Steroids

[NinaB73]

I have just been prescribed Prednisolone tablets for an allergic skin reaction I have been suffering from for about four weeks that is getting worse instead of better. The G.P I saw said I really needed them, I reminded him I'm type 1 and he asked if I tested regularly, I said about 8 times a day so I can be on top of it, he pondered for a while on the dose, hit it hard quickly or longer more gently....decided on somewhere in the middle. I asked him whether this would mean pretty much doubling my insulin and he said probably, so my question is has anyone else had experience of this and just how much did their insulin requirements go up?

There is no question about me taking them as I cannot live with the complaint I have and have tried all the alternatives but am scratching myself to bits morning, noon and definitely at night! I am prepared, just not really for how much more insulin I may need. Any advice as always appreciated

 

[Jaylee]

Hi,

My four penneth?
Start with basal testing for the duration of the steroid dosage. (background insulin.) & get that sorted first...?

 

[Odin004]

Hi @NinaB73,

Firstly, I'm sorry to hear about your allergic reaction. I took a course of Prednisolone about 15 years ago - which left me with type 1 diabetes thereafter; so I'm always cautious when I hear people talking about steroids. It's quite probable that your insulin requirements will increase while you're taking the steroids, as your doctor says - so I would first ask whether you've been referred to a consultant dermatologist for a specialist opinion on whether there are any other options? If not, it might be worth insisting on it.

If you have to take the steroids, I'd personally start on the lowest possible dose; but I'd also ask your doctor about whether chromium supplementation may help you while you're taking them; there's some evidence that chromium can help reverse steroid induced diabetes:

https://www.ncbi.nlm.nih.gov/pubmed/10229312

I don't know whether this might help, but certainly worth asking!

 

[NinaB73]

Thank you @Odin004 that is interesting and a supplementation is well worth thinking of. I am worried about the impact on my diabetes but I have been type 1 for a while now and am just preparing myself for the onslaught! I have reached the point in my skin complaint where I would do anything to stop the itching!!! I have put up with it for four weeks and it is spreading with a vengeance and needs drastic action! I have obviously gone into a reaction overdrive

 

[Odin004]

My pleasure @NinaB73, and I completely understand - it's the sort of thing that can completely stop you from thinking about or doing anything else! I just worry sometimes that steroids seem to be the first line treatment, when other treatments may be available, hence my suggestion to see a specialist. If you're going to take the steroids, then it may also be worth considering going on a low carb diet while you do so, just until you know how your insulin requirements have changed, and to limit the amount of insulin in your system. Whatever you decide, I hope you feel better soon!

 

[catapillar]

Steroids can, and do, raise blood sugar and cause a bit of insulin resistance. But I don't think there's a strict rule of how much (or indeed whether) a steroid dosage will increase your insulin requirements - that's going to vary on the individual. Just just go cautious, I wouldn't leap straight in with a 100% increase in insulin dosage in anticipation of an increase in requirements before you actually know if that's going to kick in. Test a lot and adjust as you go. Sorry, it doesn't help a lot with the being prepared aim. Good luck with it, hope it sorts out the allergy.

@Odin004 steroids don't leave people with type 1 diabetes. There is steroid induced type 2. But type 1 is caused by autoimmune attack. If you have autoimmune type 1 it could be that the illness requiring steroid treatment was the trigger for your immune system to start attacking healthy cells. Or it could be that your pancreas was already on the way out following an immune attack (I think it's something like 80% of your beta cells need to have been killed off before you start having diminishing insulin production) when you commenced steroids and that shone a light on it to allow for diagnosis. If you have type 1 you'd still have type 1 whether or not you took steroids.

 

[Odin004]

Hi @catapillar,

Tthank you for the message - I have to agree with you, and to be honest, I've never really understood my diagnosis of diabetes; or indeed the current state of my pancreas. I suspect you are correct that the illness requiring steroid treatment was the trigger.

Around 15 years ago, I began experiencing a repeated sharp pain, about 2 inches below my sternum, in the soft area of the abdomen - which struck only during the hours of 2am and 4am every day; the pain would strike for a minute or two - then disappear for about 10-15 minutes before recurring. This pain increased each day in severity over a 2 week period, and in the end, the pain become so severe that I was rushed to hospital and given morphine; no diagnosis was ever made however, and the pains disappeared after a course of steroids - following which ever since, I have needed to inject insulin.

In the early stages, I was simply told I had type 1 diabetes on the basis that I needed to inject insulin, and that the steroids may have "unmasked" the diabetes - but this explanation has never really sat well with me. It is true that, following the steroids, I became fully insulin dependent - but because of the lack of initial diagnosis, I've always been left wondering what exactly happened to my pancreas. I always wondered whether the abdominal pain I'd experienced was a symptom of autoimmune pancreatitis, in which case, I may well have become a true type 1 in any case; or whether the cause of my pain could have been something completely different, and the steroids themselves caused the damage to my pancreas (which steroids can do - in which case, albeit my pancreas doesn't work, it's not because of autoimmune condition, and therefore not type 1). I wonder if I'll ever have an answer!

PS - @NinaB73 - please forgive me for hijacking your post!

 

[NinaB73]

My pleasure @NinaB73, and I completely understand - it's the sort of thing that can completely stop you from thinking about or doing anything else! I just worry sometimes that steroids seem to be the first line treatment, when other treatments may be available, hence my suggestion to see a specialist. If you're going to take the steroids, then it may also be worth considering going on a low carb diet while you do so, just until you know how your insulin requirements have changed, and to limit the amount of insulin in your system. Whatever you decide, I hope you feel better soon!

Thanks @Odin004, yes I always try to adjust carbs in periods of high BG. I felt I did exhaust all other medication including 4 antihistimines a day and steroid creams but it just seems to be on the march! I started this morning and have tested vigorously and haven't actually had much rise yet, but day one! As for a specialist, the waiting list for a referral is 16weeks here and my G.P was worried that it was starting to look infected so I felt I had no choice but actually the itching is calming already I appreciate your advice x

 

[NinaB73]

Steroids can, and do, raise blood sugar and cause a bit of insulin resistance. But I don't think there's a strict rule of how much (or indeed whether) a steroid dosage will increase your insulin requirements - that's going to vary on the individual. Just just go cautious, I wouldn't leap straight in with a 100% increase in insulin dosage in anticipation of an increase in requirements before you actually know if that's going to kick in. Test a lot and adjust as you go. Sorry, it doesn't help a lot with the being prepared aim. Good luck with it, hope it sorts out the allergy.

@Odin004 steroids don't leave people with type 1 diabetes. There is steroid induced type 2. But type 1 is caused by autoimmune attack. If you have autoimmune type 1 it could be that the illness requiring steroid treatment was the trigger for your immune system to start attacking healthy cells. Or it could be that your pancreas was already on the way out following an immune attack (I think it's something like 80% of your beta cells need to have been killed off before you start having diminishing insulin production) when you commenced steroids and that shone a light on it to allow for diagnosis. If you have type 1 you'd still have type 1 whether or not you took steroids.

Thanks @catapillar, wish I'd read your post earlier! took a couple of extra units with breakfast and promptly crashed! Not too much of a rise so far and feeling slightly better for it so I'm hoping the steroids will sort the problem now! Thank you for your reply it has been reassuring!

 

[Odin004]

My pleasure @NinaB73, and I'm glad to hear you're starting to see an improvement already - I hope that continues, and that this very irritating condition disappears soon!