Steroids effects

[StaceyF87]

Hi everyone,

I was diagnosed with type 1 diabetes in July this year. I've worked really hard since then to get my blood glucose into healthier ranges!

Anyway, I have recently been in contact with someone who tested positive for Covid-19, and the day after contact (I personally think there is no connection at all!) I started becoming really wheezy and have been in the throes of an asthma attack.

I have moderate - severe asthma, so this is a regular occurrence in the winter (and normally all year long!). Due to the severity of the asthma attack, I have been prescribed steroids by the GP.

The only problem is, this is the first time I have required oral steroids since being on insulin (lantus and Novorapid), and my DSN is away until Monday!

The GP mentioned monitoring my sugars more closely (which I have already been doing due to feeling unwell with the asthma), but gave me no advice on what to do if they do run higher than usual!

Have any of you got any advice as to what to do if my sugars do run too high over the next 5 days?? Typically I will be able to speak to both my DSN and my usual next week on the day my steroids end!

Kind Regards.

 

[Ley666]

Hi everyone,

I was diagnosed with type 1 diabetes in July this year. I've worked really hard since then to get my blood glucose into healthier ranges!

Anyway, I have recently been in contact with someone who tested positive for Covid-19, and the day after contact (I personally think there is no connection at all!) I started becoming really wheezy and have been in the throes of an asthma attack.

I have moderate - severe asthma, so this is a regular occurrence in the winter (and normally all year long!). Due to the severity of the asthma attack, I have been prescribed steroids by the GP.

The only problem is, this is the first time I have required oral steroids since being on insulin (lantus and Novorapid), and my DSN is away until Monday!

The GP mentioned monitoring my sugars more closely (which I have already been doing due to feeling unwell with the asthma), but gave me no advice on what to do if they do run higher than usual!

Have any of you got any advice as to what to do if my sugars do run too high over the next 5 days?? Typically I will be able to speak to both my DSN and my usual next week on the day my steroids end!

Kind Regards.

Hiya
Have your diabetes team taught you about correction doses if your bg raises too high?

 

[urbanracer]

Hi everyone,

I was diagnosed with type 1 diabetes in July this year. I've worked really hard since then to get my blood glucose into healthier ranges!

Anyway, I have recently been in contact with someone who tested positive for Covid-19, and the day after contact (I personally think there is no connection at all!) I started becoming really wheezy and have been in the throes of an asthma attack.

I have moderate - severe asthma, so this is a regular occurrence in the winter (and normally all year long!). Due to the severity of the asthma attack, I have been prescribed steroids by the GP.

The only problem is, this is the first time I have required oral steroids since being on insulin (lantus and Novorapid), and my DSN is away until Monday!

The GP mentioned monitoring my sugars more closely (which I have already been doing due to feeling unwell with the asthma), but gave me no advice on what to do if they do run higher than usual!

Have any of you got any advice as to what to do if my sugars do run too high over the next 5 days?? Typically I will be able to speak to both my DSN and my usual next week on the day my steroids end!

Kind Regards.

What is your insulin regime? Are you on fixed doses, Multiple Daily Injections (MDI) or perhaps even using a pump?

 

[StaceyF87]

Hiya
Have your diabetes team taught you about correction doses if your bg raises too high?

I sort of know about correction doses, my DSN said to take 1 unit if above 9, but my diabetes consultant said to do that only if above 12, so I have conflicting advice as to when to do a correction dose!

 

[StaceyF87]

What is your insulin regime? Are you on fixed doses, Multiple Daily Injections (MDI) or perhaps even using a pump?

I am on MDI, I take 10 units of lantus in the morning and have an insulin to carb ratio of 1:20 for the Novorapid.

 

[Maco]

I am on MDI, I take 10 units of lantus in the morning and have an insulin to carb ratio of 1:20 for the Novorapid.

1unit of rapid per 20g of carbs? Wow

 

[urbanracer]

I am on MDI, I take 10 units of lantus in the morning and have an insulin to carb ratio of 1:20 for the Novorapid.

Do you know or have a rough idea at least, how much 1u of rapid acting insulin drops your glucose level by?

For me, if I was around 10mmol I'd assume that 1u would reduce my blood glucose by around 2mmol. If I get up into the mid teens then I add a unit (or 2) based on the circumstances.

If you're on MDI then you have the freedom to experiment. From the 1:20 ratio you've stated, it sounds as though you're quite sensitive to insulin. This maybe why your Endo' is erring on the side of caution.

If you know what 1u does to you, then you should feel free to take your insulin when you think you need it.

 

[StaceyF87]

1unit of rapid per 20g of carbs? Wow

Yeah I am very lucky at the moment that during the 'honeymoon period' my insulin requirements don't seem to high! Although I generally need more than 1:20 both for the morning meal and the evening meal, the only time that the 1:20 ratio keeps my bg stable is at lunchtime and even that is starting to change!
I think I need to have further discussions with the DSN about it as well because my requirements for every meal seems to be increasing now!

 

[StaceyF87]

Do you know or have a rough idea at least, how much 1u of rapid acting insulin drops your glucose level by?

For me, if I was around 10mmol I'd assume that 1u would reduce my blood glucose by around 2mmol. If I get up into the mid teens then I add a unit (or 2) based on the circumstances.

If you're on MDI then you have the freedom to experiment. From the 1:20 ratio you've stated, it sounds as though you're quite sensitive to insulin. This maybe why your Endo' is erring on the side of caution.

If you know what 1u does to you, then you should feel free to take your insulin when you think you need it.

Apparently 1u of insulin can reduce my bg between 3-5mmol.

Thank you so much for your advice, that has been very helpful!

 

[Maco]

Yeah I am very lucky at the moment that during the 'honeymoon period' my insulin requirements don't seem to high! Although I generally need more than 1:20 both for the morning meal and the evening meal, the only time that the 1:20 ratio keeps my bg stable is at lunchtime and even that is starting to change!
I think I need to have further discussions with the DSN about it as well because my requirements for every meal seems to be increasing now!

Yeah that makes sense, in my honeymoon period I could go days or sometimes even a week without any insulin at all.
Im on 30 units of tresiba & a 1:7 ratio for Novorapid but im changing over to a pump on the 7th of January. If your anything like I was you will slowly but surely increase your insulin amounts as time goes on.

1 Unit per 3-5 Mmol as a correction dose is probably correct if your still in your honeymoon period, I'm 1 unit per 2 mmol.
The best way to work out your correction factor is to add up your daily insulin dose then do 100 divided by the total. So your 10 units of Lantus, then roughly how much novorapid you take per meal. Say It all adds up to 30, 100 divided by 30 would mean 1 unit of rapid brings your bloods down 3.3.

Its pretty accurate, 30 tresiba for me then usually 7 units off rapid per meal comes to 51. 100 divided by 51 is 1.96 & like I said novorapid brings my bloods down by 2mmol per 1 unit.

 

[StaceyF87]

Yeah that makes sense, in my honeymoon period I could go days or sometimes even a week without any insulin at all.
Im on 30 units of tresiba & a 1:7 ratio for Novorapid but im changing over to a pump on the 7th of January. If your anything like I was you will slowly but surely increase your insulin amounts as time goes on.

1 Unit per 3-5 Mmol as a correction dose is probably correct if your still in your honeymoon period, I'm 1 unit per 2 mmol.
The best way to work out your correction factor is to add up your daily insulin dose then do 100 divided by the total. So your 10 units of Lantus, then roughly how much novorapid you take per meal. Say It all adds up to 30, 100 divided by 30 would mean 1 unit of rapid brings your bloods down 3.3.

Its pretty accurate, 30 tresiba for me then usually 7 units off rapid per meal comes to 51. 100 divided by 51 is 1.96 & like I said novorapid brings my bloods down by 2mmol per 1 unit.

Thank you so much for this advice! It is very informative and makes total sense as to why my correction doses can bring my blood glucose down by between 3-5mmol, because it depends on my total daily insulin requirements!

Even though my insulin to carb ratio is low at the moment, I cannot miss a single dose without going into double figures, so I make sure I always take at least the lantus (if I'm not well I tend to not eat much so don't require the Novorapid during those occasions!).

Thank you again for your very informative advice.

 

[oldgreymare]

Thank you so much for this advice! It is very informative and makes total sense as to why my correction doses can bring my blood glucose down by between 3-5mmol, because it depends on my total daily insulin requirements!

Even though my insulin to carb ratio is low at the moment, I cannot miss a single dose without going into double figures, so I make sure I always take at least the lantus (if I'm not well I tend to not eat much so don't require the Novorapid during those occasions!).

Thank you again for your very informative advice.

Pragmatically it is sad to acknowledge the end of LADA / honeymooning as it means no more active pancreatic Beta cells. But on the other hand it may make it easier to work out ratios and regimes for injected insulin whether via MDI or pump. But be aware even moderate carbs, and/or high BG levels will make you more insulin resistant and may throw your bolus and correction ratios - keeping this disease under control will give you plenty of mental stimulus!

 

[StaceyF87]

Pragmatically it is sad to acknowledge the end of LADA / honeymooning as it means no more active pancreatic Beta cells. But on the other hand it may make it easier to work out ratios and regimes for injected insulin whether via MDI or pump. But be aware even moderate carbs, and/or high BG levels will make you more insulin resistant and may throw your bolus and correction ratios - keeping this disease under control will give you plenty of mental stimulus!

I have been told my diagnosis is a definite type 1 diagnosis due to a positive GAD antibodies of 657 and a positive ZnT8 antibodies alongside this, and was never treated as having LADA, I was instantly put on insulin on the day of diagnosis (probably due to the high level of ketones in my urine) and was told that whatever the results of the antibody tests that I would remain on it for life. Obviously when the antibody results came back my DSN confirmed I definitely have type 1.

Is this correct? Or can it still be classed as LADA despite my antibody results and my immediate need for insulin? I was also told that due to my high GAD results that it is likely my 'honeymoon period' will not last that long, although I don't understand how or why that's the case?

On the whole I have had really good control of my bg, in fact both my DSN and consultant were really impressed that I started carb counting and trying to adjust my insulin based on what I need for each meal during the 'honeymoon period'. But I want to control the diabetes rather than letting it control me, which is why I began trying to do so!

It's just the past few weeks that my requirements seem to be changing, and then I have to take steroids on top of this, and unfortunately for me, my DSN has had the past two weeks off, so I haven't been able to discuss what I need to do about that with her yet!

She's back next week though and I am definitely going to phone her asap because the last thing I want is any of the long term complications that hyperglycaemia causes!

Thank you for your advice and help!

 

[oldgreymare]

I have been told my diagnosis is a definite type 1 diagnosis due to a positive GAD antibodies of 657 and a positive ZnT8 antibodies alongside this, and was never treated as having LADA, I was instantly put on insulin on the day of diagnosis (probably due to the high level of ketones in my urine) and was told that whatever the results of the antibody tests that I would remain on it for life. Obviously when the antibody results came back my DSN confirmed I definitely have type 1.

Is this correct? Or can it still be classed as LADA despite my antibody results and my immediate need for insulin? I was also told that due to my high GAD results that it is likely my 'honeymoon period' will not last that long, although I don't understand how or why that's the case?

On the whole I have had really good control of my bg, in fact both my DSN and consultant were really impressed that I started carb counting and trying to adjust my insulin based on what I need for each meal during the 'honeymoon period'. But I want to control the diabetes rather than letting it control me, which is why I began trying to do so!

It's just the past few weeks that my requirements seem to be changing, and then I have to take steroids on top of this, and unfortunately for me, my DSN has had the past two weeks off, so I haven't been able to discuss what I need to do about that with her yet!

She's back next week though and I am definitely going to phone her asap because the last thing I want is any of the long term complications that hyperglycaemia causes!

Thank you for your advice and help!

My GADAb results came back at 10x the normal reference levels, but I had some honeymooning effects for maybe another 18 months. However we're all different! Great that you're determined to be proactive with your control, but with injected insulin we are basically using a sledgehammer to crack a nut, and it is impossible to replicate the exquisite hormonal balance that a functioning pancreas provides. So please don't let the roller coaster journey that most of us Type 1s can have with BG levels panic you. This site is a great resource and I've learnt so much from it.

 

[Fairygodmother]

Hi @StaceyF87, it might help you to be more flexible with your doses if you had a pen that gave 0.5 of a unit; they’re available for novorapid, and may also be for lantus.
I’ve had steroids in the past and find they can do horrible things to blood sugars making them much higher than liked, especially if already feeling rough. In the situation you’re in now it might be an idea to ring your GP and ask them to prescribe a 0.5 unit pen with which you can be reactive to highs. I think novo takes about 15-20 mins before it becomes active after a dose and it remains active for about 4 hours so be careful you don’t end up with a big load of insulin you need a whole bag of jelly babies to quell. The odd high is unlikely to damage health in the long run.

 

[StaceyF87]

My GADAb results came back at 10x the normal reference levels, but I had some honeymooning effects for maybe another 18 months. However we're all different! Great that you're determined to be proactive with your control, but with injected insulin we are basically using a sledgehammer to crack a nut, and it is impossible to replicate exquisite hormonal balance that a functioning pancreas provides. So please don't let the roller coaster journey that most of us Type 1s can have with BG levels panic you. This site is a great resource and I've learnt so much from it.

My GAD results were 131 times the normal reference levels, so I have no idea how long my honeymoon period will last, if your ten times only lasted 18 months!! I think I may be coming to the end of the honeymoon period now because my bg is rising more each day! I can't wait until Monday to be able to discuss all this with my DSN.

I understand and appreciate what you are saying about it being impossible to "replicate the exquisite hormonal balance that a functioning pancreas provides", even though I have been very proactive in trying to control my BG, I still get it wrong sometimes and will either have a hypo because I've overestimated the carbs, or a hyper because I've underestimated the carbs, protein and the effect of a woman's cycle!
Thank you so much for you advice and support! I agree that this site is a great resource and I've also learnt a lot from it! In fact it was on here that I first learnt about carb counting and the insulin to carb ratio!

 

[StaceyF87]

Hi @StaceyF87, it might help you to be more flexible with your doses if you had a pen that gave 0.5 of a unit; they’re available for novorapid, and may also be for lantus.
I’ve had steroids in the past and find they can do horrible things to blood sugars making them much higher than liked, especially if already feeling rough. In the situation you’re in now it might be an idea to ring your GP and ask them to prescribe a 0.5 unit pen with which you can be reactive to highs. I think novo takes about 15-20 mins before it becomes active after a dose and it remains active for about 4 hours so be careful you don’t end up with a big load of insulin you need a whole bag of jelly babies to quell. The odd high is unlikely to damage health in the long run.

Thank you for your advice! I have a pen with 0.5 units, because of my insulin to carb ratio being 1:20, i just need to keep an active eye on my sugars and try to correct if necessary! Thanks again.

 

[oldgreymare]

My GAD results were 131 times the normal reference levels, so I have no idea how long my honeymoon period will last, if your ten times only lasted 18 months!! I think I may be coming to the end of the honeymoon period now because my bg is rising more each day! I can't wait until Monday to be able to discuss all this with my DSN.

I understand and appreciate what you are saying about it being impossible to "replicate the exquisite hormonal balance that a functioning pancreas provides", even though I have been very proactive in trying to control my BG, I still get it wrong sometimes and will either have a hypo because I've overestimated the carbs, or a hyper because I've underestimated the carbs, protein and the effect of a woman's cycle!
Thank you so much for you advice and support! I agree that this site is a great resource and I've also learnt a lot from it! In fact it was on here that I first learnt about carb counting and the insulin to carb ratio!

@StaceyF87 If you have time and mental bandwidth to explore in more depth some ways to practically fine tune your control, I can strongly recommend "Sugar Surfing" by Stephen Ponder. He is a US endocrinologist that also has been a Type 1 for 50 years. Fascinating reading, but to action his recommendations you need to do very frequent BG monitoring, ideally using a CGM or at least a Libre. May be worth discussing with your DSN the likelihood of qualifying for a Libre. You can also self fund, but not cheap.

 

[StaceyF87]

@StaceyF87 If you have time and mental bandwidth to explore in more depth some ways to practically fine tune your control, I can strongly recommend "Sugar Surfing" by Stephen Ponder. He is a US endocrinologist that also has been a Type 1 for 50 years. Fascinating reading, but to action his recommendations you need to do very frequent BG monitoring, ideally using a CGM or at least a Libre. May be worth discussing with your DSN the likelihood of qualifying for a Libre. You can also self fund, but not cheap.

Thank you, I will look into 'Sugar surfing', anything that may help with BG control is beneficial to me!

I began self funding the Libre two weeks after I was diagnosed, and because it has helped me reduce my HBA1C and mange my bg better, my DSN agreed to put me on a six month NHS trial for the Libre, and I picked up my first prescription for it on Christmas Eve! It was the best present I got this year for sure, I feel so lucky to have it on prescription now! It saves me just under £100 every 4 weeks!

 

[TypeZero.]

Hi everyone,

I was diagnosed with type 1 diabetes in July this year. I've worked really hard since then to get my blood glucose into healthier ranges!

Anyway, I have recently been in contact with someone who tested positive for Covid-19, and the day after contact (I personally think there is no connection at all!) I started becoming really wheezy and have been in the throes of an asthma attack.

I have moderate - severe asthma, so this is a regular occurrence in the winter (and normally all year long!). Due to the severity of the asthma attack, I have been prescribed steroids by the GP.

The only problem is, this is the first time I have required oral steroids since being on insulin (lantus and Novorapid), and my DSN is away until Monday!

The GP mentioned monitoring my sugars more closely (which I have already been doing due to feeling unwell with the asthma), but gave me no advice on what to do if they do run higher than usual!

Have any of you got any advice as to what to do if my sugars do run too high over the next 5 days?? Typically I will be able to speak to both my DSN and my usual next week on the day my steroids end!

Kind Regards.

Well the answer to high blood sugar is... insulin

I am warning you, steroids may permanently increase your basal insulin requirement

Just keep bolusing to correct it and observe blood sugar over night to see if basal needs correcting