Type 1 (pump) and cortisone injection

[divadiane]

Hello! I have had Type 1 for 28 years (oh my, that seems like so long!) and have used a pump (now filled with Fiasp) for 14 years, since trying to get pregnant (and succeeding) while living in Germany. Needless to say, I am quite experienced.

I had a procedure on my shoulder on Thursday after which I received a small-ish dose of cortisone. I was not thrilled about the idea of cortisone because about 8 years ago I had a cortisone injection so I knew what was going to happen.

In case you are not familiar, cortisone and other steroids inhibit insulin from doing its job and thus create high blood sugars which are resistant to correction.

The first day was not too bad but the 2nd (yesterday) and both nights have been awful. I’d say 90% of my reading yesterday (and I checked 27 times!) we’re over 11! I have increased my basal rate with the temporary option by 120%, then 130, 140 and finally 150% and corrections in general seem to only keep it holding steady between 11 -13. I haven’t been conservative either. My pump tells me if I still have active insulin in my system, but I have overridden that consistently in my corrections to no avail.

8 years ago I didn’t know this was a known problem and muddled through what seemed like weeks and weeks of horrible readings. Everything I’ve read says 7-10 days, but I’m worried it will be longer. And naturally, I’m concerned about how quickly the drop off will happen!!

Does anyone here have experience with cortisone injections and can relate what that experience was? Did you have any help from your DSN? How much additional insulin did you end up using? How long did the effects last? Did your BGs slowly drop or quickly?

I’m grateful for any and all discussion!

 

[Hopeful34]

Hi @divadiane

It's a few years since I had a cortisone injection into my shoulder, so I can't remember how much additional insulin I used, and as we're all different you may need more or less than I did, but it took a lot of extra monitoring, so you've got my sympathy.

However, I do remember increasing my basal to 150% like you, and giving lots of correction doses. I gradually reduced basal and correction doses over about 3 months, as BGs levels slowly dropped, but I seem to recall a sudden drop at one point. I gave some of the correction doses by pen, as that seemed to help.

I don't think I asked for any help, apart from when my bloods shot up initially, but it's too long ago to remember, sorry.

 

[Deleted member 527103]

Our pumps are great when we are insulin resistant due to steroid injections of a cold or ... by being able to do a temporary basal of 110%, 120%, 150%, ... hey 200% but
- my temporary basal can only be set for up to 24 hours so I have to remember to reinstate it. If I know I am going to need this for more than 24 hours, I set up a new basal pattern. This makes it easier to revert back to my "standard pattern" and reuse the "steroid pattern" for my next injections
- it does not take into consideration that we are just as insulin resistant for boluses as we are for basal. I will do a bit of mental arithmetic and override the suggested bolus in the same ratio at the basal.

The other thing to remember is that I get even more insulin resistant when my levels are higher. So, I may need even more bolus to bring my levels down under 10.
And, finally, whilst Fiasp can be fast, when my levels are higher, it feels like injecting water until a part of my body opens a valve and then, whoosh, the bolus works and my levels plummet.

 

[divadiane]

Thanks, @Hopeful34 and @In Response for your engagement. It’s now been a little over a month and I’ve been able to dispense with the 130-150% temporary basal rate, and am just using a basal rate adjusted permanently about 10% up from my highest version. However, I am still ignoring the bolus Wizard’s recommendations and either bolussing the original estimate (ignoring active insulin adjustments) or increasing the recommended calculation by x1.5. My insulin sensitivity increases and decreases pretty dramatically with my cycle, so when my sensitivity increased (and BGs dropped) that was my motivation for discontinuing the temp basal rate. It was really annoying anyway, because I had to wake up at 3am to increase the rate to 160% until 7am and remember to drop it to 130% from 3pm to 7pm.

TL;DR - still not back to pre-cortisone levels but getting there.

 

[Dave9]

Hi divadiane​

I have had type1 for about 48 years, pump about 14 years.

I had a shot of cortisone in my shoulder a few years ago, I doubled Basal and Bolus for about 3 weeks with lots of testing (Blood) it then eventually started returning to normal doses after another couple of weeks. But I do remember having a few cortisone injections for tennis elbow (4) about 30 years ago which never affected my Diabetes at all, it didn't cure my tennis elbow either, that is why I wasn't too bothered about it to start with.

 

[divadiane]

Hi divadiane​

I have had type1 for about 48 years, pump about 14 years.

I had a shot of cortisone in my shoulder a few years ago, I doubled Basal and Bolus for about 3 weeks with lots of testing (Blood) it then eventually started returning to normal doses after another couple of weeks. But I do remember having a few cortisone injections for tennis elbow (4) about 30 years ago which never affected my Diabetes at all, it didn't cure my tennis elbow either, that is why I wasn't too bothered about it to start with.

Huh, that’s interesting, Dave, that it didn’t affect your BGs when you were younger.

 

[bonerp]

Hi all, sorry to drag this post up. Just had a double shot of cortisone - one in each shoulder just yesterday and last night I was hitting 15-16. Had to take a shot from a pen because my TSLIM CIQ pump with dexcom couldn't deal with it.
I'm using lyumjev and find it causes bleeds under the skins because of the acid in it which makes it act faster (until the bleeding starts cos of the amount I'm doing). I guess the more I bolus the more of a problem this will become for the next 3 weeks.
I'm minded to switch back to fiasp while I'm doubling up on my background and boluses. Although as mentioned fiasp is like water when BG's are high. Its strange no significant new insulins have been developed since Humalog and Novorapid with issues like these with Fiasp and Lyumjev. Both of the new insulins are much faster acting but with significant downsides. I believe they are just modified Humlog and Novorapid!
I'm also knocking back apple cider vinegar which I find helps with big meals...makes my insulin more useful.
I think I'm going to try some inulin too which again helps with BGs (in some).

 

[divadiane]

Hi all, sorry to drag this post up. Just had a double shot of cortisone - one in each shoulder just yesterday and last night I was hitting 15-16. Had to take a shot from a pen because my TSLIM CIQ pump with dexcom couldn't deal with it.
I'm using lyumjev and find it causes bleeds under the skins because of the acid in it which makes it act faster (until the bleeding starts cos of the amount I'm doing). I guess the more I bolus the more of a problem this will become for the next 3 weeks.
I'm minded to switch back to fiasp while I'm doubling up on my background and boluses.
I'm also knocking back apple cider vinegar which I find helps with big meals...makes my insulin more useful.
I think I'm going to try some inulin too which again helps with BGs (in some).

I think something like this is always useful, so no worries about bumping it up. It wasn't that long ago, that I posted first anyway.

So, my experience tells me that once you get your BGs back down, it will be much easier to keep them there with an increase in both basal rate and bolus. I don't have any experience with lyumjev (?) or inulin, but I did need to increase my Basal rate to at least 130%. It still fluctuated, though. I think I did a temporary basal rate of 150% for most of the day, 130% between 3pm and 6pm and 170% between 3am and 6am. Yes, I had to wake up at 3am to change the temporary basal rate. I did that for about 2 or 3 weeks. In retrospect, I probably could've changed one of my set basal rates, but I had no idea how long it was going to last, since I couldn't find anyone with recent experience really. I also did about 1.5 times what the Bolus Wizard recommended as a general rule. Almost 3 months later, my BGs are not quite, but almost back to normal levels.

I wish you all the best @bonerp ! Let us know how you get on. Hopefully, the experience will help someone else getting cortisone injections.