Steriods and T2

[Pinkorchid]

My T2 husband is 84 and suffers from Polymyalgia it went into remission for almost 3 years and he eventually came off the low dose of steroids he had got down to. According to his doctor they were probably the reason he developed T2 in the first place. Now the Polymyalgia is back as can happen but the doctor was very reluctant to put him back on the steroids because of the diabetes and raising his BG but steroids are really the only affective treatment that works so after a month of various pain killers that did not do anything he was finding it difficult with moving around and had really bad pain in his shoulders back, arms and legs and swollen hands. The doctor then said it was up to him if he had the steroids again as long as he knew his BG would probably go up. He has always had good BG control with lower carbs and fats averaging in the 5/6's He has been on the steroids now for 7 days he is like a new man pain all gone and he is moving freely again but his BG has gone up and now averages between 5/6's when he gets up in the morning to the 9's when he goes to bed. He has to reduce the dose from 6 a day in the first week to 5 a day the second week then 4 in the third week then see the doctor again . I know there are others here who take steroids and wonder how you manage them with the diabetes

 

[Daibell]

At least the GP realises that steroids are a problem for diabetics; he gets a tick for that. Do discuss amitriptyline with the GP. In low doses it can be a very effective pain killer. My wife's consultant prescribed it for her frozen shoulders and it worked extremely well with no apparent side effects.

 

[Bluetit1802]

It must be very worrying to see well controlled BS levels rise due to necessary medication.

All I can suggest is a tweak of his diet to reduce his carbs to the extent his levels return to what they were. I can't see anyway round this. It may not take a drastic reduction - again it has to be a question of eating to his meter and keeping those post meal levels down to previous levels - perhaps smaller portions of carbs or the odd thing eliminated. You know his diet better than we do.

 

[Sid Bonkers]

If its only for a short period I wouldnt worry just accept that his control wont be good for that period. However if he should have to take pred for any length of time over a week or two I would talk to gp about upping medication and even consider insulin.

I found that with multiple daily injections (MDI) insulin and a reduced carb diet it was relatively easy to keep my bg levels stable. I was diagnosed after 3 years on prednisolone and put straight on insulin and used it for about 12 months before weaning myself off both the pred and insulin.

If I had to go back on steroids for any length of time over a few weeks I would not hesitate to ask to be allowed to go back on insulin as the benefits far outweigh the inconvenience of multiple daily injections.

ps. steroid induced T2 is well documented.

 

[MargaretR]

Hello Pink Orchid,

I've had Polymyalgia for about 10 years. This is unusual, as it usually goes into remission before that. I have taken Prednisolone for all that time, in various doses depending on flare ups, and 2 bouts of Giant cell Arteritis/Temporal Arteritis - (very nasty, and the only treatment is high doses, 70 mg, of prednisolone. It is something that polymyalgia sufferers have to watch out for, although there are some cases of it developing without the polymyalgia as a precursor). One consultant tried to switch me to methotrexate as a steroid sparer. It works for some people with PMR, but you have to have blood tests every 2 weeks, and then every month. These showed that my liver was reacting badly, so I was taken off them. The consultant then tried leflunomide, and I also reacted badly to that. So I gave up on the alternatives, and stuck with the prednisolone.

The diabetes started about 2 years ago, and was diagnosed with steroid induced diabetes. I had already started losing weight very slowly using Hairy Bikers Cook Books, but then I was diagnosed with Rheumatoid Arthritis. A different consultant decided to have another try with methotrexate, as by this time I had lost 11 stone (thank you LCHF) and she thought that might mean a different reaction from my liver. It did, and I've managed to decrease my Prednisolone dose as my methotrexate has increased. Good thing really, as the surgeon who is planning my knee replacement in the new year won't do it until my Prednisolone is down to 5 mg. I've just reached that.

About 4 years ago I had a bout of hip bursitis, which resulted in being hospitalised for a few days until I could move again. The hospital added amylotryptilin as Daibell mentions above. It helped with the hip pain, (totally different to PMR pain) but had no effect on the polymyalgia, and I've never come across anyone else with polymyalgia who has used it successfully. Polymyalgia is well known for being resistant to pain killers, and most anti-inflammatories. Indeed one of the diagnostic indicators of polymyalgia is that it doesn't respond to pain killers, but Prednisolone will have a effect within a few days.
So, there are one or two alternatives to Prednisolone for polymyalgia, but the medics don't usually try those unless you are having difficulties getting your steroid dose down. And they work for some people and not for others).
I've never been on insulin, so I was interesting to read Sid's comments, in case my polymyalgia flares again.

Margaret

 

[Pinkorchid]

[

At least the GP realises that steroids are a problem for diabetics; he gets a tick for that. Do discuss amitriptyline with the GP. In low doses it can be a very effective pain killer. My wife's consultant prescribed it for her frozen shoulders and it worked extremely well with no apparent side effects.

Even strong pain killers do not work for Polymyalgia that is why steroids are the only effective treatment