steroid induced diabetes

cazanne4 said:

in may i was taken ill with sever chest inception, i suffer from non allergenic asthma and i am constantly prone to chest infections therefore on constant steroids and antibiotics.. On admission to hospital they checked my bloods and the reading was 30??? the doctor asked how long i had been diabetic!!! never new i was, after investigations and many tests it was found that it was STEROID INDUCED DIABETES!!! The hospital monitored this and on 4 separate occasions i had to be given insulin as the bg was very high. I was at the time being given metformin and glicazide. The problem i have now is i am back at home and after two weeks i have now yet again got a severe chest infection and the nurse practitioner has put me back on steroids!!! my bg ratings are now 17.9 - 13.7 i am at a loss what to do, how do i get this down as i know its the steroids and poss the antibiotics that are doing this, do i need a backup of insulin pen as a standybye at some stage as this infection comes and goes every couple of weeks. any advice ore help would be very much appreciated as this is all new to me and I'm starting to panic

Click to expand...

Hi Caz,
sorry to hear about all your problems
If it were me I would ask for a referal to an endocrine specialist as this is out of the remit of the nurse practitioner. Besides causing your diabetes you are also in danger of getting steroid induced Addison's.
So please do not take no for an answer insist you are seen by someone who knows what they are dealing with. The damage to your bones long term is another factor that needs to be taken into account

For the time being the only thing you can do is limit the amount of startchy carbs you eat as this will hopefully offset some of the steroid induced high blood sugars.

Hi cazanne4, I am a T2 diabetic and my diabetes was caused by long term steroid use after being diagnosed with Bronchiectasis and COPD. And I fully agree with CarbsRok that you should ask for a referral to see a specialist endocrinologist (diabetic consultant) as most doctors/nurses seem to have very little understanding of diabetes or the effects of corticosteroids on blood glucose levels, I had to use insulin for about a year until I had lost weight and got my diabetes well enough controlled to be able to wean myself off insulin. I will always be diabetic now but at present at least I am able to control it with diet and a minimum of medication, but if I had to go back on insulin I would not be surprised to find I needed extra medication, possibly even insulin again.

Do you know what your blood glucose readings were before the latest steroid course as it may well be that you have been diabetic for some time, perhaps since the last steroid course or even longer.

Its very hard to offer any concrete advice as no one here is a doctor and no one will know or understand your medical history but reassurance I can do

Prednisolone will raise blood glucose of that there is no doubt but you have to balance that with how it helps with your respiratory problems as there is also no doubt that pred is absolutely great at helping you breath. It definitely saved my life but at the same time caused my diabetes so yes I have diabetes but yes I am still alive and survived six days of being intubated whilst having a very bad chest infection/pneumonia treated with huge doses of IV antibiotics, I was in intensive care for two weeks in total and it certainly sorted out my chest infection but I wouldnt recommend that route if it can be avoided :lol:

I was given four courses of pred before my v bad exacerbation and whilst in hospital I was initially given 300mg of pred a day by IV that was reduced and by the look on my consultants face I assume it was a mistake to have given me such a large dose anyway, when the IV pred was stopped I was then given a fairly large daily dose of pred which after my recuperation was reduced further to 40mg a day and I stayed on that dose for another 2 years which is I guess when I became diabetic. At that point I suffered an SVT which in lay terms is a very erratic out of sync heart beat in my case of 188 beats per minute and I had to have my heart stopped and restarted in normal rhythm again, it was because of a blood test in hospital that showed my bg level at 29 + mmol/L and an HbA1c of 12.9% that I was seen by a Specialist Diabetes Nurse who worked under an Endocrinologist at the diabetic clinic in the hospital and she put me straight on insulin, in fact I had been given an insulin drip overnight to reduce my bg level, so I had no experience of anything else and I soon not only got used to the four times a day injections but also got used to matching it to my diet and I was determined to lose weight, over the next six or seven months I managed to lose around three or four stone in weight and reduce my insulin considerably from the initial doses. I found that as I lost weight I obviously lost much of the insulin resistance that was stopping my insulin working.

At about this point after a consultation with my respiratory consultant I gradually reduced the prednisolone over a six month period from 40mg a day down to just 1/2mg a day and then every other day, the reason for such a slow reduction was due to my having relapses every time I had come off pred prior to my stint in ICU and it was thought that my adrenal gland had stopped producing cortisol and the slow reduction is thought to kick start the adrenal gland into starting its own production again, thankfully it worked. In retrospect I do wonder if my adrenal gland had stopped working or whether the prednisolone had been covering up a more serious chest infection than was first thought, but of course I will never know for sure.

I would have no qualms about going back on insulin if I had to at some point in the future, and if it should be suggested that you should start on insulin you should not be scared or worried, do though ask for a referral to a diabetes clinic/endocrinologist as it is only their superior knowledge of diabetes that helped me come to terms with it so (relatively) easily, I really cant emphasise that enough as predniolone, insulin and diabetes combined is a very specialist area indeed.

I was initially put on 10 units of Humulin I a long acting insulin at night to help to keep my bg down overnight and 10 units of fast acting Humulin S before meals, this I increased over the following days in order to keep my bg levels around an average of 7 mmol/L. I was told to inject 15 to 20 minutes before eating but a bit of tweaking told me that for me 30 minutes was the optimum time, for you or others it may well be different but I found that at 30 minutes I could inject the minimum amount to cover any meal.

As I started a diet at this time motivated by my diabetes diagnosis over the following months my insulin needs reduced from a maximum of 48 units aday down to around 25 units a day or there abouts and after weaning myself off prednisolone and losing a few more pounds I was able to stop using insulin all together. So it is possible to lose weight and reduce your insulin while on prednisolone.

Again, please dont worry about going onto insulin it will almost certainly not be as bad as you imagine it to be and if you have to take prednisolone thaen it may be the only way to keep a check on your bg levels. If you want any further information on T2 insulin use please dont hesitate to ask, and above all dont worry, get your respiratory problem sorted out first and then focus on the diabetes :thumbup:

Sid,how many units of Humalin I did you need at night to bring your morning readings down? I'm on 12 units of Humalin I at bedtime and I now can't get my morning reading below 8,is 12 units a large dose or a small dose in your opinion? I didn't get much advice in that area TBH and your feedback would be gratefully recieved.

Paul

P.S apologies to the OP for going off topic a bit.

At diagnosis I weighed about 18.5 stone around 260lbs and am around 5ft 10ins tall and the 10 units Humulin I as well as the Humulin S I was started on was arrived at I was told by my height, weight BMI, so many units per kilo or whatever. The nurse spent a long time talking to me about keeping my levels as low as possible without hitting hypo territory every day and over the first week I had increased my I and S insulin to 12 units per shot. I was initially told to aim for a target of under 10 mmol/L's.

I actually found it quite easy to keep my fasting levels between 5's and 6's just by adjusting my evening shot of Humulin I, in fact at my first follow up I was told to aim a little higher but by that time I had joined this forum and was a slave to low numbers even recording a low of 5.1% on one of my HbA1c's which the SDN wasnt at all happy about :wink:

Its hard to say whether 12 units is a high or low dose as often T2's need considerably more insulin due to insulin sensitivity and as has been mentioned here once or twice we are all different having different levels of insulin sensitivity and pancreatic function as well as many other factors like weight, height, various hormone gland functions etc.

Oh, I was also told that I could take a corrective dose of Humulin S if needed and that one (1) unit would reduce my bg by around 3 mmol/L. I rarely had to do this though as I was trying to keep as low as possible. Who me, anal? :lol:

I would advise talking to your SDN/Doctor etc but if like me you must to tinker about yourself just up your evening long acting insulin by one unit at a time and try not to aim too low until you are sure you are not at risk of night time hypos, as in retrospect I was probably a little foolish. Hindsight eh? But little by little is the way I would suggest and if your levels are not at all stable ie wild differences every morning then dont be tempted to aim for the lowest level as you will not be leaving yourself any leeway.

Cutting back the carbs I ate did definitely help although I did increase them a little after I had lost the weight and come off insulin, I do still watch what I eat though.

Heres a couple of scans from my first log book, the first is page one started in hospital and the second is a couple of months later having lost some weight, I really did find the amount of insulin I was using reduced with my waistline, but if you are LADA and not overweight obviously that wont help you.
The log started after I had been on an insulin drip for one or two nights before being shown how to use my pen for the first time.



And after I was a little more used to it. If I had had to use a set amount of insulin every time and eat to that amount I would not have been able to maintain the levels I did, but as I have mentioned before I had very good teachers in my SDN along a few of the members here, sadly some no longer post although happily a few still do.



My apologies for another long post :|

Thanks Sid for that really good and helpful post! :wink:
I wasn't happy about just dialling the pen up in big incriments to get a low morning reading,because as you rightly say,there's no Leeway and a nighttime hypo is not something I would like to experience if at all possible(as I'm sure they're terrifying for those who experience them).I will try 1 unit at a time over a few weeks and if no joy I will phone the clinic as I can't realistically lower my carbs more than the 50g a day I eat now but I need to get my readings lower as I now have Retinopathy.

Many thanks again

Paul