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Steroid induced diabetes and conflicting information...

Discussion in 'Newly Diagnosed' started by janeage, Apr 24, 2015.

  1. janeage

    janeage Type 2 · Member

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    Hi everyone wonder if you can offer some help. I'm a chronic brittle asthmatic and i'm on anywhere between 20-50mg daily of steroid medications as a result i was diagnosed with steroid induced diabetes about a month ago and started on Metformin 500 mg twice a day. The diet advice i was given from GP at the time was to follow a balance diet, plenty fruit and veg, balanced wholemeal carbs , low saturated fat etc. I''ve been back today ,as i don't feel i'm doing enough and don't like idea of medication on enough already, and saw a different GP. He advocates the low carb approach, no pasta rice bread etc etc and to exercise at least 1 hour a day to burn off some of the excess energy triggered by the steroids. (im about 4 stone overweight).

    The new GP's advice seems to tie in with what i've seen on here, but i'm just not sure how to go about it, do i measure everything, how do i control this, can you do so much exercise without carbs? i've always thought if going to the gym need to have carbs that day. I'm in a bit of a muddle and i can't seem to find any info on Steroid induced diabetes. Any help is appreciated, thanks
     
  2. Dizzydog

    Dizzydog Type 1 · Member

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    Hi I'm also new here but am also brittle asthmatic & steroid dependant. (Again 25- 50mg daily) and a cupboard full of other medication that does strange things to blood sugars I've found! was diagnosed back in oct and put straight on to insulin with a recent change from mixed to basal/ bolus, best thing I ever done and find it so much more flexible & I've soon worked out my own personal response to steroid dose changes and insulin requirements. I have also worked out all my carb ratios etc.

    I also found little information on steroid induced diabetes (consultant said it is more tricky to control deal with but at least my excellent GP admitted he had little dealings with this type & referred me straight to the diabetes specialist team ( I also use subcutaneous terbutaline & methtrexate off licence and so the gps won't generally have much to do with any of that & needed specialist input re that & diabetes etc)

    I'm unable to do any exercise really & have chronic asthma symptoms nearly all of the time & diabetic consultant suggested the normal balanced diet approach but in fairness also explained the lower carbohydrate/ less insulin scenario etc etc advice seems to vary.

    Also I'm assuming it's pred you take and it has a distinct affect on blood sugar patterns during the day (basically gets higher & higher through the day and then lowers overnight with a peak at around 3pm! & once you get your head around that I've found it easier to deal with/ control but then I've been on pred so long now I could tell the diabetes consultant exactly what times pred was at its most effective!!

    I'm by no means an expert & am still learning but hope that helps a little from personal experience. Sorry if it seems a bit of a waffle and feel free to message any questions or thoughts & I'll do my best to help :)
     
  3. janeage

    janeage Type 2 · Member

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    Thanks so much for your reply, its good to know i'm not on my own with this weird and wonderful strain of diabetes!!! It is indeed the fantastic prednisolone i'm taking, and all my respiratory specialists have said is that if i can keep at a steady dose it will make controlling sugars easier, but when i have an exacerbation and have to do increased doses of pred then this make things harder to control! I know i will get there but it is a bit overwhelming!! only just realised the link between the steroids and sugar increases etc

    The exercise i want to do but again like you i am restricted by how good a time i'm having with my breathing, touch wood its ok so i can go for a walk but not a chance of running!! lol.

    There is so much of my health that is out side of my own control that i feel this is one thing i can really try and get a handle on i've got a fighting chance, nothing i can do about my steroids they are a part of my day to day life now i've accepted that but this has got to be sortable surely! the way i see it is if i do as much as i can then i know i've tried... i just don't quite know what that should be!!
     
  4. Dizzydog

    Dizzydog Type 1 · Member

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    It's sortable my readings were constantly up in the high 20's & are now coming back in to the 4-7 range- I'll admit at first I was naive & thought compared to the other health stuff going on this would be the easier thing to control, maybe not quite that easy & for steroid diabetes that is quite tight control & may not suit everyone I believe. At one point it was phrased as all we could attempt was damage limitation but I wasn't happy with that at all, but I'm a stubborn mule & at least wanted the chance to see if I could get better control hence the change to basal/ bolus.

    I've found with the steroids it's best not to get to upset by the odd few high numbers & I do get completely random highs but I'm on so much other stuff & I swear sometimes my body doesn't know how to respond to what at times & I've got every listed side effect from steroids but needs must.

    Initially with the diabetes consultant it felt like being sat in front of the steroid police & I do understand his point of view as I guess they get left to deal with the damage they do but they now realise I can't do anything without them & it's a quality of life issue & breathing is quite important to me lol (if only it was that easy)

    I also have such a supportive respiratory consultant (he fought tooth & nail with the trust to get funding agreed for the subcutaneous terbutaline infusion & they all fell out over syringe drivers of all things) & I'm given freedom to lead my own treatment/ dose changes & not sure all consultants agree with that approach. Polar opposites I think would be the nice way of putting it.

    My steroid dose changes so often & in a way that's helped me ( but given diabetes team a challenge) as I've become a bit of a ninja at working out my personal response to the dose changes and my insulin needs. I would just say if you are not happy with something be persistent as you know you're own body & from experience the medical profession can struggle if you don't fit in the 'box' or come from the text book...
     
  5. mrspuddleduck

    mrspuddleduck · Guest

    Hi. Cant add anything but Im steroid dependant (but it didnt cause my diabetes) so am interested in your thread. Ive been on pred for 10 years and have the same problems with its effect on blood sugars - I climb through the day and hypo at night! Will be keeping an eye on this thread and will contribute if I can. Sue xxxx
     
  6. janeage

    janeage Type 2 · Member

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    Thank you both for your help, i'm just doing as much research as i can now on the low carb side and looking through the forums on here, going to give it a whirl and see what happens!
     
  7. Nuthead

    Nuthead Type 2 · Well-Known Member

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    Interesting thread this one. I do not take steroids but have let's say Steroid enhanced diabetes. They had to give me such high doses of the stuff to keep me alive in A&E and subsequent treatment over a period of weeks pushed me into insulin. I was diagnosed with cancer and part of the chemotherapy included steroids. I have found lchf the way to go. I've started cycling a bit to loose weight and get fitter. When out peddling for the day I have to load up with carbs or reduce my insulin considerably. When I was taking steroids my bg went through the roof. I needed approximately 30 to 40% more insulin. It's quite a juggling act to get the correct balance. Unfortunately as we all react differently, I think it's going to be trial and error. You could find high bg caused by steroids offsetting the need for carbohydrates. However I think you need to test regularly when exercising to find out how it affects you.
     
  8. Daibell

    Daibell LADA · Master

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    Hi. It is difficult to handle steroid induced diabetes and my only advice is to ensure that anyone on steroids is on the minimum necessary dose and only for the necessary length of time. Many NHS HCPs seem think of steroids as harmless wonder drugs. They are certainly a very important drug but harmless; no. My wife was on steroid enemas for many years for her colitis. The experts said they wouldn't be absorbed by the body; they were and her weight suffered.
     
  9. Russ

    Russ Type 2 · Well-Known Member

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    Hi, I'm on sterioids for COPD (lung disease) which sent my BS level up. I added extra Gliglazide at night which worked well except I sometimes get hypos in the night. Not funny. I also take a small amount of apple cider vinegar last thing at night - that helps, but clean your teeth straight after, because of the acid.

    It takes time to learn WHAT SUITS YOU and you'll be ok. Don't beat yourself up and take things at your own pace.

    Good luck.
     
  10. vinylandtrinkets

    vinylandtrinkets Type 2 · Active Member

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    i am so glad i found this thread! i was diagnosed a month ago with steroid induced type 2 diabetes, i was also on pred's for rheumatoid arthritis, when i started taking them 3 years ago it was 50mg twice a day, over the years it was reduced due to other treatment but it was to late the damage was done, my liver function blood tests were always through the roof also.

    the only reason i found out i had diabetes was because i went to my gp about being thirsty & weeing all the time and my vision was off.
    i would like to add that at no time did anyone tell me steroids can bring on diabetes which has now left me very very upset,. the arthritis clinic was not bothered at all when i told them , nurse said oh well are you off them now!?

    I am now thanks to my gp completely off the steroids as my bg upon diagnoses was 29.8.
    i have other serious health issues and take a lot of other medication for that.

    my problem now is the same as opening posts on this thread, spikes in the morning even though my diet is totally controlled and then hypos after breakfast,
    the only thing my diabetic nurse and gp said to me was cut out all sugar, be careful of my in food sugar intake, avoid fruit completely until my sugar was controlled, no one mentioned carbs ( although as soon as diagnosed i was on here reading up)

    i dont understand how to work out the carbs im allowed to have? i dont want to keep bothering my gp they are busy enough without me there all the time,

    Im trying to stay positive about all this but it is starting to wear me down,
    i take metaformin 240mg ( which after reading other peoples intake is really low)
    stopped the glick this week as my sugar is finally down to between 6.7 & 9.8, so im hoping this will level off too.

    i will be eagerly watching this thread as there is little info anywhere regarding steroid induced,
    i would like to wish everyone well too
     
  11. MargaretR

    MargaretR Type 2 · Well-Known Member

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    Hello, i'm also steroid induced. I've taken steroids for about 9 years for polymyalgia rheumatica, My current dose is 25 mg red, but I have got that down from 40 mg at Christmas when I had a flare up. I'll be back later, the kitchen timer is beeping at me.
     
  12. vinylandtrinkets

    vinylandtrinkets Type 2 · Active Member

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    forgot to say " nice to meet you all"
     
  13. MargaretR

    MargaretR Type 2 · Well-Known Member

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    Continuation of above post.

    Sorry about not coming back, but i couldn't find the thread.
    When I got the diagnosis I was put on metformin (3x 500mg) . my GP told me not to bother testing, but I bought a meter and started testing to see what foods I needed to cut out completely. The GP is happy to look at my readings.

    At first my readings were all over the place, but I gradually realised that the readings correlated with when I took the prednisolone. I normally take it 9.00am. My fasting readings are usually in the 6s, but that will rise to anything like 12 or 13 by mid afternoon, before dropping to 7 or 8 in the late evening. The key thing to my realisation that it is a direct affect was that if I took a 25 mg non coated tablet, my bg peak was about 3.00pm If I took
    5 x 5 mg sugar coated ones it takess longer to absorb and my peak bg is about 5pm. Recognising this has meant going back to my food listings, and reinstating some of the foods I had previously banned.

    I can't find much on the web, but I did find these 2 references and posted them about 6 weeks ago. I've pasted them below


    www.imperialendo.co.uk/Steroids

    It's written for medics at Hammersmith hospital, but there is a useful and interesting flowchart at the end. Many of the other references are mainly about people who have only been on very short courses of steroids, but this one does discuss long term steroid use,and does explain why why the blood glucose readings can rise during the day.



    There is also some interesting stuff in here. It's an old thread (2006) and American, so the BS are all in old money, but it does cover some of what we have been trying to find out about eating and BS levels.



    HealingWell.com Forum > Diseases & Conditions > Diabetes > coping with steroid (prednisone) induced diabetes



    Margaret
     
  14. janeage

    janeage Type 2 · Member

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    Thank you to everyone that has posted, its much appreciated, its only once i started looking into things that i realised that the steroid induced diabetes is more difficult to manage because how it changes the sugars regardless of what i do...... i feel like its a bit of a losing battle before you even start but hey there's got to be a way!!

    Thanks Margaret for posting the links i will take a look at them and see what information i can learn. Im in the unfortunate position of being steriod dependant now as my body no longer makes its own as i've been on them so long, its for the foreseeable future so i've got to find a way of handling it.
    if i find out anything else i'll put it on here as it seems to be an area that isn't very well known! typical me!!
     
  15. MargaretR

    MargaretR Type 2 · Well-Known Member

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  16. MargaretR

    MargaretR Type 2 · Well-Known Member

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    Today has been interesting. First thing this morning my bs was 7.2 I took my medication at 9.00am, and today was my first day on 20 mg of prednisolone, having been on 25 mg for a couple of weeks. I took 4 x 5 mg of sugar coated pills. Since diabetes was diagnosed I've never had a day when my bs readings didn't go into double figures from late morning to late afternoon. However, today the highest was 8.8 straight after lunch. If this happens every day, rather than just being a one-off, then I'll be delighted!

    When I was diagnosed with diabetes my GP said he thought I would need to get down to about 6 mg of red before I saw any reversal. I think that is highly unlikely judging by the aches and pains I've had today, but any improvement is welcome.

    Margaret
     
  17. Dizzydog

    Dizzydog Type 1 · Member

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    I've found for me personally any steroid dose change does not really effect my blood sugars/ insulin needs until the following day for some reason (although I know from various tests I am also fairly steroid resistant & need large doses)

    I've also found that although certain aspects are beyond my control, much of the other advice applied to non-steroid diabetes is applicable to me so maybe I had something else going on anyway! Yes we will struggle with the high numbers rising through the day but the dietary / exercise advice etc all still helps & stops it going crazy high. With infection & higher steroids I seem to go through insulin like water & don't beat myself up too much/ let it run a bit higher for a short time. I also have hypos when I have asthma attacks but you'd expect the opposite & for sugars to go up but hey I like to be different obviously :)

    I've found things are more stable now I'm on basal/ bolus but with my basal in the morning so in theory reduces the night hypos & I'm sure there is a certain amount of steroid involvement in my carb ratios as they also vary slightly with steroid dose changes. Today's numbers have been 4.2, 5.2 & 5.0 & after meals with in 2 mmol so really pleased with that, but as is the nature of the beast will have odd spikes & higher days. I'm just pleased to be out of the 20's and in single figures most days.

    Good luck with the exercise I only wish I could but even consultant advised against it as I can barely walk to the end of the path without the asthma kicking off these days & much as they might think I love them I don't need to keep ending up at the hospital & a season ticket holder!!

    I'm also still losing weight on insulin so at times I still think my body is just confused with what to try & deal with at what time!!
     
  18. vinylandtrinkets

    vinylandtrinkets Type 2 · Active Member

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    Margaret & Dizzydog, both brilliant news about your BS hopefully they will continue to be lower then then use to be,
    i also wish i could do exercise but i have a spinal problem which prevents me from doing so.
    in the last 5 weeks ive lost 2 stone in weight because of my sugars, so im not 100% sure what caused that, im 6ft and my weight did go up to 15st so losing some wasnt a problem but still a worry none the less.

    so far the highest my sugar has been since on metaformin alone is 11.8 which made me really feel ill, but thankfully over the last couple of days the highest has been 8 and the lowest 6!! i am over the moon!

    Janeage how are you doing?
     
  19. MargaretR

    MargaretR Type 2 · Well-Known Member

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    Thanks Vinyl, Today's pattern has been the same as yesterday, lower dose of prednisolone, bs levels in single figures all day. Magic!.
    My GP rang an hour ago to give me the results of some blood tests. It seems I am highly Vitamin D deficient. When he had finished explaining the treatment for Vit D he said 'and keep trying to get the steroids down'. I explained what had happened the last 2 days with my bs levels he said 'that's absolutely fantastic.

    It looks as if things are moving in the right direction.

    Margaret
     
  20. vinylandtrinkets

    vinylandtrinkets Type 2 · Active Member

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    so please Margaret , can you take supplements? might be worth double checking, i take calcium with added vit d because of my arthritis , would say sit out in the sun but we dont get any lol
     
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