Can Abiraterone/Zytiga cause low blood sugar?

[happycamperguy]

I’m diabetic and use an insulin pump. I’m on Abiraterone for about 5 months now, with hydrocortisone 10 mg per day to control Abiraterone side effects during PC treatment. Also took about 9 months Firmagon shots, but just switched to Lupron to preserve belly area for pump insulin insertion ports or continuous glucose monitoring ports. PSA is down to 0.342.

Hydrocortisone is used instead of prednisone or dexamethosone because, at least in theory, it doesn’t raise blood sugar/glucose as much. Though I see no discernible rise in blood sugar due to hydrocortisone.

However, for the past 2-3 months, I’ve had intermittent LOW blood glucose readings (down to 70 or so, which I fight by eating more carbs) after I eat (post-prandial hypoglycemia). My blood glucose doesn’t rise after 15-20 minutes as it usually does. Instead, During these intermittent episodes, I can eat 60 to more than 100 grams carbohydrates, but it won’t raise my blood sugar for about 3 hours. Then it skyrockets to 300 or higher.

Got any ideas or research on Abiraterone or hydrocortisone LOWERING blood sugar?

[Tall_Allen]

The prescribing info says:

"• Hypoglycemia: Severe hypoglycemia has been reported in patients with preexisting diabetes who are taking medications containing thiazolidinediones

(including pioglitazone) or repaglinide. Monitor blood glucose in patients with

diabetes and assess if antidiabetic agent dose modifications are required. (5.6)"

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[MateoBeach in reply to Tall_Allen]

I don’t see that he is on that category of diabetes agents. He has a 24 hour insulin pump. Perhaps reprogramming it for the current pattern would be more appropriate.

[happycamperguy in reply to MateoBeach]

Thanks. I’m not on that category of anti diabetic agents, but I appreciate knowing the manufacturer says that Zytiga can lower blood glucose under certain circumstances.

But there is no way to program insulin pump for “intermittent” or unpredictable post-prandial hypoglycemia.

[MateoBeach]

Perhaps see if your endocrinologist can reprogram your insulin pump settings to adjust to your current regimen and post prandial hypoglycemia pattern?

[happycamperguy in reply to MateoBeach]

No way to program insulin pump for “intermittent” or random, unpredictable episodes of hypoglycemia.

[MateoBeach]

😣

[happycamperguy in reply to MateoBeach]

I did work with endocrinologist to adjust “carb ratios” on insulin pump to reduce overall dosage for. This slight adjustment may help a bit.

[dougnola]

Hey happy camper. I’m curious about the latest on your glucose. I’m on Zytiga/eligard and prednisone for four years now. My glucose tanked to 54 on my latest labs (it’s been fine before). Wondering if it has to do with prolonged ADT. No history in my family of diabetes. Thanks for your advice! ✌️ DougNOLA

[happycamperguy in reply to dougnola]

I have intermittent low glucose levels on Zytiga/Abiraterone for about 7 months. By “low” I mean 50 to 120 grams carbs intake after a low reading does not increase my blood glucose for up to 2 hours or so.

No way to predict them. My endocrinologist and I note these intermittent lows or delays coincide with start of Abiraterone, so we believe Abiraterone is connected somehow with these lows. If glucose I take is delayed, it is typically about a 2-hour delay.

[happycamperguy in reply to happycamperguy]

So when I eat carbs to cover a low, I only enter, say,a couple of grams of glucose to put a time marker on my carbs consumption. Then I wait about 20 minutes to see if blood sugar rises, or not. Whenever blood sugar rises, I take additional pump insulin to cover that rise and bring it back down.