Steroid Induced Diabetes Management

[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

[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






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[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.