Steroid injection and high blood sugars

[Emck]

Hi all,

I had a steroid injection in my hip today for a hip injury.

I was warned that my blood sugars might be a bit off kilter for a while but I am stressed out with it all.

I had the injection at lunchtime and at between 3pm-5pm I spiked from 7mmol to 16mmol. I have done a correction with my normal dose but it has had no effect. I’ve been stuck at 16mmol for 3 hours.

I asked my diabetes team for info but they said to test for ketones of over 14mmol and if I have them to follow sick day rules. No ketones yet thank god!


Does anyone know how long this is likely to last?

 

[h884]

Hi Emck

Based on my own previous experiences it may last for a while yet. I had an intramuscular steroid injection some 7 weeks ago and the effects are still there. I have a pump and with the help of the team here I have increased my basal rate by 25%. For a few weeks I was also adding 10 to 15% when I bolused for food. I do not need that now thankfully.

That is obviously how the steroids affected me and you may not be the same.

Hope the steroids help your hip

 

[Emck]

I do have ketones now and sugars not moving down

 

[h884]

Morning Emck

How are things with you this morning ? I did not experience ketones any higher than 0.1.

Perhaps 111 could give you some advice

I do hope your sugars are now more under control and ketones have disappeared

 

[Emck]

Morning Emck

How are things with you this morning ? I did not experience ketones any higher than 0.1.

Perhaps 111 could give you some advice

I do hope your sugars are now more under control and ketones have disappeared

Morning! I have gotten rid of the ketones overnight, I think looooots of water helped with that more than insulin.

Despite taking my 10% daily dose every 2 hours I have only managed to moved my sugars down to 12mmol. I also increased my basal overnight which did help.

I think I’m going to avoid carbs today and just keep correcting every 4hours until I’m in range. Rationale being that if I don’t eat carbs then I know it’s definitely the steroid messing with my sugars.

I’m based in NI so I don’t think I have access to 111. I called our out of hours gp service as I had run out of ketone test strips yesterday (I had a virus last week - bad timing). They were pretty dismissive and just scolded me for not keeping on top of my prescription. Apparently prescribing ketone test strips is not something they do. They would only give me ketostix, so the ketone results are not the most accurate.

 

[EllieM]

Despite taking my 10% daily dose every 2 hours I have only managed to moved my sugars down to 12mmol. I also increased my basal overnight which did help.

I think I’m going to avoid carbs today and just keep correcting every 4hours until I’m in range. Rationale being that if I don’t eat carbs then I know it’s definitely the steroid messing with my sugars.

Is that what your sick day rules say to do? I understand your rationale but would like to point out that if you don't eat any carbs you may go into dietary ketosis, which could be difficult to distinguish from DKA. (Though I appreciate your blood sugars are key here).

(Happy to be corrected by someone more knowledgeable).

Is there no way for you to contact your clinic at the weekend?

 

[Emck]

Is that what your sick day rules say to do? I understand your rationale but would like to point out that if you don't eat any carbs you may go into dietary ketosis, which could be difficult to distinguish from DKA. (Though I appreciate your blood sugars are key here).

(Happy to be corrected by someone more knowledgeable).

Is there no way for you to contact your clinic at the weekend?

I’ll be testing ketones regularly and would hope a day of no carbs won’t do anything too much.

All I have is an email address for diabetes nurses. They just said to follow sick day rules. For us that is 10% daily dose whilst over 13mmol and more than trace ketones showing. I’m just assuming it wouldn’t be much different from not eating when unwell?

 

[h884]

That is great that you have got rid of Ketones. As EllieM said check your sick day rules. I would also keep an check on your sugars to check that you do not go low.

It is not easy to balance everything out. It is hard work and time consuming.

 

[EllieM]

I randomly googled nhs sick day rules T1 and got these ones
https://www.england.nhs.uk/london/w...abetes-Sick-Day-Rules-Type-1-MDI-06042020.pdf
Please do not fast. Try to eat some food which contains
carbohydrates e.g. yoghurt, toast, ice cream and cereal
On a personal basis, if I don't eat carbs for a day when I'm well , I can get blood ketones of 1 by the evening....

It seems crazy to me that there is no one you can contact at the weekend. (Sorry, complaining about the system, not complaining about you).

 

[Emck]

I’m definitely not fasting! I’ll maybe grab a a yoghurt and just try to stick to small portions of carbs to avoid big spikes.

 

[Emck]

That is great that you have got rid of Ketones. As EllieM said check your sick day rules. I would also keep an check on your sugars to check that you do not go low.

It is not easy to balance everything out. It is hard work and time consuming.

It really is! Diabetes is certainly a full time job!

 

[david4503]

I agree with ElllieM about not fasting when blood sugar is very high but not for the same reason (I’m not very familiar with dietary ketosis). At some point soon, your insulin requirements are likely to drop suddenly and when that happens, it’s good to have some food in your system. All that extra insulin can give you a bad hypoglycemic reaction.

 

[Hopeful34]

When I had a steroid injection into my shoulder some time ago, I needed increased basal and bolus insulin for a few weeks. For me the hardest thing was when the steroid started to wear off, and it wasn't a steady decline in the amount of extra insulin needed. I ended up doing lots of extra blood tests, but was able to eat fairly normally.

i hope tomorrow is a better day for you, and you get some help onTuesday.

 

[Emck]

For reassurance, I promise that I didn’t fast!

I eventually got through to a sympathetic receptionist at my hospital who got an endocrine doctor to call me back over the weekend. She reassured me that the high blood sugars were normal, that I should continue to eat carbs just so I wasn’t getting ketone readings that might make me think I was unwell (d’oh!) and that I could expect my sugars to be even higher in the evenings that other times of day.

I’m still not back to normal, but today i have seen my first sub 10mmol readings since Friday. I ended up doubling my correction dose and increasing my basal by 20% to get here (this may not work for others - I was recommended to do this by the dr).

 

[JMK1954]

Sounds as if it was worth getting in touch with the hospital ! Glad you're more under control. The whole experience of this sort of situation is stressful for all of us, but sometimes HCPs can be less than sympathetic.