Prednisolone and its immediate impact on blood sugars

[JohnEGreen]

I have been taking steroids for several years and have been told that my T2 is steroid induced. I have for the last year or so been taking a maintenance dose of 15 mg a day and have been suffering other side effects among which is severe bruising on arms and hands so after months of nagging my neurologist has finally agreed to me stepping my dose down to a lower level. I am also on imuran (Azathioprine a steroid sparing medication) 200 mg per day but that has it's own list of side effects it is also thought to possibly increase BG. It can increase the risk of certain cancers. and can increase the risk of progressive multifocal leukoencephalopathy-PML amongst other things.

I think that if causing higher BG that is overridden by the benefits steroids can bring like a longer life.

 

[ickihun]

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.

Don't feel bad about taking what you need.
I read last night one med is sometimes given to counteract high glucoses but it didn't go into depth. Metformin?

 

[pleinster]

Don't feel bad about taking what you need.
I read last night one med is sometimes given to counteract high glucoses but it didn't go into depth. Metformin?

Renal transplant patients are not generally offered metformin...and to be honest, I did not find Gliclazide helpful while on prednisolone. I stopped today...still high levels but hope to get it down again purely with low carb dieting. I shall have to tolerate the discomfort until the infection clears...I am not risking such high levels and the possibility of it setting everything back so far.

 

[plr36]

Hi I have been on and off steroids for asthma before my 12 year old daughter was born, only in 2015 was I tested for diabetes and now have type 2!!! I am steroid based asthma and without them I don’t function.. so now my diabetes is out of control and now being referred to the hospital and think I might need insulin... I’m really fed up as I’m not only fighting asthma and nasal polyps I’m also fighting T2D

 

[JohnEGreen]

@pleinster Have you not been offered Imuran or is it contra indicated for you it is commonly used as a steroid sparing drug now.

 

[pleinster]

@pleinster Have you not been offered Imuran or is it contra indicated for you it is commonly used as a steroid sparing drug now.

No, John...maybe it's to do with the other anti-rejection drugs I am on. My Prednisolone dose is no pretty low and I have managed to get my numbers down despite it. I have raised coming off it with my doctors a number of times but they are very reluctant to say yes (I think largely as it was so relied on before more recent immuno suppressants and they are all hesitant to risk it). Obviously, I could take the risk but as it's all reasonable at the minute...I am hesitant myself. If things change, I will certainly ask about Imuran. Thanks, John.

 

[Mommayorkie]

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

Is it ok to abandon prednisolone half way through the course? i am type 2 .with asthma and COPD among other conditions. taking short course of steroids and antibiotics to ward off a chest infection. feels like it was caught in time before it got a hold but how can i be sure? fasting bloods so far have been fine. 7.7/7.and 6.2 this morning. the last is normal for me.and my docs are happy with that. post lunch were not too bad but after supper (which is what i always eat. same ingredients every night and at bedtime 2 hours later are within or just over normal limits but tonight they went up to 21. that was scary. coming down now 3 hours after eating to 15.6. wont go to bed til they are around 12 tops.(which my diabetic doc says is to be expected most normal nights. ) or lower. depending how long i can stay up. but am seriously thinking of stopping the steroids but carry on with the antibiotics and finish the course... anyone think i should?
have had 3 days on them so far.

 

[Tophat1900]

I've taken prednisone everyday for the past 20 yrs (after a double lung transplant due to cystic fibrosis). Just No escaping the use of it for me. It certainly spikes BG's.... I do find using apple cidar vinegar and a few other supplements helped keep numbers lower then they could of been. Prednisone certainly was the cause of my CF related diabetes. Transplant medications also played a role in it, but nothing like prednisone.

I've been on imuran for a long time, not any longer as it was causing live damage. Something to think about if you plan on living for as long of a time as possible and want to discuss with your doctors. Not trying to put you off it. Just worth asking a few about.

 

[deb1960]

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).

I was managing my type 2 with metformin with no problems until I was put on prednisolone for polymyalgia. I wasn't warned that steroids could make my diabetes worse but within a week or two I was drinking gallons of water and had thrush ( neither of which I had when originally diagnosed with diabetes ) I wasn't testing but realised that something was wrong I went to the GP and was told that I would have to start extra medication and see the specialist diabetes nurse. I tried various medication but nothing was working and I had to start using insulin. Dulaglutide was then added and my bs were anything between 7 and 9 with the odd 11 or 12. The nurse told me that I wouldn't be able to lose weight because of the insulin and steroids although I'd just joined slimming world. I didn't lose weight on their low calorie diet so pretty much just gave in. I only wish that I had been advised that the steroids would cause so many problems and I would never have taken them. It took over 13 months to gradually reduce the dose. I would feel differently if the pred I was prescribed was for a life threatening condition but mine was for pain relief mainly.
I'm now doing lchf and my bloods are between 4.5 and 7 and I've lost half a stone. Feeling so much better.

 

[francesk]

I'm on an eight week course of Prednisolone, started at 40mg a day, for a bowel infection. Before this my last HbA1c was 39 and I was very pleased with that. I'm now having to inject a great deal more insulin to keep my bgs at a reasonable level. They have also raised my blood pressure considerably, although the dr has adjusted my Bisprolol to help with that. I wish that I could stop them but apparently it is dangerous to do so. (Why?) They are also causing dreadful insomnia! I've just started the LCHF diet, which I'm very grateful for, as if I was still eating too many carbs goodness only knows what my bgs would be.
Does the horrid mettalic taste in your mouth ever go away?

 

[Brunneria]

Hi, you asked if it is ok to abandon steroids half way through a course?

I would say a definite NO, unless the prescribing doctor has been consulted and agrees.

Steroids are funny things and they often need a very careful withdrawal period to prevent problems. So I would strongly urge you to get medical advice on this before you change your dose from what the prescription says.

Having said that, I do understand how much you blood glucose is being affected, and hope your doc can help you!

 

[MargaretR]

Hi, you asked if it is ok to abandon steroids half way through a course?

I would say a definite NO, unless the prescribing doctor has been consulted and agrees.

Steroids are funny things and they often need a very careful withdrawal period to prevent problems. So I would strongly urge you to get medical advice on this before you change your dose from what the prescription says.

Having said that, I do understand how much you blood glucose is being affected, and hope your doc can help you!

Brunneria is right, withdrawal from steroids has to be done gradually. I’ve been on steroids for more than 10 years and the GP who first prescribed them impressed on me the danger of stopping taking them suddenly. I’d have to look up the biochemistry but it is due to the links between the various hormones eg Adrenalin and cortisol. In extreme cases unconsciousness or even death can result.

Last April I had a knee replacement, and the morning after my operation when the drug trolley arrived there was no prednisolone prescribed for me. I should have had 15 mg. The nurse in charge of the trolley refused to let me have them as they hadn’t been written up for me, and she would have to find a doctor or a pharmacist to write it up. This was even though I’d taken all my own drugs with me, plus a copy of my prescription. I asked again at about 10.00 am, and she said she still hadn’t found anyone. I told her I was likely to be a gibbering wreck before much longer. At about 12 noon a student nurse in her 1st year found me in tears, confused, slurring my words, and shaking. Fortunately for me the student had a grandmother who took steroids, and she recognised what was happening. She went to the senior nurse and said I needed to be given the prednisolone immediately. I was given the 15 mg (from my own supply which had been locked away) but with dire warnings that it was my responsibility.

I’m due to have my second knee done, and I will take some prednisolone with me hidden in my wash bag.

I’m eternally grateful to the student.

 

[Pinkorchid]

My husband developed T2 after taking prednisolone for about 2 years for Polymyalgia and the doctor said the steroids were probably the cause He went into remission from the Polymyalgia for about 18 months and then it returned. As steroids are the only thing that works for the pain and pain killers don't touch it he had to go back on to them. Because of his age he is now 85 his doctor was worried about his bones because she said long term steroids can make them brittle so he takes a tablet for that. He got his dose down to 7.5mg a day less than that and the pains come back and that is what he will probably have to take for the rest of his life. His GB levels are good normally around the 6s and 7s he has a moderate carbs and fat diet

 

[francesk]

At any rate I've done two weeks of an 8 week course now, so must just get on with it. It's the insomnia and high blood pressure that are getting to me, the dr has already raised my bisoprolol from 1.5mg to 2.5mg, but it doesn't seem to be having much effect. Have upped my insulin so am managing to keep my bgs between around 8 - 12. Thank you all for your helpful answers. I'm seeing a nutritionalist at the Renal unit tomorrow - I wonder what her reaction to the LCHF diet will be?!

 

[Mommayorkie]

Brunneria is right, withdrawal from steroids has to be done gradually. I’ve been on steroids for more than 10 years and the GP who first prescribed them impressed on me the danger of stopping taking them suddenly. I’d have to look up the biochemistry but it is due to the links between the various hormones eg Adrenalin and cortisol. In extreme cases unconsciousness or even death can result.

Last April I had a knee replacement, and the morning after my operation when the drug trolley arrived there was no prednisolone prescribed for me. I should have had 15 mg. The nurse in charge of the trolley refused to let me have them as they hadn’t been written up for me, and she would have to find a doctor or a pharmacist to write it up. This was even though I’d taken all my own drugs with me, plus a copy of my prescription. I asked again at about 10.00 am, and she said she still hadn’t found anyone. I told her I was likely to be a gibbering wreck before much longer. At about 12 noon a student nurse in her 1st year found me in tears, confused, slurring my words, and shaking. Fortunately for me the student had a grandmother who took steroids, and she recognised what was happening. She went to the senior nurse and said I needed to be given the prednisolone immediately. I was given the 15 mg (from my own supply which had been locked away) but with dire warnings that it was my responsibility.

I’m due to have my second knee done, and I will take some prednisolone with me hidden in my wash bag.

I’m eternally grateful to the student.

I agree about having to come off steroids gradually but thats only if your on them long term/ not a short sharp course of 6 tablets a day for 5 days. then stop. (which is what they have always treated me with for a chest infection.its the usual treatment for people with asthma and /or COPD, it zaps any bacteria causing an asthmatic/COPD patient to wheeze badly and stops them getting out of breath simply by moving a few yards, ). once asgain i started witha cough (I do not cough normally at all) and grtting out of breath which got worse over 3 days. but eased during the day. so the dr prescribed just steroids not antibiotics as well( our surgery is following a derective now of not issuing us rescue meds. i would rather risk becoming immune to antibiotics than put up with such high blood sugars before bed. 25mmols tonight. took first lot of steroids this afternoon about 2.30pm . supper was at 10pm. same as i usually have. its coming down now but still 23.4 so its very slow. trouble is i am now feeling hungry. which i know within the next hour i will also start feeling ill if i dont eat something,.im drinking soda water. (no sugar no calories.no nothing but water and fizz)

 

[Kiteslady]

I have just had a double whammy. Asthma due to the incredibly high pollen counts, prednisolone x 40mg x 5 days. Then a tooth abscess for which I have been prescribed metronidazole 400mg x 3 x day for a week! This has sent my bs up from fasting 5.3 to 10.1 in four days, now today it has crept up to 27.3 by 4pm! I am type 2 so have hit my pancreas with a double dose of glycazide and am now sitting it out until I have finished both courses. As my breathing and abscess are improving fairly rapidly, I don’t want to stop taking the offenders, but it is very worrying seeing my precious single figures go so high.

 

[Pipp]

I have just had a double whammy. Asthma due to the incredibly high pollen counts, prednisolone x 40mg x 5 days. Then a tooth abscess for which I have been prescribed metronidazole 400mg x 3 x day for a week! This has sent my bs up from fasting 5.3 to 10.1 in four days, now today it has crept up to 27.3 by 4pm! I am type 2 so have hit my pancreas with a double dose of glycazide and am now sitting it out until I have finished both courses. As my breathing and abscess are improving fairly rapidly, I don’t want to stop taking the offenders, but it is very worrying seeing my precious single figures go so high.[/QUOTE

Oh, how I can identify with this. Steroids and antibiotics play havoc with my blood glucose levels, too. Each time I need them for breathing difficulty /asthma I find the numbers stay high for several weeks, and it is taking longer for them to settle each time.
Last time I had them I was told I could reduce the prednisolone after three days if my breathing improved. It did, so I did. Numbers came down, but remained in double figures for a several weeks. Much higher than usual. Sometimes it is necessary to prioritise the most debilitating health symptoms of one condition over the management of another.
I never got as high as 27.3, though, @Kiteslady. I would seek advice from GP or NHS 111 at a level such as that.
Hope things improve for you soon.

 

[JohnEGreen]

After upping my steroid dose a few weeks ago and telling me I can't come off them my neurologist now is suggesting his words weaning me off them if possible emphasis on if possible.

Now it seems he want's to start me on a long term antibiotic Co-Trimaxozole.

The steroids cause high BS and have in the higher dose recked my bs control but it seems the antibiotic has been known to cause hypoglycemia maybe they will balance out.

 

[MargaretR]

Me too! I’ve just been mentally composing a post asking for advice about my soaring blood sugar levels, and Pipp and Kiteslady have just reminded me of the most likely reason. I’ve normally been getting bloods of between 4 and 5 first thing in the morning, and this will have dropped to 4 before lunch.. I’ve had a difficult time since February with a knee transplant which got infected, and still hasn’t healed properly, so my BG has been creeping up because of the infection(s) and multiple antibiotics,, plus hospital food. I started on prednisolone 10 years ago for polymyalgia rheumatica, and it’s that that triggered the Type 2. My PMR has changed to rheumatoid arthritis, so I’m now on methotrexate, but still taking 10 mg of prednisone. Yesterday I thought an RA flare was coming on as I couldn’t use my hands, so I took an extra 10 mg of pred as advised by the rheumatologist in order to nip it in the blood. That at least has worked! Then late yesterday my dog jumped over my legs to get to the window to see the Amazon man, and ripped the skin on my leg (not the one with the new knee) tearing back a flap about the shape and size of an envelope flap. Off to A and E. And I forgot to check my blood sugar.

When I took it this morning I was in the 7 s and it has continued to rise all day, despite my meals being tried and tested ones. It’s currently 11.1, and I haven’t eaten since lunch.

I was about to post asking if people thought it was
A). The heat
B). The trauma of skin being torn off ( prednisolone is notorious for causing fragile skin)
C). A possible infection starting.

The 2 previous posters have reminded me that the likely cause is the extra prednisolone I took yesterday

Many thanks for reminding me.

Margaret

 

[Kiteslady]

Oh, how I can identify with this. Steroids and antibiotics play havoc with my blood glucose levels, too. Each time I need them for breathing difficulty /asthma I find the numbers stay high for several weeks, and it is taking longer for them to settle each time.
Last time I had them I was told I could reduce the prednisolone after three days if my breathing improved. It did, so I did. Numbers came down, but remained in double figures for a several weeks. Much higher than usual. Sometimes it is necessary to prioritise the most debilitating health symptoms of one condition over the management of another.
I never got as high as 27.3, though, @Kiteslady. I would seek advice from GP or NHS 111 at a level such as that.
Hope things improve for you soon.

Thank you, it is good to know that is the problem. I have had a conversation with 111 and they advised me to take more medication. I did and my bs are down to 14.5 now. I shall stop the prednisolone tomorrow, you are right, I need to be careful of managing one over the other.