T2s on insulin for steroids

[xfieldok]

Can anyone point me to information regarding insulin use for high glucose caused by steroids please.

Going to get it on Thursday so don't know what flavour yet.


I just want an idea before I go so I can prepare my questions for the appointment.

I am assuming that to begin with it will just be a flat dose (to be tweaked) just to try to adjust for the steroids. There would be no adjusting for carbs as in the case of a T1.

Sorry if this sounds a bit dim. High sugars are making things difficult to think at the moment.

 

[h884]

Hi there. When I was initially started on insulin, I was being treated as having type 2 diabetes Subsequently I was
diagnosed as having type 1.

I was started on insulin as I could not tolerate any of the oral drugs. I was started on long acting insulin once a day.
I was then started on steroids. I was given steroids orally, intramuscularly and by injection into various joints. I am still on steroids at a lesser dose.
Like yourselve my sugars were out of control. I was then started on shortacting insulin with meals, fixed doses.
The dose of both the long acting and short acting were slowly increased until my sugars were controlled.
It took a while to get things under control as the dose of steroids was increased and decreased depending on how I was.
The plan initially was for me to stop the short acting insulin once I came of steroids. That plan obviously went out
the window when my diagnosis was changed from type 2 to type 1.

You will start to feel better when you get your sugars under control. You will obviously need to monitor your blood sugars regularly. On the plus side you will get testing strips on prescription. Testing every 2 hours when driving will become nescessary. You will need to let DVLA and your insurance company know as well.

Hope this of some help. If you have any questions please ask.

 

[Tophat1900]

Yeah, you will be put on a calculated starting dose and it's case of testing and seeing how it goes. You can expect a roller coaster ride, but there is no real way around it. One of those things where you will learn as you go. I've taken prednesalone since 1997 every day, and I have to test more frequently then I'd like to, but it's the only way I can things under control. And yes, I do take some insulin.... wouldn't have to if were not for the steroid use, but that's life.

 

[Deleted Account]

We are all different, on different insulin and, if we take it, steroid doses (and types).
I had a cortisol injection a few years ago and needed to increase my basal dose by 40% for about 10 days afterwards.

As @Tophat1900 mentions, unfortunately, the only way to tell how much extra insulin you need will be trial and error with lots of testing and correcting.

 

[xfieldok]

Thank you so much, exactly what I wanted to know. Taking my last dose of glic on Wednesday. Will see DN 2pm Thursday. Probably start insulin Friday. Feeling horrendous with high blood at the moment. Can't think straight.

I think I am prepared for the rollercoaster but I am not looking to far into the future.

 

[xfieldok]

Thanks Helen, yes do understand. Fortunately, I recently started using a freestyle libre which has been a godsend. Scanning for fun at the moment. Also got strips so I can test accuracy of lows.

 

[h884]

Hi there, hold on to the fact that you will feel better once your levels are under control.

On Thursday they should go through injection technique, whether you want to use reusable or disable pens, hypo management etc.

Ask about follow-up and how you get in touch if you need.

Will be thinking about you on Thursday

 

[Energize]

I can't comment re insulin etc but, as for the Freestyle Libre, that's money well spent. It will help you enormously I hope your nurse will support and encourage you in learning how to interpret the graphs and other information you can get from Libre.

There is a book called Sugar Surfing by Stephen Ponder (£5.49 on Kindle) You can download Kindle app to PC/Laptop/Phone, if you haven't already got it. It seems to be rather expensive in book form.

I appreciate this book is for those with Type 1 and CGM but, even as Type 2 on oral hypoglycaemic meds (or without), I found the principles very helpful.

The other thing to note is that those with insulin resistance (ie Type 2 and some Type 1 - to a degree) will have insulin resistance and therefore lowering carbs so to use less insulin is possibly the better way.

Having said all this, your personal situation re steroids etc, will be individual so it will be your choice as to how you approach this. One size does NOT fit all, as we know

If I'm way out, off beat etc, hopefully someone will put me straight

Good luck and {{{Hugs}}}

 

[xfieldok]

Hi there, hold on to the fact that you will feel better once your levels are under control.

On Thursday they should go through injection technique, whether you want to use reusable or disable pens, hypo management etc.

Ask about follow-up and how you get in touch if you need.

Will be thinking about you on Thursday

 

[xfieldok]

Thanks. Making copious notes! I can't believe how horrible I feel with such high numbers, an this was probably how I felt before dx and thought I was normal. Will report back Thursday PM.

 

[xfieldok]

I can't comment re insulin etc but, as for the Freestyle Libre, that's money well spent. It will help you enormously I hope your nurse will support and encourage you in learning how to interpret the graphs and other information you can get from Libre.

There is a book called Sugar Surfing by Stephen Ponder (£5.49 on Kindle) You can download Kindle app to PC/Laptop/Phone, if you haven't already got it. It seems to be rather expensive in book form.

I appreciate this book is for those with Type 1 and CGM but, even as Type 2 on oral hypoglycaemic meds (or without), I found the principles very helpful.

The other thing to note is that those with insulin resistance (ie Type 2 and some Type 1 - to a degree) will have insulin resistance and therefore lowering carbs so to use less insulin is possibly the better way.

Having said all this, your personal situation re steroids etc, will be individual so it will be your choice as to how you approach this. One size does NOT fit all, as we know

If I'm way out, off beat etc, hopefully someone will put me straight

Good luck and {{{Hugs}}}

You are spot on. I have downloaded the book and will have a read.

Only been using the freestyle for 3 days so it doesn't have a huge amount of data yet. My dn is very supportive so hope we can come up with a plan. I generally stick to ketogenic but at least to begin with I will follow her advice until I know what I am doing.

It goes against everything I have learned from the forum but I will have a sandwich before bed as instructed.

Last night I had a Chinese at 10pm and my low at 4am was 4.1. Can't do that every night

 

[Bluetit1802]

I would not wish to be in your shoes for all the gold in the world, but I can't help feeling a little envious of a sandwich before bed. Reminds me of my childhood - tea at 5pm then a Golden Syrup butty at bedtime. Make sure your butty is one you have always loved.

 

[xfieldok]

I would not wish to be in your shoes for all the gold in the world, but I can't help feeling a little envious of a sandwich before bed. Reminds me of my childhood - tea at 5pm then a Golden Syrup butty at bedtime. Make sure your butty is one you have always loved.

My dad used to make me sweetened condensed milk sandwich. Perish the thought now

 

[DCUKMod]

@xfieldok - Oh bother. What a pain, but I'm sure getting those numbers into a better place will help a lot.

 

[Rachox]

My dad used to make me sweetened condensed milk sandwich. Perish the thought now

I used to eat them as a child too

 

[xfieldok]

I thought I might keep this thread going for a while. I am approaching the next few days with a little trepidation. Today I started my max dose of steroids. I also took my last 80mg of glicazide.

Tomorrow I see the DN with regards to insulin. By the time I see her the glicazide will have left the building. I am currently scanning the freestyle libre, probably more than is strictly necessary but hey ho, it doesn't hurt!

So the past couple of days, once the rise starts, it seems to be going up around 5mmol/l per hour. Remember, this includes glicazide.

Elevated readings last for around 8 hours or so.

I have no idea what will happen tomorrow but I am compiling a list of questions in case they are not covered.

I will report back.

Please note that this is not intended as a tutorial in any shape or form.

 

[Bluetit1802]

Good luck tomorrow.

I think it is a good idea to keep this thread going if it helps you to work things out.
5mmol/l an hour with Gliclazide is horrendous. Poor you. Insulin seems to be the best way forwards.
Which steroids are you on? Not that I know anything about them, but are there other types that have less effect on BG levels?

 

[DCUKMod]

I thought I might keep this thread going for a while. I am approaching the next few days with a little trepidation. Today I started my max dose of steroids. I also took my last 80mg of glicazide.

Tomorrow I see the DN with regards to insulin. By the time I see her the glicazide will have left the building. I am currently scanning the freestyle libre, probably more than is strictly necessary but hey ho, it doesn't hurt!

So the past couple of days, once the rise starts, it seems to be going up around 5mmol/l per hour. Remember, this includes glicazide.

Elevated readings last for around 8 hours or so.

I have no idea what will happen tomorrow but I am compiling a list of questions in case they are not covered.

I will report back.

Please note that this is not intended as a tutorial in any shape or form.

I just hope you aren't given a mixed insulin xfieldok. I hope you are given something you can learn to adjust over time.

 

[xfieldok]

Thanks @Bluetit1802. It seems they use 2. Prednisone which cause mood swings, but thet chose to give me the fun one which can cause convulsions, happy days.

@DCUKMod me too! I have been reading up on insulin, there seems to be a lot of micro managing with related to carb consumption. I can only do what I am told to begin with.

I am finding it hard enough to eat my wholemeal sandwich before bed. It seemed to work last night my lowest reading was 5. But didn't get much sleep trying to keep an eye on things. I will relax in a day or two.

 

[SimonCrox]

Hi
Interesting review here:-

https://www.diabetes.org.uk/resourc...t of hyperglycaemia and steriod therapy_0.pdf

Main prob in my experience of steroids in diabetes is that the glucose levels go up a lot over the afternoon; although these guidelines suggest trying an intermediate (NPH) insulin eg Humulin I to try and cover the rise over the afternoon, I find that this often does not control the rise and escalating the dose leads to overnight / early am hypos. it is really handy to keep good notes of testing results and insulin so that if one has to repeat the course of steroids in the future, one knows what hopefully worked in the past,

Hope all goes well

best wishes