Added medication

Are you still on steroids?

If you are still on steroids the Gliclazide should help. If you have stopped them and still have high BS you might need to ask for the two tests for T1.

I was on glicazide for steroids and they didn't work for me. I dropped the glic and went on insulin. Weaning off the steroids now.

Which one and what is your dosage?

I am on prednisolone. I have been reducing down fro 40 and now on 7mg. I am not currently taking insulin, however, I found that after reducing, there is about a 2 week delay and I get a sudden spike and I have to take it again. The 2 week delay has been consistent during the reduction period.

The nurses at the surgery didn't have a clue. Eventually, they told me that a Specialist Diabetic Nurse visited the surgery every month. She knew exactly where I was coming from, together we sorted it out. I ended up on 2 types of insulin. One I took at the same time as the steroids, and the other for correcting it later on.

I was eating keto before and durig the steroids, so the injections had nothing to do with food. I used fingerpricks but more importantly the libre, to monitor my bloods.

How often are you testing?

KarenGG said:

GP had no clue and said he didn’t know why the hospital had me on metformin because my A1c is below ‘diabetic’ but the specialist nurse said my A1c is all over the place because I’m anaemic

Click to expand...

I think they usually do a fructosamine test instead of a hba1c for people who are aneamic. A hba1c wouldn't make sense, as it gives a false low result.

I have been taking preds for a long time, now down from 40 mg per day to 15 mg neuro says no lower.
Was put on Azathioprine as a prednisolone sparing medication ended up taking both for about three years until it became obvious that Azathioprine was actually quite dangerous for me and it was stopped.

Preds make it very difficult to control blood sugars and insulin is normally the therapy of choice though I have never been offered it. I keep my blood sugars low by very strict control of carbs and calories it's a drag and makes me very low on energy a lot of the time.

This gives some insight into the effects of steroids
"
Glucocorticoids

Glucocorticoids are widely used medications and clinical experience indicates that diabetes is a frequent side effect. Ingle first reported glucosuria in rats receiving glucocorticoid.1 A human retrospective epidemiological study of adult Medicaid patients carried out over 9 years identified almost 12 000 persons with new onset diabetes and closely matched controls which did not develop diabetes. Patients who were taking glucocorticoid were more likely to be in the diabetes group (relative risk 2.23) and the relative risk was dose dependent.2 One intuitive hypothesis for the mechanism by which glucocorticoids cause diabetes is development of insulin resistance. To test this hypothesis, hyperinsulinemic‐euglycemic clamps with tritiated glucose tracer were performed on 10 healthy subjects after 7 d of placebo and after 7 d of prednisolone.3 This study demonstrated that prednisolone induced insulin resistance in liver, muscle, and adipose tissue by decreasing the ability to suppress hepatic gluconeogenesis, as well as by decreasing peripheral glucose disposal in muscle and adipose tissue. There are multiple plausible biochemical mechanisms for development of insulin resistance in the postreceptor insulin‐signaling pathways in all tissues (reviewed by van Raalte4). In addition, there is evidence for decreased insulin‐induced vasodilation in muscle leading to reduced glucose delivery to muscle beds, reducing the opportunity for muscle to clear glucose from the blood.4
Glucocorticoids also have additional direct effects on release of insulin from beta cells.5 Six healthy subjects were given three mixed meal challenges at baseline on day 1, 2 h after 75 mg of prednisolone on day 2 and without any additional prednisolone on day 3. Plasma glucose was elevated during the day 2 challenge, but c‐peptide was unchanged from baseline suggesting that the beta cells were unable to release additional insulin to overcome the peripheral insulin resistance resulting from the acute exposure to glucocorticoid. There are also a number of plausible postreceptor biochemical targets in the beta cell for glucocorticoid suppression of insulin secretion.4
The initial common sense approach to glucocorticoid‐induced diabetes is to minimize the glucocorticoid dose as much as possible. There are few studies of optimal medical treatment for glucocorticoid‐induced diabetes.6, 7 Guidelines are largely based on expert opinion and therefore vary. The consensus is that postprandial excursions in blood glucose are more significant than fasting hyperglycemia in most instances, and therefore recommendations are made for use of glinides, thiazolidinediones (TZDs), glucagon‐like peptide 1 (GLP‐1) analogs, or dipeptidyl peptidase 4 (DPP‐4) inhibitors.6-10 The TZD, troglitazone, has been shown to improve postprandial glucose excursions (lower area under the glucose curve in an oral glucose tolerance test (OGTT)), decrease HbA1c, decrease low‐density lipoprotein, and increase insulin secretion in patients on chronic glucocorticoid,9 but is not widely recommended due to side effects of weight gain, heart failure, and bone fractures, all of which may be additive to similar side effects of glucocorticoids in the USA, the drug was removed from the market in 2000. There are few studies of metformin in glucocorticoid diabetes, and it has not generally been recommended as many patients taking glucocorticoid have renal failure or may be prone to lactic acidosis, which constitute contraindications to metformin.8, 10 Consensus is that blood glucose consistently over 200 mg/dL associated with glucocorticoid therapy should be treated with insulin."

I know the article is more aimed at pediatric diabetes but think it is still relevant

https://onlinelibrary.wiley.com/doi/full/10.1111/pedi.12406

They tried me on glicazide and it did nothing except give me hypos. Eventally I got to see a specialist diabetic nurse who understood me immediately. The doctors and surgery nurses do not have a clue about steroids and diabetes. Ask your surgery if they have access to a SDN, mone visited the surgery once a month. Agree the Fructosamine would be suitable,

I was on 40mg prednisolone. My readings were high teens 20s.

The sdn put me on humulin I which kicks in the at the same time as the steroids. The humulin wasn't enough to last through the day so I got novorapid to top up as I needed
. It worked eventually after a lot faffing about. It's complicated at first and I probably wouldn't have managed it without the libre.

I have been off insulin for around 3 weeks so will have to give up my libre shortly.