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Thread: Steroid Induced Diabetes Management

  1. #21
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    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 )))
    "Slow and Steady wins the Race"
    All the best, Inge

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    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.

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

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    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!
    Auntie TooToo ~ diagnosed {finally} 4/2013

    “Each morning when I open my eyes I say to myself: I, not events, have the power to make me happy or unhappy today. I can choose which it shall be. Yesterday is dead, tomorrow hasn’t arrived yet. I have just one day, today, and I’m going to be happy in it.”

  5. #25
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    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.
    "Slow and Steady wins the Race"
    All the best, Inge

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

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

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

  9. #29
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    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

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

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