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Prednisolone and its immediate impact on blood sugars

pleinster

Well-Known Member
Messages
1,631
Location
Scotland
Type of diabetes
Type 2
Treatment type
Diet only
Dislikes
ignorance
Hi. I am sure many of you will be aware that steroids can cause dramatic increases in blood sugar levels, and that long term treatment with particular steroids can actually trigger or directly cause Type 2. I got diabetes after taking prednisolone for over three months as part of my anti-rejection treatment following a renal transplant (due to a hereditary condition). Most people will experience an increased level with this drug but things should drop back down to normal if the treatment is under 30 days or so. Most transplant patients will be on it for life though the dose can be dramatically reduced. I was warned by all my doctors pre-op that it was a common consequence of the transplant treatment..and I was more than happy to take the risk..indeed, I would do it again and would always take having Type 2 over total renal failure..of course. Some uninformed people still think Type 2 isn't so much caused by steroids as it is triggered. Initially, my doctors (a number of them) referred to to it as Steroid Induced Diabetes but all of them are now clear, as is the diabetic consultant I see, that long term treatment with this particular steroid CAUSED my diabetes. Now, after a great deal of effort, testing, recording, avoiding carbs and getting docs to cut my prednisolone down to a minimum, my levels have been pretty normal (so long as I stick to my approach), and my last HbA1c was 41 (barely diabetic), averaging meter readings under 7mmols. I have not been on any meds for diabetes for at about 18 months (by choice). Problem is, people on anti rejection drugs have their immune systems suppressed to minimise the body attacking the intruding new organ..and as a consequence they are open to more infections than the average person. One particular infection I just got can cause pain from inflammation in a rather sensitive place...and doctors don't want renal transplant patients to take anti-inflammatory drugs like ibuprofen or voltarol ..soo...they up the prednisolone for a period as pain relief while the anti-biotics hopefully do the job. ANYWAY...point is...three hours after the increased dose my levels went up to about 14mmols, and have not been much below that over the last two days regardless of zero carbs. I am not just writing this to **** off prednisolone (it has some very good uses), but to inform...I worked very very hard to get things under control only to have to start again when I come off this (as it doesn't just drop down right away when you stop). My point is that if you don't have to take this particular steroid...don't. Many transplant centres are not avoiding it completely. I am not saying stop taking it..but discuss alternatives with your doctors. I think I might just try and bear the pain rather than risk further damage (however temporary).
 


Pleinster, I've always been incredibly impressed by your pragmatic approach to your collateral damage. You have never appeared to seem bitter about it, rather just seeing it as something that has to be dealt with. My father became T2 as a result of long-term prednisolone medication, plus a few others I never hope I have to take. At the time, the pred was part of the alchemy keeping him alive, so he just went with the flow. He was the first person I ever saw do a finger prick blood test, although back then in the late 80's it was very different to these days!

Bearing in mind the immediate correlation between your prednisolone and the much increased numbers, would you consider speaking to your team about some short-term diabetes meds to bring those numbers down, for the course of the steroids? If you're going up to 14 it can't be helping you feel well, and be dispiriting.

Maybe keep some pretty detailed data over this course - your bloods and food intake sort of thing, and discuss them with your team next you see them?

I'm passionately keen to remain meds-free, or where meds need to come into the picture, keeping them to a minimum, so please don't think I'm being gung-ho is suggesting you just add another med to the mix. If you were just able to keep the peaks down a bit it might help you.

Just my 2p worth of brain dump.
 
I've had the similar problem in that I have to take regular steroids particularly in the winter for my breathing. I was disagnosed as type 2 although my sugars go back to normal when I was off them. I eat carefully on moderate carbs.i did discuss medication while I was on them as my bs goes up to 13 but because I'm not on them long enough ( and don't know whether I will need to keep taking them)I was told no medication would kick in time. I have come to the conclusion that breathing is important and I will just have to put up with higher levels. Hopefully with the nicer weather , I will not need them over the summer and so get back to normal bs levels.
 
Oh pleinster, that must be so frustrating, I hope your figures improve soon and the pain improves.

It is a good warning.
A consultant wanted to put my mum on steroids for pulmonary fibrosis (caused by antibiotic she was taking), she said no, due to side effects. At our next check up the consultant was surprised how much better her lungs were (she had stopped antibiotics of course), and said he couldn't believe the improvement without steroids.
So I totally agree with you.
 
@pleinter bless you. It is annoying when a med causes more damage long term, especially after it has been stopped. I feel that way about canagliflozin. And about diabetes from childhood. Argh!!!
I wonder why it causes type2 and not type1? Do you know how it causes it?
Much interested. Vicky
 
What a frustrating pain in the backside!

Here's hoping that this is just a temporary thing, and that your bgs drop again once you stop the pred.
Is this going to be a long, or shorterm course of the steroids?
 

Thanks @AndBreathe, your concern is very much appreciated. I think I shall ride it out for the next couple of days and then reinforce my approach ( the course is short). The low level prednisolone I am usually on these days, hasn't been too difficult to manage. I had been getting away with a few carbs here and there quite happily with minimal impact, so I suppose I shall just use the experience to refocus my efforts to ensure i get things to a reasonable and sustainable place again soon enough. To be honest, it has been quite a trying time with several low level infections one after the other (all due to my immune system being suppressed) and I am still fighting off a rather nasty virus in the new kidney, so I think I am taking it a bit easy for a short spell just to stay motivated overall. It is what it is, eh? Thanks for your words, pal.
 

Hi. yup, "breathing is important". I had a similar approach to the steroids causing my diabetes, along the lines of "Oh well, avoiding rejection of my new kidney is important". I get that. Still, I would say keep asking about alternatives or reduced dosages. Here's hoping the sun comes out in more ways than one. By they way...don't move to rural Stirlingshire...brrrr.
 
I am also immune suppressed and subject to frequent infections, lung infections in particular as I have a history of asthma and pneumonia. Over the last 30 years I have used very large amounts of steroid ointments on my skin on a regular basis, often occluded to increase penetration, and I have wondered if this either triggered or aggravated the diabetes. I have also been on prednisone a time or three. I will probably never know and I guess it really doesn't matter at this stage of the game.
 

I think it's a safe bet it's steroid induced. I suppose it was easy for me to identify it as the cause because I had been warned by at least 6 renal doctors in advance of my operation....a clear risk (worth taking in my case...and probably in many, including yours). I had no issues with weight gain at all at any stage in my life (then 53 years) nor any real problems with diet or lifestyle. No doubt as to the cause at all. You might think it's not important at this stage what caused it, but it does let you know that you will benefit from avoiding the steroids where possible...each dose of prednisolone still causes a spike for a few hours in my case...so you would do well to eat around them, avoiding high carbs until the level has come down a bit. I hope the infections lessen. They wear you down, eh? Good luck.
 
Hi pleinster, like you I have (SID) steroid induced diabetes, of that they is no doubt as I was taking prednisolone for 3 years in total and diagnosed T2 after 2 years!

I had suffered respiratory failure which happened 3 times over 4 months, basically ever time I stopped taking prednisolone I was having another attack and it was thought that my adrenal glands had stopped producing cortisol due to the pred providing my needs, anyway after the last attack I was so bad that I was admitted to intensive care where I was intubated for 6 days whilst being fed huge doses of IV antibiotics and 300mg of prednisolone a day also intravenously! After bringing me out of the induced coma they slowly reduced my pred down to 10mg a day where they kept it even after I left the hospital as they feared a relapse.

I was prescribed MDI insulin treatment at diagnosis of my T2 and that helped me enormously to control my bg levels pretty quickly, in fact without insulin I dont think I could have controlled it at all as I was still taking 10mg of pred a day. After about 12 months and having lost 4 stone in weight I managed to wean myself off both insulin and prednisolone and touch wood I have not had to take it again since.

So again like you I truly believe that without prednisolone I wouldnt be here so I cant really complain about having T2 diabetes which I thankfully have under good control at present. So yes its a double edged sword, both life saving but also a serious cause of insulin resistance which leads to T2 diabetes.

Would I take it again? Yes, if I had to as a live saving measure but I would ask to be put back on MDI insulin along with it so that I could keep my bg levels stable whilst using it again.
 
Gosh! This is really interesting. I wonder if I was given steriods for pneumona at 3mths old. It really opens your eyes!
 
Hmm just googled asthma inhaler and diabetes. Apparently there is also a risk.
 
I wonder if uncontrolled diabetes causes Asthma. I know beta blocker can irritate Asthma. I don't doubt some drugs cause diabetes. Drugs can cause loads of side effects.
Naively I always thought once no longer taking drugs they go away. Not diabetes eh?
I don't think some people get rid of side affects once no longer taking that particular drug which caused it.
Maybe side affects shouldnt be written off so easily by prescribers?
 

Not sure, Vicky. I guess it's just that where the pancreas produces no insulin with type 1, a separate condition really to type 2 (I would say), steroids can simply increase the blood sugar and this causes a degree of adaptation of how the pancreas deals with it when the treatment is longer term. Just a guess though...a solution (or an alternative treatment) would be nice.
 
Supposedly only a 5 day treatment if the anti-biotics work meantime...but today's levels are above 17mmols four hours after taking the pills (would normally be about 6.5 at most around that time)...even my waking level was up 6 points! So, I think I shall abandon them tomorrow and hope it comes right back down. x
 

Yup, Sid - sometimes things are trade off, eh? Well done getting off it. I hope it stays that way.
 

Hi. With prednisolone, it's all to do with how long the treatment is, though obviously our systems are variations on a theme, like we are. Thanks for you earlier words, pal.
 
Yes. Treatment which does exactly the opposite to steriod. Not sure what that is but I'm sure some clever scientist can work it out! I'm not even sure what a steriod is......a growth hormone? Maybe thalidomide drug to restrict growth, or something? Not sure.
 

Generally, they are anti-inflammatory drugs...but they have other uses...and misuses. In my case, they are the only anti-inflammatory drugs I can take...as drugs like Ibuprofen and voltarol etc are harmful to less than perfect kidneys and particularly risky in relation to transplanted organs.
 
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