Steroid Induced Diabetes Management

[ingemlb]

I thought to start this thread to specifically discuss diabetes but with a focus on steroid induced diabetes.
Within 3 days of starting Prednisolone in late January my sugar went out of control and I was diagnosed as steroid induced diabetic. I had been on and off diagnosed pre-diabetic but managed to control it with diet and the last few years blood tests had been in the normal range.

It was decided with my own input to start insulin injections. I didn't want to fiddle around for months trying to stabilise on some other oral drug living with the high hope that once the pred was reduced or even discontinued the diabetes would reverse itself. I also felt that as the pred was going to be adjusted continuously it would be easier to adjust the insulin than oral diabetic medication.

Only issue was that I was put on Novamix which controlled the highs but introduced too many lows for my liking. I was constantly worried about hypos especially during the night and early mornings. The insulin was reduced when the pred was reduced however that then made the sugar jump far too high in the afternoon/evenings.

I finally managed to get hold of an Endocrinologist who decided that in my case the novamix wasn't the best option. Something I had been wondering myself as I figure with normal fast acting Insulin I could be more in control. So I am now on Novarapid which I take 2x a day. 8 Units after I take the pred with my lunch and 6 units after dinner.

But it's a learning curve for me. So I am doing very frequent measuring of my blood sugar with the aim being to get it to as normal a level as possible. Having the instant insulin here also means I can now reduce my carb consumption. I was eating cake and carbs around the clock to avoid hypos. Not great for the waist.

The cake weaning was a bit harder than I thought. Also because I stuffed up on Tuesday and was 8 hours late with taking my pred hence everything was rather mucked up.

Wednesday was my last day on Novamix and due to the very late (8pm) intake of Pred my sugar jumped to an all-time high before bedtime
Thursday I was surprised that overnight it had dropped to 6.6 which is close to normal for fasting (should really be under 6)
Thursday lunchtime it was 6.3. I had Chicken casserole and rice for lunch. 30 mg Pred and 8 units of Novarapid.
Here is how the sugar behaved:
5am 6.6
1pm 6.3 (before eating lunch and taking pred)
2.30pm 9.4
6pm 17.9 (regarded dangerously high) - before dinner
9pm 15.0 (I was initially told I must try to keep it below 14 however as long as it keeps dropping the Endo was not too worried)
3am (Friday) 8.6
So I wasn't too worried it being day 1. I also know what drove it up so high after dinner. I had some cake as afternoon snack. Bad time of day
for me to eat cake as it was also on top of the rice for lunch.
Friday was as follows:
5am 7.0
1pm 6.5 (before lunch and pred)
6pm 16.9 (after dinner and 6 units of Insulin)
9pm 16.6
11:45pm 9.4
Same transgression. Had cake in the afternoon

Saturday I behaved myself.
5am 8.6
1pm 6.8
6pm 14.2 (after dinner and 6 units of Insulin)
8pm 17.7 Now I worried and decided to take 2 more units of Insulin
10pm 14.8

By Sunday (today) morning it was down to 6.7

Strange thing I found was that the sugar was higher in the evening when I didn't eat the cake in the afternoon. All I can think is that on both previous days instead of our usual soup we decided on a toasted chicken or ham sandwich made with wholegrain bread. But it must be the bread was too high in carbs. Not sure will be tracking this a bit longer. But I think when the sugar climbs above 14 I will simply take 2 Units of insulin or 4 if it is much higher.

Ringing the Endo early next week to discuss progress. He may decide to increase the novarapid both at lunchtime and dinner time.

Anyway, thought for anyone else totally new to diabetes management this may be useful information. The units we use in Australia are different to those used elsewhere when measure Blood Glucose. Here are the recommended values explained:
Fasting - if below 5.5 no diabetes; if between 5.6 and 6.9 could indicate pre-diabetic and needs more testing; If over 7 it's diabetes.
Non-Fasting - if below 5.5 no problem. if between 5.5 and 11 more testing could a) decide no diabetes or pre-diabetic . if over 11 and fasting glucose tolerance test shows up over 7 then it's definitely diabetes.
I was told at the hospital to sing out when the blood glucose goes over 14 after eating. So at the moment that is the guideline I am using. If it is constantly over 14 after lunch and dinner I should probably increase the insulin.

The great thing with novarapid is I can sleep at night without worrying about hypos and go out in the mornings without worrying about hypos. It will also be very easy now to adjust the units once the pred starts coming down again.

[annekat]

Very interesting and informative, Inge. My mother had the steroid induced diabetes and had to give herself insulin, but only for maybe a couple of months, after having pneumonia and being put on pred. No sign of this happening in me, yet, but reading your experience is enlightening in case it ever should. Those hypos sound awful. I'm sorry you have to go through this, but you are really taking it in stride and handling it intelligently, which I admire, and reporting on it in a way that will help others!

[ingemlb]

Well clever me!!! Today I wanted to get it TOTALLY RIGHT and avoided all cake. Had no bread for breakfast or lunch. Then got extremely hungry around 4pm so had a bit of cheese, a bit of salami and probably bad idea a tangelo. Before dinner BS was 14.8 and we had roast chicken, roast pumpkin and roast sweet potato and roast potato.

So I decided i would increase the insulin to 8 units instead of 6. Which I did. However I had a hard time pushing the needle down and then it got totally stuck on 2 units. I pulled it out and examined it and found that I had not screwed it on properly. funny enough I had not seen that when I primed it. So I screwed it tight and a big stream of insulin came spurting out. So now I don't know if any or none of it got into my system. I decided to take another 4 units and then check every 2 hours to see how it is going in case i need more :(

[drz]

In my experience managing my diabetes takes a lot more work and creates a lot more emotional strain than Wegs but learning to manage my diabetes was really good training to help me adjust to having Wegs. Hypos are a bad experience and can be very dangerous but the other extreme can also be too.

I rely on on my continuous glucose monitor to help me monitor both plus 8-10 finger stick readings a day and a 6-12 adjustments to my insulin pump to try keep blood glucose in a tolerable range. Is USA we usually similar numbers for our A1C levels which average blood glucose for past 60 days and I finally got my A1C level under 8 again for first time since I started on prednisone over four years ago because of Wegs. One can get normal or lower A1C levels by having many hypoglycemic episodes but this is very undesirable way to do so. My endo is more concerned with number of hypos than overall A1C levels.

My meters are calibrated for a 100 being normal desirable, 70-75 starting the hypo range, and anything over 250 getting dangerously high. I usually see both extremes most days but my endo is happy with my management given the fact i still take 5 mg of pred daily and most likely will continue to do so the rest of my life.

[chris.wg]

I was diagnosed as a diabetic in the hospital when I had my WG diagnosed. But I was barely over and knew it was coming family history and all. Within both parents immediate families out 8/12 with it. Plus I have helped manage a young lady with type 1. First question I have is are you snacking between meal. High protein style snack with a little carbs. I have been pure diet controlled for over a year now since getting off the pred the first time. I was on metformin before that. But what was explained to me is the mid meal snacks are needed to help regulate sugar. It actually helped a lot I use to find myself with spikes just before my dinner testing. When I started a mid day snack between lunch and dinner. Nothing high carb mostly cottage cheese or cheese or things like that it helped a lot. As for the lows I will warn you watch those CLOSE highs can do damage as everyone knows but lows are the danger because most people don't realize how dangerous they are. I have not looked into it but was told that low drops can actually kill brain cells. Maybe someone with more medical back ground then me can confirm this but was told this is due to the fact that sugars is the only thing that feeds our brain. But something my fathers doctor said to him why lows are extremely dangerous. For 2 different reasons both high and low can render you unconscious. When you are too high in most situations eventually you will come back to as your body disposes of the sugar. But if your to low its not like your taking food in. Still all and all I seriously suggest adding a higher protein snack between breakfast and lunch and between lunch and dinner.

[ingemlb]

Thanks Chris. Yes I was freaking out with the lows. Last year a young friend I had met online died during a hypo attack in her sleep. Hence my paranoia. I was having constant snacks between breakfast and lunch to avoid the lows and also before bed time and sometimes 3am in the morning.Some days even the snack was not enough and if I got distracted I would suddenly find myself shaking and sweating.

However now that I am off the novamix the lows are no longer a problem. I was only getting them because the novamix was releasing a constant stream of insulin into my body which I only needed to lower the sugar after taking the pred. Hence now I can control it quite well. Just have to be firm with myself. Since starting on the Novarapid I have never been below 6 so that's the lows gone. I now just need to get on top of the highs.

And thanks drz I can relate to the frequent finger stick exercises. I had the A1C test done recently and it came back 7.2 so my Rheumatologist said not perfect but better than lots. My Endo said should be lower. So will see what it says next time now I am on the new insulin. Mind you now that I read your post I am wondering if the 7.2 was thanks to the regular hypos!!!

Really appreciate your feedback :)

[ingemlb]

Ok it’s been 6 days on the new Novarapid so here is a summary of how the days went.


Date

Time

BG reading



Thursday 3rd July

5am
1pm
2.30pm
6pm
9pm

6.6
6,3
9.1
17.9
15.0



Friday 4th july

3am
5am
1pm
9pm
12:00am

8.6
7.0
16.9
16.6
9.4



Saturday 5th July

5am
1pm
6pm
8pm
10pm

8.6
6.8
14.2
17.7
14.8



Sunday 6th July

5am
8am
1pm
6pm
8pm

6.7
6.7
6.7
14.8
16.4



Monday 7th July

2am
5am
8am
1pm
2.30pm
6pm
9pm

9.1
6.4
10.9
6.4
7.6
14.0
13.0



Tuesday 8th July

2am
5am
8am
1pm
2.30pm
6pm
8pm

9.1
6.4
10.9`
6.4
7.8
13.3
21.00




I take the Novarapid 2x a day 8 units after lunch and pred and then 6 units before dinner. Three times I have had to have a 3rd dose for various reasons. Saturday I was worried about the 17.5 reading so took an extra 2 units. Sunday I didn’t screw the needle in properly so was unsure how much insulin had got into my body. So after fixing the needle it all spurted out so I took an extra 4 units then after measuring the sugar later on at 8pm took another 4 units.
Tuesday i don’t know why the sugar went so high after dinner. i had chicken and rice soup. Must be the rice. The day before we had chicken, sweetcorn and barley soup and the sugar was fine. Today it shot up to 21.0 within 2 hours of eating so I took another 4 units of novarapid. At least the stuff is instant and I can measure again before I go to bed.

I am still not sure what effects the sugar. Some days I appear to eat similar food and yet the sugar behaves totally differently. I am wondering if Stress can put it up as today was very stressful. Well … Time will tell I guess. I sent all the results to the Endo then tried to ring him. They said he would ring back when he was free but that never happened. So will ave to follow up tomorrow.

Anyway the hypos are a thing of the past. It’s only after the pred at lunchtime that I start to have issues with my sugar going too high. Normally my body seems to produce enough insulin to process the carbs I eat as it drops down fairly well once the Pred effect has worn off.

I read that it takes between 4 to 6 hours for the steroids to keep increasing blood sugar. Well that seems to be proven in my case. Its the extra food at dinner time that puts me in the dangerously high level. So I should probably be taking a bigger dose with my dinner. Will discuss with the endo when I can get hold of him.

I have discovered I can eat fruit in the morning and drink coconut water without having a major effect on my blood glucose. I read some time ago that fruit is best eaten early in the morning when the liver has bigger stores of cortisol and that it therefor won't convert the sugar into fat. Once the cortisol is exhausted we should avoid fruits and sweets. So now on waking I have a banana and an orange or tangelo and the coconut water. Then a few hours later for breakfast I usually have some kind of egg dish with either bacon or omelette or instead of the eggs some lamb cutlets. I seem to manage some wholegrain toast for breakfast without any damage but bread for lunch or dinner is totally out.

We try to have our main meal at lunchtime. So meat and veg or salad. Then for dinner we live on soup. Usually works but apparently I need to avoid soup with rice i n it and also with pasta. That seems to be lethal for me :( Pity as I love both.

[chris.wg]

I am looking at your meter readings and trying to figure them out but from what I can tell its just a decimal shift I haven't found a conversion online for Aussie to U.S. But the patterns of your readings do suggest a decimal shift. Any rate yes stress can effect your sugar some people it contributes more then to others. Also getting sick can shoot your sugar up. The way I was taught to measure for myself was in diabetic carbs. <the name it was given> I was allowed while on my metformin. 4-5 diabetic carbs for breakfast 2 for each snack 5 for lunch and dinner. I was told to stay within those carb ranges or close as obviously to many will shoot the sugar up to few can bottom. Each person is slightly different and has to be tweaked and activity levels will play a big roll. But that was pretty much the generic numbers for my size. A diabetic carb is a kind of abstract thing I was given a chart. 1 small to medium size potato = 1 most servings of fruit = 1 other then banana's which = 2 at the junk food end pizza 1 average size slice =2.5 Obviously the chart cant cover all so the general rule of thumb I was given when deciding on a diabetic carb. 15 grams of carbs is approximately equal to 1. It was stressed to me and I'm sure goes without saying this is not a excuse to eat junk to that limit and be done. You still need the protein and such this was just the carbs to consume with your protein. Again though I was on metformin which is just a pill not a insulin shot. I have yet to learn those rules for myself and hopefully will avoid it as long as possible.

[ingemlb]

Thanks Chris. will study that up a bit more. Just heard back from my Endo who also studied the chart and said great we got rid of the hypos but now need to increase the insulin. So he wants me to try 10 Units for lunch and 12 for dinner (up by 2 at lunchtime, 4 at dinner time) as I am into double figures too much.

So will start that right now and see how it goes. He said I may even need to increase the evening dose more.

He also said to check with my doctor if they have a diabetes educator on hand and if not to get back to him. Think I will also find out if there is a good dietician around who can help me figure out a good meal plan :) so I am feeling less frustrated now.

[chris.wg]

I'm not sure what you are advised to eat and what not but if you wish for a good source to learn what different foods bring to the table so to speak check this site out. Home - MyFoodAdvisor? (http://tracker.diabetes.org/?loc=ff-slabnav) Its from the American diabetes association its a food advisor.

[ingemlb]

Thanks Chris. Looks good. Trying to register. i have saved it in favourites.

[vdub]

I had never heard of steroid induced diabetes. No wonder my endo keeps track of my A1C and worries about my glucose. As drz said, in the US we use a different scale for testing -- 100 is normal, so your scale is less meaningful. It almost looks as if its the scale we use for A1C. My son is a juvenile diabetic and got the disease when he was 8. He leads a pretty normal life because he has a pump. They put him on a pump because he was "brittle", meaning he had large swings in his sugar levels. The pump has been great for him. It would probably be premature for you to check into getting a pump, but someday....

[ingemlb]

Hi Vdub. I am still living in hope my steroid induced diabetes will go away when I am (if ever) off the steroids. And as they steroids are going up and down this will be tricky to manage for now :(

[ingemlb]

Ok I must have been rather brain dead last few months. I finally realised it might just be important to invest in some books on diabetes control. I found one written by a local diabetic specialist who is now retired and after only reading a few pages am learning heaps. Here is an extract which will explain the differences between the Australian values and those used elsewhere:

In people without diabetes fasting blood glucose levels (after not eating overnight) is less than 5 millimoles per litre or 90 milligrams per deciliter (shorted to mmol/l or mg/dl). After food it rarely rises above 8mmol/l (145 mg /dl). If untreated or uncontrolled diabetes blood glucose may even rise above 30mmol/l (or 550mg /dl). With treatment your doctor will aim to keep your levels at less than 10 mmol/l (180mg/dl) for all or most of the time and will often help you to achieve lower levels 4-7mmol/l (7-125mg/dl) before meals and and 7-10 mmol/l (125 -180 mg/dl) one to two hours after meals. It is important to emphasise that symptoms of hyperglycemia rarely occur unless blood glucose is consistently higher than 14mmol/l (250 mg/dl).

That is exactly the kind of information I was not taught at the hospital when first diagnosed with steroid induced diabetes. Nobody told me to aim for such low levels of blood glucose or even suggested adjusting the dose of insulin to compensate. On retrospect the worst thing they did was put me on the slow release insulin which made it impossible to adjust things in any case as they hypos became too frequent and dangerous.

I have a long way to go to get to those levels above regularly. But with the help of this book and some trial and error I am more confident now I an achieve this.
I couldn't even find it so clearly explained on the diabetic foundation website here in Australia. Yesterday was the first time I heard the idea (from my new Endo) that the values are far too often in double figures. So that means they would like me to aim to keep things AT LEAST below 10 mmil/l.

Guess I was so focused on other stuff and kept thinking this diabetes is going to go away soon as I reduce the pred that it didn't occur to me to check it out more thoroughly. Anyway I am on the case now!

[windchime]

I found this today while checking on why I'm having morning highs. Thought is might help.

What Causes High Blood Sugar Levels in the Morning (http://my.clevelandclinic.org/disorders/diabetes_mellitus/hic_what_causes_high_blood_sugar_levels_in_the_mor ning.aspx)

[ingemlb]

Well that's one issue I have never had. Until I changed to the Novarapid I was more inclined to be close to a hypo in the morning. Now my usual readings are around 6.2 every morning regardless of what I do at night. But I have been able to give up having supper so my last meal is 6pm and then at 5am when I measure my sugar it is almost at fasting level. I usually then have a snack as I am hungry. Now going back to banana and yoghurt and followed by breakfast at 8am. Then at 1pm before I start lunch my BG is usually back down to the 6.2 area. I eat lunch take Pred and then take the first dose of insulin to combat the pred. If I didn't take the pred I think I would stay in single digit figures all day. Anyway I am determined to get it down now.

So .. my "highs" are from around 4pm to 9pm at night.

[ingemlb]

Diagram which shows what effects Blood Glucose Level. More than food and excerise On the right are the things that raise on the left the things that lower blood glucose

https://fbcdn-sphotos-e-a.akamaihd.net/hphotos-ak-xpa1/t1.0-9/s526x296/65935_10152235320910893_8709074714513780247_n.jpg
(https://www.facebook.com/photo.php?fbid=10152235320910893&set=gm.683661291681937&type=1)



Like (https://www.facebook.com/groups/516643745050360/683661291681937/?ref=notif&notif_t=like#)

[ingemlb]

With all the drama / trauma at our place around our son forgot to update this thread. I didn't change what I was eating so all I can say is I continued in double digits because the stress was out of this world in our house in the last couple of weeks. When I sent my charts to my endo on tuesday he was quite drastic in increasing my insulin. So now I am supposed to take 18 Units after the pred at lunchtime and 16 units before dinner however even that is not doing the trick so before dinner been taking 18 as well.

I reduced the pred yesterday by 2.5 and that hasn't made an impact on BG as yet. Only the pain returned today :(

[godgirl]

Hi, Inge.

I'm on the verge of being diagnosed with this. My mother died from a rare auto immune disease and developed steroid induced diabetes very soon after she started prednisone. My doc thinks I will as well. We've been trying to control it with oral meds, but my non fasting and A1c is a bit high for her liking. Not too high over normal, but much higher than before the pred. In the next week or so, I'm going to up that medication to see if I can get it under better control.

One thing that I've found is that if I eat more salad and vegetables, I seem to do much better. I know that sounds like common sense - no carbs, no sugars - but it really helps me out. My main meal is at night, because I work during the day. At work, I usually have fruit and cheese or yogurt for breakfast, a big salad for lunch (lots of lettuce and veggies, maybe some cheese and meat) with some fruit and nuts and for dinner, I cook up a couple of kinds of vegetables and have a small baked potato. I'm not always so good about it, but I try to keep this regiment. I also make my own salad dressings - I know what goes into them, then.

Now, if only soda pop - Mountain Dew in particular - wasn't the sweet, sweet nectar of the gods... <sigh>

Jen

[ingemlb]

Hi Jen. Thanks for sharing your experience. Sorry about your Mum. My Dad also died from a rather rare Autoimmune Disease called MSA (Multiple System Atrophy) and he too developed a very sudden onset of diabetes but he was not being treated with steroids. The diabetes was so severe out of the blue that he was put immediately on insulin. My father was not overweight so they couldn't blame the lifestyle. I since discovered that both is father and his father's father developed a very severe diabetes late in life (60's) and because neither went to the doctor the first symptom that was noticed by family were totally black leg. My great grandfather had to have his amputated. My grandfather was hospitalised and died very soon after from pneumonia. That was in the 60's when immunosuppressive drugs were not in wide use yet. My father died 2005 after 7 months lying on a hospital bed not able to move.

So in my view there is a very nasty type of diabetes around that comes late in life. Maybe connected to other autoimmune diseases Can't find out now if either my grandfather or great-grandfather had anything other than the diabetes.

My mother developed type 2 diabetes at 40. She was on meds for a short while then had to go onto insulin and lived until last year when she was 83. However she had very poor health most of her life. In her case the type 2 diabetes was put down to lifestyle issues as she refused to eat food suitable and instead found out the insulin allowed her to be rather generous with what she would eat. She told me many times that the meds didn't help her at all and that she felt like a different person once she started injecting the insulin. I have also read that studies in germany say insulin has far less side effects than the meds used to treat type 2 diabetes.

In my case it is very clear that the sugar only goes up for a number of hours after I take the Pred (I take i after lunch) and research shows that the pred will start to raise the blood sugar within 4 to 8 hours. So that seems to be the pattern with me. Whilst the pred is actively raising the blood sugar seems to make little difference what I eat. My next aim will be to move the pred forward to breakfast time as they only got me to take it with lunch due to being on novamix which has slow release insulin mixed in with fast acting. Now I am only on fast acting there seems no reason why I can't swap around. In fact I may even try that from tomorrow. I had forgotten about it. Seems everyone else takes pred with breakfast. Will probably make it easier to sleep at night too :)

You are right about the carbs. Any white starchy sugary food of course will add to the problem.

Good luck with your journey. I opted to go straight onto insulin instead of tablets and am still glad I did it. Because I want to also get off this as fast as I can once the pred is reduced/gone.

[ingemlb]

Made the switch today to move the Pred to the morning. So the plan is:

On waking measure sugar (usually around 5am) and have some fruit (i like a small banana and a tangelo)
8am have breakfast, followed by meds including Pred, then 16 Units of Novarapid
10am measure sugar
1pm measure sugar, have 18 Units of Novarapid (decrease if sugar is low), then eat lunch (apart from Wednesday which is MTX day, no medication required at lunchtime unless on pain meds).
3pm measure sugar (if needs be take more insulin)
6pm measure sugar (if needs be take more insulin) eat dinner, take evening meds
8pm measure sugar take bed time meds.
10 pm if still awake measure sugar, if too high take inulin, too low eat a snack

Of course once there is stability with the blood glucose levels I will reduce the amount of measuring. So far doing ok. Apart from the morning fruit snack I am trying to avoid eating anything between meals.

If the sugar was low in the evening I also measure it again during the night if I happen to wake up. Hopefully that will all soon be no longer necessary. Have not had a hypo since moving from Novamix to Novarapid :))))

[vdub]

My son is a rocket scientist (really -- he is a rocket scientist, think of Leonard on Big Bang) and he keeps fast acting insulin in his pump all the time. The pump administers short "keep-alive" bursts throughout the day and night. He only keeps track of his carb intake (as far as I know). Whenever he eats some carbs, he does some sort of calculation and administers an extra bit of insulin. He manages pretty well with the process and keeps his a1c's at a respectable, pretty much normal, value.

[ingemlb]

Yes I think this fast acting insulin gives you far better control. Thanks for sharing. I am still hoping the 2 doses day will do it once I understand what is raising the sugar. So for it's the PRED having the biggest impact. At least I know the stuff works quickly and I don't mind the regular readings for now as it helps to teach me what I can and can't eat :)

In fact I have a friend who was put onto an blood glucose controlled diet. He had to measure his blood glucose after eating anything new and record how high it jumped. This way he gradually removed all those items out of his diet that he couldn't cope with. Apparently not everyone reacts the same to all foods. He found some things very peculiar. Cheese for instance had a huge impact on his blood glucose. Which explains to me why over the years when I suffered with Hypoglycaemia I could control it quickly with a piece of cheesecake but also with some dry biscuits and cheese. I used to run for the fridge and shove a piece of cheese into my mouth.

Anyway he lost AN ENORMOUS amount of weight just avoiding the foods that would raise his blood glucose levels. He had to due to heart condition. But he kept to the regime and didn't put it back on.

In time he didn't need to measure as he had his list all prepared and managed to work out a for him healthy diet. But his advice was ... don't assume what foods your body can tolerate as far as sugar goes :)

[Auntie TooToo]

Just now reading your post ... I too have been having the same problems with my blood sugar. For many yrs {prior to WG} I dealt with low blood sugar; then with the introduction of steroids to my daily regime it turned into full blown diabetes. At one point, mine were so high that my meter would not even register {but then I was on 120 mg daily of prednisone}. So my rheumy & pcp referred me to an Endo for consultation. He has been excellent, BS is getting better controlled; I'm on Metformin 1000 mg twice daily along with Lantus during the day & Novolog at bedtime. As my rheumy reduces the steroid dosage, my BS is lowering and we are tapering down on insulin's as well. Just have to continue monitoring, I notice that my afternoon sugars are usually the highest due to taking steroid in am. This is all such an adventure - WG {and the meds to treat} sure wrecks havoc on our bodies {not to mention our emotions}. Hang in there ..... this too shall end one day!

[ingemlb]

Thanks Tootoo :) Yes well Hypoglycemia is seen as pre-diabetic but I was luckily able to avoid the diabetes via strict diets. Now that I swapped to taking my pred in the Morning I too get that spike mid afternoon. Today I had to take 2 extra lots of insulin. Maybe it takes a few days for the body to adjust to the new routine.

[drz]

I have had diabetes for decades and was already on insuln pump and CGM (continuous glucose monitor) for years before my Wegs developed and was diagnosed. When in the nursing home for rehab work dafter my initial treatment for Wegs I remember my blood glucose levels often ranged from 400 plus in mornings and early afternoon to lows of 40 in early hours of AM when high does of pred wore off. I often had to have hourly checks of my blood glucose and snack several times every night. I would nap most of the time due to high levels of fatigue and having poor sleep most nights. Blood glucose levels improved slowly as my pred dosage was decreased and my insulin dosages in my pump were increased and tweaked to follow my blood glucose levels. I still need my Dexcom CGM to help monitor my highs and lows and to make adjustments on my insulin pump frequently throughout the day but I had my best A1C level last check up and finally got back to A1C levels I had my Wegs was diagnosed. I am still on 5 mg of pred which affects my blood glucose levels. Higher dosages create more problems.

[ingemlb]

Thanks for sharing drz. I am finding things still very confusing. I have now increased the Insulin in the morning to 24 Units (up from the initial 8 at lunchtime) and to 28 Units for lunch (up from 6 units with dinner). That seems to be so far the best I can manage to keep the blood glucose as normal as possible. However I find incredible swings. I can eat the same stuff each day and yet the BG levels are wildly different.

For instance I have a piece of fruit on waking. Sometimes it puts the blood glucose up by a very small amount, other times it goes up by at least double. Then yesterday I skipped the snack. My blood glucose was close to normal for fasting on waking and 3 hours later, without eating anything at all it had climbed up quite a bit. I had one cup of herbal coffee substitute with a bit of milk but I have that with the fruit every morning so I simply can't explain the rise in levels apart from stress. Also I have been going down with the pred but needing to go up with the insulin. But then we have had the most stressful couple of weeks in ages with our son having his psychotic episode and that most likely is affecting not only the wegener's but also the diabetes I am assuming.

I now have a referral to a Nurse diabetic educator. Will have to make an appointment. Too many appointments already this week so will have to wait until I can catch my breath next week :)

[ingemlb]

Continuing on from the last post ... Nurse told me yesterday (had to fast for a gastroscopy) that the body will produce extra glucose when it hasn't had anything to eat for a while which explains to me the reason how come my BG levels can rise in the mornings before I even eat anything. Happened again yesterday. Fasting BG level on waking was the usual 6.2 and by the time I was ready to go into theatre a few hours later it was 7.6. Had not eaten or had a drink since the night before.

Anyway good news is I am achieving my goal of single digits (Australian measurement of BG levels) i.e. close to normal now most of the time with the 2x Novarapid insulin (Breakfast and Lunch) and my HbA1C test was 7.1 the other day so my Endo is very happy with things right now.

It is very clear now that what influences the BG the most in my case is the pred. It takes bout 3 hours to start raising BG levels and keeps trying to raise them for 8 to 10 hours after that. Actually what it does is it inhibits the insulin so makes you more insulin resistant. And by the way, so does stress. My Rheumy told me that many of our hormones work on resisting insulin and of course stress plays havoc with our hormones. So that's the way it works. Reduce the effectiveness of your body's insulin and also any insulin you inject and your body will push the glucose into the blood.

So my advice to anyone coming down with Steroid Induced Diabetes is - go for a fast acting insulin which you can adjust to the exact level your body needs to combat the insulin resistance caused by the steroids. At least that works for me. I don't need the slow release insulin as that is what was putting me in constant danger of hypos.

Hopefully next week I will start seeing the diabetes educator nurse. She is supposed to be very good and will also help with diet etc. So ... will be interesting to hear her views on things.

[ingemlb]

Just repeating post here that I posted on the Australian FB Wegener's forum that could be of interest to others struggling with Diabetes who are on steroids.

Forgot to mention something that my Endo said the other day. This may already be known by all who struggle with diabetes. He told me that the issue is not that Pred raises blood sugar levels but that it INCREASES insulin resistance in the body. My Rheumy when I told him I felt that stress was also raising my BG levels he said that stress affected many hormones in the body and unfortunately a lot of our hormones can increase insulin resistance. I just read a scientific paper from 2012 which is talking about a potential breakthrough for stopping this when using corticosteroids. (the insulin resistance) but can't find any more up to date information on it. However the article is interesting to read as it seems to lump together the insulin resistance of corticosteroids with other undesirable side effects such as the weight gain. So if they can produce a drug that people on corticosteroids can take it may well get rid of many of the nastier side effects. Wish I could find more recent info but will continue to look. In the meantime here is the link to the article for those interested.

New mechanisms of glucocorticoid-induced insulin resistance: make no bones about it (http://www.jci.org/articles/view/66180)