Steroid induced Type 2 diabetes

gillytee31 said:

I have been diagnosed now with diabetes type 2 for around 3 years and for the first 2o months manage to control it with diet alone. May 2014 went on to one Metformin per day, but had major deterioration January 2015 and over 4 weeks meds increased to 4 x 500 metformin and 4 x 80 gliclozide per day. It then stabilised until January 2016 when I was hospitalised with unrelated medical problem and it was realised that my fasting blood sugars were 20+ every day (my gp had told me I did not need to test my sugars at all). I was then referred to the hospital diabetes clinic and put on insulin. I am taking long acting insulin initially 14units pm but although that brought my fasting blood sugar into the normal range, the other 3 readings (before lunch, evening meal, and at bedtime) were still very raised so I was told to take insulin in the morning as well and I am now taking 16 units am.
Many other people with diabetes have told me it would only be raised like this if I was eating an unhealthy diet which I am not. The hospital disagree and say I have got steroid induced diabetes which would explain why it got so much worse so quickly and why it is still so high even taking a total of 30 units of insulin per day (today it was 12.5 before lunch, 14.5 before evening meal and 10.8 when I went to bed). Is there anyone else out there with steroid induced diabetes, or even with the usual Type 2 who has a similar story?

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Hi. All I can tell you is that I was diagnosed with steroid induced diabetes following treatment with the steroid, Prednisolone (25mg daily initially) as part of post transplant treatment ( as I was warned in advance may happen as it is not uncommon with such treatment). My diabetes was actually spotted 2 months after treatment had started when my blood sugar was found to be above 20mmols. Insulin was never considered! Renal transplant patients cannot handle Metformin, so I was placed on a low dose of Gliclazide with some but only little effect. It was the doubled as my steroid reduced to 20mg..to no effect...15mg...10 mg...no real effect. My levels came down a wee bit over time on 5mg a day but I was still hitting as high as the 14-18mmols range until I opted for control of my carbs and recording my food and my meter readings. I came off the Gliclazide to see if my low readings were due to them or the diet or a combination. Very clearly, it was nothing to do with the Gliclazide at all. I stopped taking them months ago. I remain on the steroid (and may do for life as it fights rejection of the new organ) and while my readings dropped to closer to the normal range most of the time (purely through a very low carb - but well sustainable, healthy and enjoyable - diet), I was still getting a spike from my steroid a few hours after taking the pill. I have recently had my steroid cut down to 2.5mg and my levels are suddenly all under 7mmols with no sign of any spike post pill! My doctors are all renal and diabetes specialists and they agree...the steroid caused my diabetes, its reduction has helped..but my very low carb diet is why my blood sugar is now pretty normal. Some on steroids for a short time (under 3 months) can and do reverse their condition when they stop taking the steroid. Those on the drug for longer probably won't reverse it (that's probably), and those dependent for life are stuck with it....ONLY through controlled dieting can it be forced to behave...but while I am confident that I can keep the numbers down, I don't expect to be free of the problem and shall have to stick to my diet (allowing myself wee treats here and there). Rather than disagree with your "hospital" (are we talking experts or general staff?), I would wonder if you are on a specific steroid which differs to all others I know of? The steroids increase the blood sugar (fact)...the diet WILL reduce your blood sugar (fact), whether you are on a steroid or not. That is both my direct experience and the view of my doctors. I would advise you to seek an appointment with a diabetes specialist (consultant) for his/her advice. if it is some horror steroid...then why can't it be changed to another less brutal? I suspect you may (and I don't mean this cheekily at all) may be eating what general doctors and non-specialists call "healthy eating" (and therefore you are baffled and they are seeking an easy explanation which allow them to support this "healthy eating" advice). I would say that if you look around on this site, you will see that maybe 80% or more of the members would say that you have to rethink what is healthy eating for someone with Type 2 and someone who is non-diabetic. My opinion (and that's all it is) is that this "balanced diet" thing is nonsense. What works? NO..and I mean NO simple carbs. What let me see the quick reduction in levels - NO bread, NO cereal, No spuds, N) rice, NO pasta....and plenty of fluids to keep well hydrated. I hope at least this is food for thought. Read around the site...ask questions. If I can help in any way..don't hesitate to ask. there are loads and loads of very experienced, helpful people here...and I'm sure there will be appropriate responses soon. Above all...worry and stress only raise levels too (ie. pointless) - it's just another thing to deal with is all...and deal with it you will.
Paul

I won't weigh into that "not cut your carbs" discussion / advice but I'm certain others will. Good luck with it all as it sounds you have enough on your plate so wish you well

Mike

gillytee31 said:

That is helpful. I am permanently on steroids (prednisolone) because of an auto immune eye condition called uveitis. Insulin has been prescribed because at its worst my blood sugars were over 30, and were regularly over 20 for 6 weeks. I am under the diabetic specialist at the local hospital and have been told by them and the dietitian that I definitely should not cut out carbohydrates because I am on insulin. The other slight complication with a low/no carb diet for me is that I am married and enjoy cooking and do not want to eat different meals from my husband.

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I am certainly not medically trained in any way, and would not want to offer the wrong advice..but I do know there are plenty of Type 2s on insulin who are also eating very few carbs...and hopefully one of them will respond to lend some weight to that viewpoint. I understand your point about being married and eating the same meals, but your health is surely far more important. I am also married and my wife has pretty much been more than happy to eat what I eat...she has realised, like so many others, that most of the carbs we are not just unnecessary..they are less than healthy for us..being largely processed rubbish. Some while I get that it's a slight complication...diabetic complications are surely worth avoiding? Anyway, whatever you choose to do..I hope the levels come down and you stay well. Good luck.

@pleinster said it well ..... the cooking "different meals" runs a distant second to your health. They don't have to be radically different from what you might serve yourself, but concessions may be required

As already said we are not medically trained here so can't know if changing your diet...if you wanted to... will be suitable for you as you have diabetes and another condition and take steroids this is something you should check with your doctor

Just to say , I often eat the same meals as my friends and family , I just eat less/no carbs than them.......

For instance having sunday lunch this Sunday and will have the same but will put extra Meat/veg on the plate and maybe have a couple of small roast spuds, they will be the only carbs I eat that day so will be under my daily limit........

I know its more difficult with some meals but I find it quite easy and once you are low carbing all the time the odd high carb meal does not hurt (I dont even think about it at xmas/birthdays etc, just eat everything)

As my daughter is waiting on the result of her hba1c test my wife's blood sugar was 8.6 last night two hours after eating the same meal that I had mine was 6.2 I'm the only diagnosed diabetic in the house and I had the lowest BG. I think we are all going to be low carbing from now on. so will not be having to cook different meals except for grandson who is tall slim and thinks he is impervious to diabetes even though his other grandparents are both Type2 and so where his great grandparents though I think his great grandfather may have been T1 as he was thin as a rake. Wife's brother and two of her cousins are T1 so if we all got together we could have a low carb banquette.
Edit
Oh I forgot to mention I am steroid induced T2 have been on steroids several years well over ten years to be honest started relatively low dose given to control Myasthenia Gravis each time they found it was not working they upped the dose till I was on 40mg a day. since they realised I was diabetic they have stepped the dose down to 15mg a day want to get off it but after such a long time they are not sure if my adrenal glands will produce cortisol again.

John

gillytee31 said:

I thank you for all your answers but no-,one has explained to me why my blood sugars would have suddenly risen very high in both January 2015 and January 2016 despite no change in my diet. In mid November 2015 my HbA1c was 46 the lowest it had ever been, and my diabetes nurse was very pleased with me, but in hospital 6 weeks later it was over 70 and yet there had been no change in diet. In my particular situation I do not think changing to an LCHF diet is going to help but will ask at the hospital on Monday.As someone else said my situation is complicated by the fact I have a lot (12) of different medical conditions and am on 11 different medications on a daily basis - 28 tablets per day - plus insulin twice daily

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Hi. I hope nothing I wrote earlier seemed cheeky...often black and white words on a page are not expressive enough in terms of sentiment and emotion, and on such forums and this can seem critical were actually the intention is to support. No knowing what you own medical conditions are makes it difficult to give sound advice to an individual other than the general stuff. That said, it is worth asking specialists more about the impact of LCHF dieting in your own case as it may well still be what could make the difference. Lots of us are on lots of meds. I also take 28 pills every day (also 11 different meds as it happens).
Anyway, to try an attempt to answer you actual question... or to at least offer my opinion...simply put, the condition is a progressive one; it gets worse by itself. So, unless it is successfully managed - numbers will increase. Had I not gone onto a low carb diet, my numbers would have gone up for sure instead of coming down. Also, tests in January are generally a bit higher following the festive period and eating and drinking habits. You say your HbA1c in the November was 46 (that's pretty good) but when you refer to a test in hospital 6 weeks later you don't say if that was an HbA1c test or not. Our levels at one particular moment are nowhere near as accurate a picture as an HbA1c which expresses the average over a 3 month period. Also, it's worth bearing in mind that stress is a big factor in increasing blood sugar levels. I hope nothing I am saying here is seen as criticism at all...really just trying to respond with whatever I have for you to consider. Please..do ask again about LCHF on Monday like you say you will...I still think it could be of great help to you.

When I was first diagnosed with Type 2 back in April 2013, the diabetic nurse told me the diabetes was a side effect of all the steroids I've taken over the years for my asthma/chest infections.

A few months back a GP I saw told me he thought that was a load of bull hockey, and that the only reason I'm diabetic is because I'm overweight. Nothing to do with the amount of steroids I've taken over the years whatsoever.

Who do I believe? The specialist diabetic nurse, or a cynical General Practitioner?

gillytee31 said:

Plinster. Yes the test in January when the number was 70 was HbA1c. That is why the hospital was so concerned because it had gone up so suddenly and stayed up. Surely if it is only to do with diet, or even just general deterioration it would not have gone up so suddenly. At the end of November my blood sugars were consistently between 4 and 7 it went up to 15 and then never went down until I was put on insulin.
I know diabetes is a deteriorating condition but of all the people I know with Type 2 diabetes (about 10 people) I am the only one who has had such a short gap between starting oral meds and going on insulin - 20 months and also the only one with such erratic blood sugars. Even the hospital are surprised by these facts and are continuing to do tests to see if I have something other than the usual Type 2 diabetes.
Sykes, whilst it is true that diabetes is to a large extent caused by being overweight steroids themselves cause weight gain as it says in the patient information leaflet. When I first went on steroids my opthalmologist warned me that I would definitely put on weight and probably get diabetes. In the first 9months of being on steroids I put on 35lbs which I have never managed to lose. Because of my experience I would definitely not believe your GP. He is in effect saying that the drug manufacturer do not know what they are talking about in terms of weight gain. All the best, Gill

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I hope there's some progress soon...certainly does sound like a pretty quick jump. Maybe it's not strictly Type 2. Good luck.

Symes said:

When I was first diagnosed with Type 2 back in April 2013, the diabetic nurse told me the diabetes was a side effect of all the steroids I've taken over the years for my asthma/chest infections.

A few months back a GP I saw told me he thought that was a load of bull hockey, and that the only reason I'm diabetic is because I'm overweight. Nothing to do with the amount of steroids I've taken over the years whatsoever.

Who do I believe? The specialist diabetic nurse, or a cynical General Practitioner?

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Frankly...your GP is talking the bull hockey (never heard that term before). Even the common out of date GP opinion is that steroid induced diabetes is simply the manifestation of a predisposition (genetically or to do with a range of other issues) to diabetes and never just simply due to weight alone. I was never overweight in my life. My diabetes was not triggered by the steroids..it was caused by them. This is the opinion of all my renal doctors and my diabetes specialist. It's termed "induced" as the term has safe implications rather than "caused" as it is a] still debated by others and b] a little less attractive financially for the drug companies. All that said, like you, I was warned of the high risk before taking them but had no realistic option and agreed...and with a new working kidney rather than dialysis..I'd make the same choice again. If you think about all that, the amount of medical expertise which does accept that steroids can and do cause Type 2, the experience of all those who have direct experience (with no evidence anywhere of underlying diabetes prior to treatment, including family history) and the actually researched and admitted side-effects of the drugs - how likely is it that your GP is right and that such long term use of steroids has had nothing at all to do with your diabetes. Bulls..hockey...problem is not that your GP is cynical; it's that he is not cynical enough of drugs prescribed. I am not saying we shouldn't take these drugs..far from it, but at least GPs should be up-to-date and honest (even if they don't agree with findings of others)..to dismiss it out of hand is an insult to you, to patients - it's your body..not his.

gillytee31 said:

That is helpful. I am permanently on steroids (prednisolone) because of an auto immune eye condition called uveitis. Insulin has been prescribed because at its worst my blood sugars were over 30, and were regularly over 20 for 6 weeks. I am under the diabetic specialist at the local hospital and have been told by them and the dietitian that I definitely should not cut out carbohydrates because I am on insulin. The other slight complication with a low/no carb diet for me is that I am married and enjoy cooking and do not want to eat different meals from my husband.

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Dreadful guidance from your health professionals ref carbs.

The less carbs you eat, the less insulin you need... The less swings and swings in levels.

Please ask to go on a carb counting course... As you are on insulin this should be a DAFNE course.

pleinster said:

Frankly...your GP is talking the bull hockey (never heard that term before). Even the common out of date GP opinion is that steroid induced diabetes is simply the manifestation of a predisposition (genetically or to do with a range of other issues) to diabetes and never just simply due to weight alone. I was never overweight in my life. My diabetes was not triggered by the steroids..it was caused by them. This is the opinion of all my renal doctors and my diabetes specialist. It's termed "induced" as the term has safe implications rather than "caused" as it is a] still debated by others and b] a little less attractive financially for the drug companies. All that said, like you, I was warned of the high risk before taking them but had no realistic option and agreed...and with a new working kidney rather than dialysis..I'd make the same choice again. If you think about all that, the amount of medical expertise which does accept that steroids can and do cause Type 2, the experience of all those who have direct experience (with no evidence anywhere of underlying diabetes prior to treatment, including family history) and the actually researched and admitted side-effects of the drugs - how likely is it that your GP is right and that such long term use of steroids has had nothing at all to do with your diabetes. Bulls..hockey...problem is not that your GP is cynical; it's that he is not cynical enough of drugs prescribed. I am not saying we shouldn't take these drugs..far from it, but at least GPs should be up-to-date and honest (even if they don't agree with findings of others)..to dismiss it out of hand is an insult to you, to patients - it's your body..not his.

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I used Bull Hockey instead of bulls*** in case there's kids on this forum - got it from Colnel Potter in the old TV show M*A*S*H!!

But you're right. The GP I saw was a locum at my surgery and he made out it was only because of my weight and nothing to do with the steroids whatsoever. I did think it was a bit strange when I knew the side effects, and what the diabetic nurse had told me in the hospital....

Like you though, if I had a choice to do things over, I'd do things the same. Those steroids kept my chest infections in check, and settled down my asthma. I could have passed away long back otherwise!