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Steroid-Induced Diabetes

Discussion in 'Newly Diagnosed' started by Wojciechu, Oct 8, 2019.

  1. Wojciechu

    Wojciechu Other · Well-Known Member

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    Hello.

    I have been on high-dose prednisone since march for my multi-organ sarcoidosis. I have not been diagnosed with diabetes prior to my steroid treatment. I have checked my fasting glucose regularly 2-3 times a year (it was always in the range of 80-90 mg/dl) because I have hisory of family diabetes and I am abit overweight. Since I started taking prednisone I have seen increases in fasting glucose of 115-125 mg/dl. One day in June (3 months on steroids) I even had 177 mg/dl. My doctor send me to Hb1ac - 7,5%. I was told steroids increase glucose and I need to adjust my diet. After week fasting glucose was 77 mg/dl. Time went on. Since September i started to have blurry vision, eye pain and was very thirsty.

    I checked my fasting glucose and Hb1ac - 299 mg/dl and 11,2% respectively

    I went to diabetician. He diagnosed it for now as steroid-induced diabetes. I was prescribed an insulin. Within three days my fasting glucose dropped from 299 mg/dl to 86 mg/dl and my daily measurments dropped from 300-500 mg/dl range to 100-180 mg/dl.

    I am wondering if someone have a history with this kind of diabetes? Is it reversable? Or those kind of glucose levels suggest that I have developed permanent diabetes (1? 2? LADA) I am now beginning to taper prednisone. I am hoping this will go away. is this even possible?
     
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  2. Rachox

    Rachox Type 2 (in remission!) · Moderator
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    Hi Wojciechu and welcome to the forum.
    I don’t have steroid induced diabetes myself but I’ll tag in a couple of people who do have diabetes and are on steroids who maybe able to compare their situations with you @JohnEGreen and @xfieldok
     
  3. xfieldok

    xfieldok Type 2 · Well-Known Member

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  4. Kailee56

    Kailee56 LADA · Well-Known Member

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    As an ICU nurse, part of our protocol, when a pt is placed on steroids, is to monitor their glucose and give insulin as if they were diabetic. Basically, what you experienced. Since we usually just give the steroids for a week or so, the glucose levels return to what ever that persons baseline is, a few days after steroids have been tapered off. The confounded, with you, is the duration of your treatment. I don’t know what will happen, since sustained, elevated glucose levels can damage beta cells. If you do not have a hidden autoimmune component, your beta cells should recover and return to a non-diabetic level of glucose control, but I don’t think anyone can give any guarantees about this. Just be careful and monitor closely as you taper your steroids off. You do not want to be giving yourself insulin if/when you no longer need it

    I have also, in the past few months, received steroid injections for an arm injury. Monitoring my glucose response was an experience. I could actually see my glucose decrease when I used an ice pack (decreased release and circulation of the injected steroids), spike when I did arm exercises, and stay way higher than usual for days. They were actually scary high for me, no matter what I did. I felt my readings should be used in a study showing the effects, literally, of steroids on blood glucose. Really fascinating to see on my monitor.
     
  5. Dudette1

    Dudette1 Type 2 · Well-Known Member

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    I was on steroids for my chest infection, i needed some more as it hadn’t cleared properly, after a few days I felt awful, I went back to the doctors and sent to the hospital and was told mine was steroid induced. I’m losing weight and managing my blood sugars, is it reversible, I don’t know.. one can hope.
     
  6. Wojciechu

    Wojciechu Other · Well-Known Member

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    Switching to low-carb diet and tapering prednisone by 10mg made the trick. I barely need insulin now. Thats a good prognosis right?

    Scary thing is after 4-5 hours of taking the pill I see increases of my glucose without any other reason, but i correct it by doing excersise or giving myself small dose of insulin if Im not able.

    My doctors tell me that given my condition I might need to be on maintenance dose of prednisone for another 6 months.....still small dose better than high-dose right?

    My bones start to hurt. Now ill get osteoporosis after diabetes...

    **** drugs, cant wait till I stop using them altogether.

    Edited by moderator to remove profanity.
     
    #6 Wojciechu, Oct 14, 2019 at 11:12 PM
    Last edited by a moderator: Oct 14, 2019
  7. xfieldok

    xfieldok Type 2 · Well-Known Member

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    It's the steroid causing the rise after 4 hours. I use humulin I at the same time as I take mine, then try and catch the rise and hit it with novorapid. I need to repeat novorapid around every 3 hours, numbers dependent.

    Good news I can start to taper starting tomorrow, down to 35mg and after 2 weeks another 5mg reduction. Aiming for 25mg, will have to see how I get on.

    They are definitely not fun things and I will be glad to see the back of them. And climb back into some smaller clothes.
     
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  8. gmmorris

    gmmorris Type 2 · Member

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    I have been diabetic (on insulin for the greater part) for 20-odd years, and started (inter alia) on 20 mg prednisolone bd several years ago also because of sarcoidosis. Initially, my blood sugar readings were completely and seemingly inexplicably out of control. I blamed the meter, the needles, the insulin itself - absolutely anything but the steroid. Then - the light-bulb moment. No-one at all had warned me what to expect.The steroid!

    From then on, I adjusted the insulin by a crazy factor I dare not publish, and regained blood figures nearer to my former normalcy. As soon as the steroid was reduced, so was the need for buckets of insulin. So - I would suggest that whenever finally your doses of steroid are reduced, your blood figures will reduce too.

    I should add that I am not a medic - just a patient. But, for what it's worth, that is my experience. Hope it may throw some light on your own.
     
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  9. xfieldok

    xfieldok Type 2 · Well-Known Member

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    I was left with little "education" so far as insulin was concerned. I was jtold that if my levels were so high, add so much insulin. i did but itI was adding far too much. I ended up with a graph that looked liked the alps. Result, my eyes are in a terrible state state. Hopefully they will improve with time. Different surgeries have a vastly different experience of steroids.
     
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  10. gmmorris

    gmmorris Type 2 · Member

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    Too true, sadly. Many seem never even to have heard of DAFNE or similar NHS courses (an immediate life-saver for the patient and a cost-saver for the NHS in the long run). Crazy.
     
  11. JudiP

    JudiP Type 2 · Member

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    I have always considered my Diabetes was steroid induced because I diagnosed it myself after being on a long term dose of steroids for asthma. The diagnoses was confirmed by my doctor. My mother had developed diabetes at a similar age (mid fifties), we had both been on a long term steroid programme in previous years and there was no known case of diabetes in previous generations. I find that when I have to go on a crash course of steroids following recurrent bouts of bronchial asthma, my glucose levels go sky high and I have to compensate by taking much higher levels of insulin. I am able to bring the insulin doses down as my steroids are reduced but I have been diabetic now for some 20 years and on insulin for about ten years. Low carb dieting no doubt helps to bring down my Hba1c but I doubt if I will ever be able to come off insulin. Steroids are powerful as well as being dangerous drugs but I have a healthy respect for them because they saved my life in my twenties when I extremely ill with bronchitis. I don’t think enough notice is taken by the medical profession in relation to steroids causing diabetes.
     
  12. Wojciechu

    Wojciechu Other · Well-Known Member

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    Hi. I have some good news. I talked with my diabetician. Since my glucose level graph (whatever that is) is in healthy person range, I am to stop using insulin altogether and see how it looks.

    I also talked with doctors that treat my sarcoidosis. They say they will take me off prednisone and try a different drug called chloroquine. Hopefully my sarcoidosis won't be causing anymore flare-ups so I won't have to go back to prednisone.

    I think there is a hope for me :)

    Oh my nerves :)
     
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  13. JohnEGreen

    JohnEGreen Other · Master

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    I am a prednisolone induced diabetic I have been taking it at various doses since I was diagnosed with Myasthenia Gravis about 17 years ago I have now tapered down to 15 mg daily but no prospect of coming off it. as to reversal I have managed to keep my blood sugars in the normal range for some time now but it is not easy it requires strict control of carbohydrate intake and I also restrict calories .

    If you are able to come of preds there is a distinct possibility that diabetes will just go away this of course may depend on how long and at what dosage you have been taking them. Sometimes it just goes away sometimes people find it is permanent especially if there was a predisposition to diabetes before hand.

    You have my sympathy and hugs for you.

    I hope very much that you are one of those for whom diabetes disappears when no longer taking preds.

    Sorry I can't be of much more help.

    best wishes and good luck.:)
     
  14. chrispem

    chrispem Type 2 · Member

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    I have sarcoidosis also and was taking a high dose of Prednisolone also whilst on a new drug trial. During the trial I had a infection that put me in hospital and was taken off the trial and told to taper the steroid off. My average BG was 7.5mmol/L for around 3 weeks even after tapering off the steroid then quite suddenly over a week or so dropped to 6.6. The only thing I did different was take my Metformin in the middle of my lunch and dinner meals. With a bit more effort on my diet hopefully put the T2 into remission and get rid of the Metformin completely.
    Might be worth asking your GP about Steroid Sparing medication, good luck and best wishes.
     
  15. Wojciechu

    Wojciechu Other · Well-Known Member

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    Hi.

    First of all thanks for all the replies and sharing your histories with me. Much appreciated.

    Without insulin, my fasting glucose is in 105-120 mg/dl range, and my after meal ranges from 130 - 190 mg/dl. Was hoping for the better but maybe im expecting too much too soon. I’m on 10mg prednisone now for 4th day - but I was on 40mg for almost 7 months. Maybe my body needs some more time to adjust right? My doctor says something about putting me on Metformin 2x500 mg daily. We’ll see.

    I also had a test for Peptide C. Don’t know the exact value yet, but the nurse told me „It’s in normal range, leaning towards the upper limit” . What does it say, if anything about my pancreas and diabetes?
     
  16. EllieM

    EllieM Type 1 · Moderator
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    c-peptide is a measure of how much insulin you're naturally producing - a high level means lots of insulin, which suggests to me that you're insulin resistant rather than lacking in insulin. The good news on that is that it also suggests that reducing carbs may well control your levels without medication.

    Having said all that, I'm T1 so don't have any direct knowledge on steroid induced diabetes, other than the reports given by others that if you take steroids you can expect your blood sugar levels to go way way up.

    Good luck.
     
  17. Wojciechu

    Wojciechu Other · Well-Known Member

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    Thanks EllieM for the reply.

    My C-peptide result is 4,89 ng/ml (normal range is 0.78-5.19 ng/ml). Should I take the tests for antibodies like GAD? Or T1/LADA is such a low probability for me that there is no need?

    Also right now I am tapered to 5mg prednisone daily, and guess what my fasting glucose was this morning - 80 mg/dl (that would be 4,44 mmol/L)

    :)
     
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