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Lupus/Steriods/Reassurance

Discussion in 'Ask A Question' started by Victoria1, Jan 10, 2011.

  1. Victoria1

    Victoria1 · Newbie

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    Hi
    I am new to the site. I apologise that my post is lengthy. My mum is 80 years old & has had Systemic Lupus for the last 21 years. She has been taking Prednisolone all this time. Initially high doses but for the last few years a dose of 3mg/4mg depending how she has been feeling. She was diagnosed with Type 2 Diabetes a few years ago & the GP prescribed Gliclazide. She has taken her blood sugar levels and we always thought is was well controlled but I do wonder now whether the levels have been plummeting during the night.

    In July 2010 she had a flare of sub-acute cutaneous lupus & the Prednisolone increased to 15mg daily. No one has ever told mum that the steriod can affect the diabetes & she has never been monitored at the hospital or GP in respect to this. It is only by chance that a new GP picked up on some blood results & sent mum for a fasting blood test and was not happy. I was asked before Xmas to monitor mums levels & when I got readings of between 20 and 30 during the day and evening but levels first thing were between 3 and 3.8 I immediately got back to GP. So GP has a special interest in Diabetes & runs a weekly clinic with a Diabetic Nurse Specialist. GP confirmed it will be the steriods that are plaing havoc with blood sugar levels & last Tuesday mum was commenced on Insulin (Insulatard/Innolet) at 10 units per day. Readings have been between 15 and 20 during the day and 22 to 28 of an evening. GP rang me on Friday for an update & has increased Insulin by a further 4 units bring the total to 14 units per day. Since Friday readings have been:
    Saturday first thing 4.8, after taking Prednisolone (morning) 13.1, after Insulin and 2 hours after lunch 15.6, 9.00pm 22.3. Sunday first thing 5.8, after taking Prednisolone 14.3, after Insulin and 2 hours after lunch 20.3, 9.00pm 28.3.

    Mum has been experiencing headaches for a while now mostly during the night (I'm not surprised) & I assume this is to do with the fluctuations in blood sugar levels.
    GP is going to ring me today or first thing tomorrow morning for a further update and I assume that she will increase the Insulin further. I think I am just looking for reassurance the blood sugar will level out and the headaches will ease. Is there anything else that I should be doing? Are there specific times when I should be taking her blood sugar? Also the hospital are also gradually decreasing the steriod medication mum is down to 10mg per day now which hopefully will start to help as well.

    I also wondered if blood sugar levels could cause confusion (mum despite being 80 is sharp as a razor!!)? One evening in September mum became quite confused just out of the blue. It lasted for a few hours. Hospital thought it was a mini stroke & she had an MRI Scan of her head which showed maybe ? there was an ischaemic change. She has also had an ultrasound of her neck and heart & the neck one seemed to be okay - no arterial problems. We haven't heard about the heart one but go to hospital in a week or so. Mum was commenced on Clopidogrel as she is allergic to Asprin. But if it turns out it wasn't a stroke can poorly controlled diabetes cause similar problems? I will raise this with the Stroke Consultant. It is just frightening when you see such high blood sugar levels & I do get concerned about the headaches.
    Any advice is very much appreciated.
    Thank you.
     
  2. sugar2

    sugar2 · Well-Known Member

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    Bump.

    Sorry, I don't have any experience of steroids and diabetes, but wanted to wish you well, and bump your post up so someone with more insight may see it.

    Your Mum is a lucky lady to have you, and well doen to the new GP for stepping in.

    I do get confused when my blood sugar is very low....but I don't think that it was this in your Mums case, as she wasn't on insulin at the time. High blood sugar does make you feel awful...for me, it is a combination of being really thristy, with blurred vision, and that feeling you get when you have been awake for 24 hours, but just can't sleep..ie ..you feel awful! It may appear like she was confused too...but the other thing to look out for is a smell. If you blood sugar is high, you can produce ketones that smell a bit like old fashioned pear drops. The fact that she didn't smell like this does not rule out high blood sugar as a cause, but it is something to look out for. If you smell this smell, seek professional advice.
     
  3. sugarless sue

    sugarless sue · Master

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    Hi
    Welcome to the Forum. Your Mom sounds like she has been through quite a bit, at 80 not exactly what you need.

    You seem to have a good grasp of what is happening, especially with regard to the Bg levels she has been getting.

    Any type of steroid can play havoc with BG levels and may continue to do so for some time after as well. The way to know is to monitor the levels more closely throughout this time, especially after meals and fasting. The low levels during the night may be the cause of the headaches but i am sure the Hospital will have checked out any other possible causes.

    At 80 yrs I wouldn't think your Mom needs too much change so asking her to reduce carbohydrates in meals may not be the best advice, if she can all well and good as they will elevate levels if too many are eaten/drunk.

    Can you give us some idea of what she eats during an average day ? Then we may be able to make suggestions about ways to reduce things if she agrees. Is she on a particular diet for the Lupus ?

    I hope she improves. I am sure you will be looking after her as best you can.
     
  4. randomange

    randomange · Member

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    Hi Victoria

    I currently take prednisolone for autoimmumune hepatitis. I'm on a dose of 12.5 mg per day at the moment (slowly reducing down from 20mg/day). I'm type 1 rather than type 2, but like your mum I noticed a huge increase in my BGs when I started on the steroids. I posted about it on my blog here:
    (If members wish to view the blog please PM Randomange for web link.)

    I also take my pred in the morning, and I see the biggest spike in insulin resistance in the afternoon - I was hitting the high teens/low 20s until I managed to sort out my insulin. I'm on an insulin pump, so I was able to adjust my basal rates to match the increase in insulin resistance. My insulin needs went up quite a bit - I was on double the insulin just to cover my background needs, and I had to increase the amount of insulin need for carbs as well. However, my insulin requirements overnight didn't really change, I think the main problem is the steroids kicking in during the afternoon.

    My BGs did level out when I got the insulin sorted. Another thing I noticed was that when the steroids were reduced, I noticed quite a rapid decrease in insulin requirements. I think the best thing you can do is keep testing, and try to figure out where the peaks in BG are, and speak to the GP about ways of matching insulin to that. It might be worthwhile asking the GP about a second insulin to cover carbs, and to use for corrections when your mum's BG is so high. I think the biggest problem you will have is trying to match the insulin to the peak of the steroids, but if you explain the pattern of BG to the GP, hopefully he will have some suggestions. You might also want to consider requesting a referral to a diabetic clinic at the hospital to be seen by a consultant who may have more experience dealing with this than the GP - I'm quite surprised that no-one was monitoring your mum's BG levels/diabetes with regards to the effects of the steroids, as it's something both my diabetic and liver clinics keep a close eye on, and I was under the impression that was pretty much standard procedure.

    I hope this helps (sorry I got so long winded! :wink: )
     
  5. Victoria1

    Victoria1 · Newbie

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    Re: Lupus/Steriods/Reply Re Diet

    Hi

    I just wanted to say thank you to those who have responded with advice - so informative and helpful. Thank you for that.

    GP should have contacted me today but is off sick!! Hopefully she will back in on Thursday.

    Sugarless Sue asked me about Mum's diet. Firstly, she does not have any special diet for the Lupus. It's just a case of not taking any Vitamins or Herbal Supplements that will kick the immune system into further overdrive!!

    An example of what she eats is:

    Breakfast. 7.30am
    On rising glass of warm water. Sometimes mum squeezes some fresh lemon juice into water.

    Special K with sliced banana, semi skimmed milk, cup of tea (no sugar!) or
    Special K with sliced apple, semi-skimmed milk, cup of tea
    Special K with chopped walnuts, pumpkin seeds, linseeds, sesame seeds sometimes dried fruit like cranberry or goji berries.

    Mid morning. 10.30am
    One slice of toast with a cup of tea. Seeded bread. Tea can be chamomile, peppermint or green tea.

    Lunch. 1.00pm
    Homemade vegetable soup with a piece of French Bread. Cup of tea.
    Wholemeal roll filled with salad and a cold meat such as lean ham or chicken. Cup of tea.
    Scrambled egg, mushrooms, ham or perhaps salmon. Cup of tea.

    Mid afternoon. 3.30pm
    Yoghurt. Cup of tea. Or
    Cracker topped with a low fat soft cheese or cottage cheese & pineapple or sliced apple. Cup of tea. Cracker can be a Jacobs cream cracker or M & S Butter Puff, Seeded Cracker. Tea can be chamomile, peppermint, green tea.
    Couple of Rich Tea biscuits. Tea.

    Dinner. 6.00pm
    New potatoes, chicken, steamed veg. Cup of tea.
    Shepherds pie, steamed veg, Cup of tea.
    Salad (if it can be eaten raw my mum puts it in a salad!) usually with chicken, or lean ham, or fish, or egg. Bowl of fuit and this can be tinned in juice.
    Few roasted potatoes, small lean lamb chop, or lean pork chop, or lambs liver, steamed veg.

    Mum is not a big red meat eater.

    Yes, at 80 she cooks all her own meals! No processed food, everything is fresh. Mum does not drink alcohol obviously. Salt used is always sea salt. Mum also drinks plenty of water. I do have to zoom her past the jam and cream doughnuts in M & S though!!

    We always thought she was eating realtively healthily but mum is willing to take on board any advice or suggestions.

    With many thanks.
    Victoria.
     
  6. sugarless sue

    sugarless sue · Master

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    After reading through your Mum's list of food, there are a lot of carbs in some of these things.

    If she is amenable try not having Special K or any cereal for breakfast as all cereals are high in carbs.

    Here is the basic advice we give to new diabetics, see if some of this helps and ask us questions.

     
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