: modest evidence

Better blood sugar balance among people with or at risk of metabolic syndrome (not specific to people with cancer) practicing tai chi (good evidence)

Turmeric and curcumin: modest evidence

Better blood sugar control and insulin sensitivity among people with impaired glucose tolerance or polycystic ovary syndrome treated with curcumin (modest evidence)

Vitamin D: mixed evidence

Higher risk of type 2 diabetes among people with lower 25(OH)D levels (good evidence)

Better markers of glycemic control (HbA1c) and lower risk of insulin resistance among people without diabetes with higher 25(OH)D levels (good evidence)Lower fasting glucose among women with polycystic ovary syndrome treated with vitamin D (modest evidence)

Lower insulin resistance and higher insulin sensitivity among people treated with vitamin D (modest evidence)

Slightly lower risk of type 2 diabetes among women with the highest vitamin D intake from supplements (modest evidence)

Higher insulin sensitivity and better blood glucose levels among people at risk for type 2 diabetes with higher vitamin D 25(OH)D levels (preliminary evidence)

Lower vitamin D 25(OH)D levels among people with diabetes (preliminary evidence)

Lower insulin resistance (HOMA) and better insulin sensitivity among people with diabetes or insulin resistance treated with vitamin D3 (preliminary evidence)

Lower insulin levels among women with polycystic ovary syndrome taking vitamin D supplements, but only when used in combination with calcium, vitamin K, zinc, or magnesium (weak evidence)

Weak (conflicting) evidence of an effect on glycemic control (HbA1c), fasting blood glucose, insulin levels, and other measures of blood glucose and insulin balance among people with diabetes or insulin resistance

Vitamin D and calcium together: modest evidence

Better blood sugar and insulin balance among people treated with both vitamin D and calcium (modest evidence)

Yoga: modest evidence

Better markers of blood sugar and insulin balance among people practicing yoga, mostly among people with prediabetes, diabetes, or metabolic syndrome (modest evidence)

Therapies with preliminary or weak evidence of benefit for high blood sugar and insulin resistance

Preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently) typically indicates that not much research has been published so far, although the outcomes may be meaningful. Weak evidenceone or more case studies, supported by animal evidence OR small treatment effects of limited clinical significance OR studies with no controls OR weak trends of effects (this is the CancerChoices definition; other researchers and studies may define this differently) may mean that the effects are small or that only very preliminary research has been published.

Acupressure Learn moreSee Less
Acupuncture Learn moreSee Less
Cannabis and cannabinoids (marijuana) Learn moreSee Less
Non-aspirin non-steroidal anti-inflammatory drugs (NSAIDs) Learn moreSee Less
Vitamin D and omega-3 fatty acids together Learn moreSee Less
Vitamin D, vitamin K, and calcium together Learn moreSee Less

Therapies with no evidence or insufficient evidence of benefit

Reishi mushroom ›

Not specific to cancer:

  • No evidence of a clinical effect on blood sugar or insulin resistance among people with type 2 diabetes treated with reishi mushrooms in a combined analysis of 3 small studies

Vitamin D and whey protein

Not specific to cancer:

  • No evidence of an effect on markers of blood glucose and insulin resistance during participation in progressive resistance training among adults aged 50–75 years with overweight or obesity and with type 2 diabetes treated with whey protein and vitamin D3 in one trial

Further therapies we have not yet reviewed

Those in bold are evaluated favorably in a clinical practice guideline for people with diabetes; see belowUse your browser's Back button to return to this location. for guidelines ›

Breathing therapies

Aloe vera (oral)

Alpha-lipoic acid

Anthocyanin

A specific Ayurveda formulation of six herbs

Berberine

Bitter melon (Momordica charantia)

Citrullus colocynthis

Coccinia cordifolia

Chromium

Cinnamon

Coenzyme Q10

Fasting ›

Fenugreek (Trigonella foenum graecum)

Garlic

Ginger

Ginseng (Panex ginseng, P. quiquefolius)

Gymnema (Gymnema sylvestre)

Gynostemma pentaphyllum

Hintonia latiflora

Inositol

Ivy gourd (Coccinia indica)

Lichen genus Cladonia BAFS “Yagel-Detox”

Magnesium

Marine collagen peptides

Milk thistle

Nettle

Nuts

Omega-3 fatty acid eicosapentaenoic acid

Prickly pear cactus, or nopal (Opuntia streptacantha)

Pterocarpus marsupium (vijayasar)

Resveratrol ›

Salacia reticulata 

Scoparia dulcis porridge

Soybean-derived pinitol extract

Touchi soybean extract

Vanadium

Traditional Chinese medicine herbs:

  • Fructus Mume
  • Gegen Qinlian Decoction (GQD)
  • Jianyutangkang (JYTK) with metformin
  • Jinlida with metformin
  • Sancaijiangtang
  • Shen-Qi-Formula (SQF) with insulin
  • Tang-Min-Ling-Wan (TM81)
  • Xiaoke (contains glyburide)
  • Zishentongluo (ZSTL)

How do integrative experts manage high blood sugar and insulin resistance?

Both medical groups and integrative experts provide recommendations for managing high blood sugar and insulin resistance. Learn more about the approaches and meanings of recommendations.

Clinical practice guidelines

These 2018 guidelines found that in adults with type 2 diabetes, the following complementary therapies were shown to lower glycated hemoglobin (A1C) by at least 0.5% in randomized controlled trials lasting at least 3 months. The researchers concluded that “these products are promising and merit consideration and further research, but, as they are mostly single, small trials or meta-analyses of such, it is premature to recommend their widespread use.”

Aloe vera (oral)

A specific Ayurveda formulation of six herbs

Berberine

Citrullus colocynthis

Coccinia cordifolia

Fenugreek

Ginger

Gynostemma pentaphyllum

Hintonia latiflora

Lichen genus Cladonia BAFS “Yagel-Detox”

Marine collagen peptides

Milk thistle (silymarin)

Nettle

Omega3 fatty acid eicosapentaenoic acid

Pterocarpus marsupium (vijayasar)

Reishi mushroom

Salacia reticulata

Scoparia dulcis porridge

Soybean-derived pinitol extract

Touchi soybean extract

Yoga

Traditional Chinese medicine herbs:

  • Fructus Mume
  • Gegen Qinlian Decoction (GQD)
  • Jianyutangkang (JYTK) with metformin
  • Jinlida with metformin
  • Sancaijiangtang
  • Shen-Qi-Formula (SQF) with insulin
  • Tang-Min-Ling-Wan (TM81)
  • Xiaoke (contains glyburide)
  • Zishentongluo (ZSTL)

Published programs and protocols

These protocolsa package of therapies combining and preferably integrating various therapies and practices into a cohesive design for care, programs, and approaches by leaders in integrative cancer care provide guidance for managing high blood sugar and insulin resistance.

We do not recommend specific integrative protocols or programs but provide information for you to evaluate with your healthcare team.

Lise Alschuler, ND, FABNO, and Karolyn Gazella

Approaches are described for certain cancer types, or along with certain conventional therapy treatments, or for particular conditions such as insulin resistance.

The Definitive Guide to Cancer, 3rd Edition lists natural agents with broad spectrum use against insulin resistance, lists therapies and natural products used in reversing/managing insulin resistance, and advises dietary measures to manage insulin resistance among people with breast cancer.

The Definitive Guide to Thriving after Cancer explains lifestyle practices such as diet and movement, and natural products used in preventing or reversing insulin resistance.

Keith Block, MD

Block KI. Life over Cancer: The Block Center Program for Integrative Cancer Care. New York: Bantam Dell. 2009.

The integrative Block Program has recommendations to people who are at different places along the cancer continuum:

  • Those who’ve been recently diagnosed
  • Those in treatment
  • Those who’ve concluded treatment and need to remain vigilant to prevent recurrence

This approach includes a test of serum insulin growth factor-1 (IGF-1) levels in terrain testing for problems with blood sugar and insulin sensitivity. This hormone, usually elevated in metabolic syndrome, can stimulate cancer cell growth.

Lorenzo Cohen, PhD, and Alison Jefferies, MEd

Cohen L, Jefferies A. Anticancer Living: Transform Your Life and Health with the Mix of Six. New York: Viking. 2018.

This book introduces the concept of the Mix of Six, which is identical to six of our 7 Healing Practices ›

Dr. Cohen and Ms. Jefferies explain that while each plays an inde­pendent role, the synergy created by all six factors can radically transform health, delay or prevent many cancers, support conventional treatments, and significantly improve quality of life.

This program includes movement as a means of combating insulin resistance and other problems of being sedentary and managing your microbiome, with insulin resistance being influenced by microbial diversity.

Gerald M. Lemole, MD; Pallav K. Mehta, MD; and Dwight L. McKee, MD

Lemole GM, Mehta PK, McKee DL. After Cancer Care: The Definitive Self-Care Guide to Getting and Staying Well for Patients with Cancer. New York, New York: Rodale, Inc. 2015.

These doctors present easy-to-incorporate lifestyle changes to help you “turn on” hundreds of genes that fight cancer, and “turn off” the ones that encourage cancer, while recommending lifestyle approaches to address each type.

This program recommends what and when to eat to prevent insulin spikes and manage blood sugar, lists foods to avoid to reduce stimulation of insulin growth factor-1 (IGF-1), and recommends exercise as a tool to manage insulin and obesity.

Neil McKinney, BSc, ND

McKinney N. Naturopathic Oncology, Fourth Edition. Victoria, BC, Canada: Liaison Press. 2020.

This book includes descriptions and uses of many natural and complementary protocols for cancer in general and for specific cancers. It also includes information on integrative support during conventional cancer treatment.

Dr. McKinney describes dietary interventions and supplements as tools to manage insulin resistance, hyperinsulinism, control of insulin-like growth factor.

Gurdev Parmar, ND, FABNO, and Tina Kaczor, ND, FABNO

Parmar G, Kaczor T. Textbook of Naturopathic Oncology: A Desktop Guide of Integrative Cancer Care. 1st edition. Medicatrix Holdings Ltd. 2020.

This book provides information on the treatment of 24 cancers, plus the most effective treatments of the most common symptoms affecting cancer patients while they undergo chemotherapy, radiotherapy, or surgery.

These doctors explain the link between glucose and cancer and advise educating patients on healthy eating guidelines that include guidance on glycemic effects of food.

David Servan-Schreiber, MD, PhD

Servan-Schreiber D. Anticancer: A New Way of Life. New York: Penguin Books. 2009.

This book provides tips on how people living with cancer can fight it and how healthy people can prevent it.

This program uses dietary patterns and specific foods to manage insulin resistance and insulin growth factor.

Nasha Winters ND, FABNO, LAc, DiplOM and Jess Higgins Kelley, MNT

Winters ND, Kelley JH. The Metabolic Approach to Cancer. 2017. Chelsea Green Publishing.

This book’s metabolic approach to cancer is a “naturopathic nutrition program that uses the medicinal powers of traditional foods, therapeutic diets and non-toxic lifestyle approaches as cancer counteragents and preventives.“ The program focuses on 10 terrain elements and how to assess them and bring them into balance.

This book provides a blood sugar balance questionnaire and suggests testing for high blood sugar and insulin resistance. If assessments indicate problems with high blood sugar/insulin resistance, they suggest focusing on chapter 4 of the book, which describes using the ketogenic diet, but under medical supervision by a practitioner experienced in prescribing and managing a ketogenic diet.

Other expert assessments

This 2014 review advises dietary control of insulin resistance and type 2 diabetes, including supervised weight loss.

Are you a health professional?

This section does not replicate the other information on this page but provides additional details or context most relevant to professionals.

Connection to pancreatic cancer

New diabetes in adults, especially rapidly progressing diabetes, could be an indication of pancreatic cancer. Cancer evaluation is recommended in such cases.125Diabetes and Pancreatic Cancer. Pancreatic Cancer Action Network. Viewed December 7, 2022.

Modes of action

Diabetes and cancer share some common underlying pathways. For example, obesity is common in people with type 2 diabetes, and it has also been associated with several types of cancer.126American Cancer Society. Does body weight affect cancer risk? June 9, 2020. Viewed August 11, 2022. However, obesity doesn’t seem to fully explain the increased cancer risk among people with diabetes. Some researchers propose that the cancer risk among diabetics is more likely linked to metabolic factors “related to insulin resistance, hyperinsulinemia, and their influence on the insulin growth factor (IGF) system, which may stimulate cell proliferation and inhibit programmed cell death (apoptosis).”127La Vecchia C, Bosetti C. Metformin: are potential benefits on cancer risk extended to cancer survival? The Oncologist. 2013 Dec;18(12):1245-1247.

Metabolism

“A common characteristic of the tumor microenvironment is altered metabolism, or energy creation. Typically cells efficiently metabolize glucose to make ATP, the currency of energy, within the mitochondria. However, some cancer cells and other co-opted cells in the tumor microenvironment lose the ability to make ATP within the mitochondria and metabolize glucose to ATP within the cell’s cytoplasm. This method is inefficient so the demand for glucose is very high. As a result of this altered metabolism, several integrative strategies attempt to limit the availability of glucose to tumors, thereby starving them. Healthy cells can withstand the lack of glucose as they are generally more adept at using other food substrates, especially fat, and to a lesser extent, protein, to make energy.128Alschuler L. (2022). Module 3: Hallmarks of Cancer/Tumor Microenvironment/Body Terrain Online Course Lecture. In Pole L, O’Toole C, Price E, Alschuler L, Romanski B, Hepp N. Integrative Oncology Patient Navigation Training. Maryland University of Integrative Health.

Researchers have proposed that the higher cancer risk seen with diabetes is linked to metabolic factors “related to insulin resistance, hyperinsulinemia, and their influence on the insulin growth factor (IGF) system, which may stimulate cell proliferation and inhibit programmed cell death (apoptosis).”129La Vecchia C, Bosetti C. Metformin: are potential benefits on cancer risk extended to cancer survival? The Oncologist. 2013 Dec;18(12):1245-124.

Potential mechanisms of action of dietary polyphenols in the regulation of glucose homeostasis and insulin sensitivity based on in vitro and in vivo studies130Kim Y, Keogh JB, Clifton PM. Polyphenols and glycemic control. Nutrients. 2016 Jan 5;8(1). pii: E17.

  • Estrogen receptor (ER) activation under chronic hyperinsulinemic conditions increases breast cancer growth131Wairagu PM, Phan AN et al. Insulin priming effect on estradiol-induced breast cancer metabolism and growth. Cancer Biology & Therapy. 2015;16(3):484-92.
  • Discussion of the interaction between insulin and IGF signaling in cancer cells132Gallagher EJ, LeRoith D. Minireview: IGF, insulin, and cancer. Endocrinology. 2011 Jul;152(7):2546-51.
  • Summary of the nosogenesis of diabetes, giving primary focus to oxidative stress and inflammation133Meng B, Li J, Cao H. Antioxidant and antiinflammatory activities of curcumin on diabetes mellitus and its complications. Current Pharmaceutical Design. 2013;19(11):2101-13.
  • “Breast cancer cells impair the function of pancreatic islets to make them produce less insulin than needed, leading to higher blood glucose levels in breast cancer patients compared to females without cancer.”134LaFee S. The paired perils of breast cancer and diabetes. UC San Diego News Center. May 30, 2022. Viewed July 2, 2022; Cao M, Isaac R et al. Cancer-cell-secreted extracellular vesicles suppress insulin secretion through miR-122 to impair systemic glucose homeostasis and contribute to tumour growth. Nature Cell Biology. 2022 Jun;24(6):954-967.

Ketosis 

Some cancer cells within tumors and some tumor-associated cells in the tumor microenvironment convert to a complete dependence on glucose for energy generation. This is a key alteration. These catabolic cells do not have properly functioning mitochondria, and so normal energy production via citric acid cycling and oxidative phosphorylation is not available. Typical Western diets high in refined carbohydrates provide this glucose substrate as well as promote the insulin pathway, releasing growth factors that may be associated with promoting cancer development and progression.135Erickson N, Boscheri A, Linke B, Huebner J. Systematic review: isocaloric ketogenic dietary regimes for cancer patients. Medical Oncology. 2017 May;34(5):72.

Stress and other lifestyle factors

The combination of the stress hormones cortisol and adrenaline increases blood glucose levels. Chronic high blood glucose episodes can be a direct or indirect mediator of the increase in tumor cell growth.136Ryu TY, Park J, Scherer PE. Hyperglycemia as a risk factor for cancer progression. Diabetes & Metabolism Journal. 2014 Oct;38(5):330-6. Cortisol also increases insulin resistance and seems to stimulate the ability of some cancer cells to grow and metastasize.137Block KI. Life over Cancer: The Block Center Program for Integrative Cancer Treatment. New York: Bantam Dell. 2009. p. 411; Moreno-Smith M, Lutgendorf SK, Sood AK. Impact of stress on cancer metastasis. Future Oncology. 2010 Dec; 6(12):1863-1881.

Besides stress, nutrition, activity, and sleep disruption all need to be assessed and managed in people with cancer and hyperglycemia and insulin resistance. These factors are described in the section above titled Why are high blood sugar and insulin resistance important?

Interactions of hyperglycemia and insulin resistance with cancer treatments

Insulin-like growth factor may partially block tamoxifen’s effects138Singer CF, Hudelist G, Schreiber M, Kubista E. Pharmacological modulation of IGF serum concentrations as a therapeutic approach to control the growth of malignant breast tumors. Drugs of Today (Barcelona, Spain). 2003 Feb;39(2):115-25; Lee AV, Weng CN, Jackson JG, Yee D. Activation of estrogen receptor-mediated gene transcription by IGF-I in human breast cancer cells. Journal of Endocrinology. 1997 Jan;152(1):39-47. and may also enhance resistance to chemo/radiotherapy.139Moschos SJ, Mantzoros CS. The role of the IGF system in cancer: from basic to clinical studies and clinical applications. Oncology. 2002;63(4):317-32; Lu Y, Zi X, Zhao Y, Mascarenhas D, Pollak M. Insulin-like growth factor-I receptor signaling and resistance to trastuzumab (Herceptin). Journal of the National Cancer Institute. 2001;93(24):1852-7; Beech DJ, Parekh N, Pang Y. Insulin-like growth factor-I receptor antagonism results in increased cytotoxicity of breast cancer cells to doxorubicin and taxol. Oncology Reports. 2001 Mar-Apr;8(2):325-9.; Singer CF, Hudelist G, Schreiber M, Kubista E. Pharmacological modulation of IGF serum concentrations as a therapeutic approach to control the growth of malignant breast tumors. Drugs of Today (Barcelona, Spain). 2003 Feb;39(2):115-25. Chemotherapy may be more toxic in people with diabetes and/or elevated blood glucose.140Gennari A, Salvadori B et al. Cardiotoxicity of epirubicin/paclitaxel-containing regimens: role of cardiac risk factors. Journal of Clinical Oncology. 1999 Nov;17(11):3596-602.

Professional resources

Journal articles

Chiefari E, Mirabelli M et al. Insulin resistance and cancer: in search for a causal link. International Journal of Molecular Sciences. 2021 Oct 15;22(20):11137.

Yee LD, Mortimer JE, Natarajan R, Dietze EC, Seewaldt VL. Metabolic health, insulin, and breast cancer: why oncologists should care about insulin. Frontiers in Endocrinology (Lausanne). 2020 Feb 20;11:58.

Mirabelli M, Chiefari E et al. Mediterranean diet nutrients to turn the tide against insulin resistance and related diseases. Nutrients. 2020 Apr 12;12(4):1066.

Shanmugalingam T, Bosco C, Ridley AJ, Van Hemelrijck M. Is there a role for IGF‐1 in the development of second primary cancers? Cancer Medicine. 2016 Nov;5(11):3353-3367.

Christopoulos PF, Msaouel P, Koutsilieris M. The role of the insulin-like growth factor-1 system in breast cancer. Molecular Cancer. 2015 Feb 15;14:43.Christopoulos PF, Msaouel P, Koutsilieris M. The role of the insulin-like growth factor-1 system in breast cancer. Molecular Cancer. 2015 Feb 15;14:43.

Hardy OT, Czech MP, Corvera S. What causes the insulin resistance underlying obesity? Current Opinion in Endocrinology, Diabetes, and Obesity. 2012 Apr;19(2):81-7.

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Authors

Laura Pole, RN, MSN, OCNS

Senior Clinical Consultant
View profile

Laura Pole is senior clinical consultant for CancerChoices. Laura is an oncology clinical nurse specialist who has been providing integrative oncology clinical care, navigation, consultation, and education services for over 40 years. She is the co-creator and co-coordinator of the Integrative Oncology Navigation Training at Smith Center for Healing and the Arts in Washington, DC. Laura also manages the “Media Watch Cancer News That You Can Use” listserv for Smith Center/Commonweal. In her role as a palliative care educator and consultant, Laura has served as statewide Respecting Choices Faculty for the Virginia POST (Physician Orders for Scope of Treatment) Collaborative as well as provided statewide professional education on palliative and end-of-life care for the Virginia Association for Hospices and Palliative Care.

For CancerChoices, Laura curates content and research, networks with clinical and organizational partners, brings awareness and education of integrative oncology at professional and patient conferences and programs, and translates research into information relevant to the patient experience as well as clinical practice.

Laura sees her work with CancerChoices as a perfect alignment of all her passions, knowledge and skills in integrative oncology care. She is honored to serve you.

Laura Pole, RN, MSN, OCNS Senior Clinical Consultant

Nancy Hepp, MS

Lead Researcher and Program Manager
View profile

Ms. Hepp is a researcher and communicator who has been writing and editing educational content on varied health topics for more than 20 years. She serves as lead researcher, program manager, and writer for CancerChoices. Her graduate work in research and cognitive psychology, her master’s degree in instructional design, and her certificate in web design have all guided her in writing and presenting information for a wide variety of audiences and uses. Nancy’s service as faculty development coordinator in the Department of Family Medicine at Wright State University also provided experience in medical research, plus insights into medical education and medical care from the professional’s perspective.

Nancy Hepp, MS Lead Researcher and Program Manager

Reviewer

Dr. Fuller-Shave is a GMC-registered integrative medicine doctor with degrees in medicine and natural sciences from the University of Cambridge. Dr. Fuller-Shavel is a fellow of the College of Medicine and the vice chair for BSIO (British Society for Integrative Oncology). Alongside her science and medical training, Dr. Fuller-Shavel holds multiple qualifications in nutrition, integrative medicine, health coaching, herbal medicine, yoga, mindfulness and other mind-body approaches.

Dr. Fuller-Shavel is the director of Synthesis Clinic, an award-winning multidisciplinary integrative medicine practice in Hampshire, UK, specializing in women’s health, gut health (microbiome and gut-brain axis) and mental health. She combines her clinical work in women’s health and supporting patients with breast and gynecological cancer with education and training for healthcare professionals and research in precision cancer medicine and precision nutrition.

Nina Fuller-Shavel, MB, BChir, MA Hons, FBANT, IFMCP, DipIM, PG Cert RYT300

Last update: December 31, 2022

Last full literature review: July 2022

CancerChoices provides information about integrative in cancer care, a patient-centered approach combining the best of conventional care, self care and evidence-informed complementary care in an integrated plan cancer care. We review complementaryin cancer care, complementary care involves the use of therapies intended to enhance or add to standard conventional treatments; examples include supplements, mind-body approaches such as yoga or psychosocial therapy, and acupuncture therapies and self-care lifestyle actions and behaviors that may impact cancer outcomes; examples include eating health-promoting foods, limiting alcohol, increasing physical activity, and managing stress practices to help patients and professionals explore and integrate the best combination of conventionalthe cancer care offered by conventionally trained physicians and most hospitals; examples are chemotherapy, surgery, and radiotherapy and complementary therapies and practices for each person.

Our staff have no financial conflicts of interest to declare. We receive no funds from any manufacturers or retailers gaining financial profit by promoting or discouraging therapies mentioned on this site.

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