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Thread: Steroid Induced Diabetes Management

  1. #1
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    Post Steroid Induced Diabetes Management

    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.
    "Slow and Steady wins the Race"
    All the best, Inge

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    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!
    Anne, dx'ed April 2011

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    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
    "Slow and Steady wins the Race"
    All the best, Inge

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    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.
    Knowledge is power! Wisdom is using it to make good decisions!

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    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.

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    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
    "Slow and Steady wins the Race"
    All the best, Inge

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    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.
    "Slow and Steady wins the Race"
    All the best, Inge

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    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.

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    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.
    "Slow and Steady wins the Race"
    All the best, Inge

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    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? Its from the American diabetes association its a food advisor.

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