Current cancer therapies and their influence on glucose control

Table 3 The underlying mechanisms and treatment considerations of hyperglycemia differ between chemotherapy classes

	Etiology of hyperglycemia	Treatment considerations
Glucocorticoids	Major: Insulin resistance	Oral hypoglycemics possible for mild
	Minor: Decreased insulin release	Consider selecting insulins with duration of action to match that of the steroid being given
5-FU and analogs	Major: Decreased insulin release and production	Diet or oral hypoglycemics for mild
		Insulin for severe
PI3K/mTOR inhibitors	Major: Insulin resistance	Diet or metformin for mild
Immune checkpoint inhibitors	Major: Profound insulin deficiency	Immediate initiation of insulin in new onset hyperglycemia
		Switch to insulin in pre-existing T2DM

5-FU: 5-fluorouracil; PI3K: Phosphatidyl inositol-3-kinase; mTOR: Mammalian target of rapamycin; T2DM: Type 2 diabetes mellitus.