I’m a 75 yo with Stage 4 PC. GLEASON 8, Metastasized to lymph gland but not bones. Treated with Lupron every three months. 28 EBRT and now Zytiga 1000 mg/Prednisone 5 mags daily. PSA at start of treatment 8.5. PSA today .04.
I am also a Type 2 diabetic. Have any of you diabetics, using Zytiga, seen an elevation of your glucoses?
I believe it is the prednisone that increases BG. Zytiga lowers ACTH and reduces BG. Prednisone makes the liver more resistant to insulin so increases BG. It also increases glucose directly.
Have you talked to your MO? Perhaps they can use a different drug or reduce the dose a little? Or maybe change the timing?
There years ago My Onc prescribed Zytiga plus Prednisone was me . I was taken it and after six weeks My glucose rose to 940. I was hospitalised. The doctors were amazed that i was Able to walk in. I have been on insulina ever since. Before this i had no problems with blood sugar. It was the Prednisone. I tolerated Zytiga well
I read some case studies and prednisone causing BG to skyrocket to over 900 has happened to others.
One thing that was advised is to monitor your BG when on prednisone. Makes sense to me to start at a small dose and see how you react. I think something like this:
Full dose Zytiga is usually 1000 mg and Prednisone either 5 mg or 10 mg
Week 1 1/4 dose of each
Week 2 1/2 dose of each
Week 3 3/4
Week 4 full dose
It also would be good to get a CMG. I used to have one (I'm not diabetic but like to test things).
I'd go over this with my MO first and show them studies showing prednisone can cause BG to shoot up (diabetics but there are also cases that happen with people who are not diabetic).
Most, but not all, cases of prednisone-induced diabetes resolve themselves after discontinuation of prednisone.
I've been taking it for 4 years and haven't seen any major BG increase (fasting BG is 75-90).
Thank you
Sounds like a viable plan. I will discuss with Oncologist.
Good reply, thank you.
Zytiga does NOT lower ACTH
I mean increase. My MO confirmed. Biology confirms. My own experience confirmed. Google it if you doubt it.
CYP17 blockade by abiraterone: further evidence for frequent continued hormone-dependence in castration-resistant prostate cancer | British Journal of Cancer
ITurns out it's the Prednisone that raises the glucoses.
Yup. Prednisone can cause liver insulin resistance. So BG goes up.
Pred is used with Zytiga to replace corticosteroids. I didn't have BG increases but had fatigue and BP increase (very high). My MO put me on a reduced dose of Zytiga. My fatigue and BP eventually resolved and I have been increasing the Zytiga dose.
I don't know if BG from prednisone resolves during treatment. Maybe an MO would have an idea? Or just try it and monitor. That's usually what I default to since the mean doesn't account for the outliers. And who knows if I'll be average or an outlier? (if I had a dollar for every time I was an outlier - I could buy dinner at Micky Dees)
Same here never had high sugar levels. My Doctor lowered my Prendisone to 5mg. One half pill with Breakfast the other half at dinner. I was also put on Metforim.
Erleada caused my thryoid to go way down and therefore my blood sugar to go way up (>8 A1C). After adjusting my Synthroid dose, glucose came back down (7.1 A1C). I have another A1C later in May.
My husband had a big increase in glucose. When he first started Zytiga and Prednisone he was taking Metforim and Ozempic to control his glucose. After starting ADT he had to add insulin twice a day and Lispro before meals. After discontinuing Zytiga and Prednisone (two years later) his glucose when back down again; Metforim and Ozempic seem to keep it under control again. By the way, eating healthy seemed to have no effect on his glucose. It took 4 different medications and constant monitoring to keep it in check. If you don't already have one I would highly recommend a glucose monitor. They aren't particularily accurate (+ or - 20%) but it at least gives you an idea of what is going on with your glucose without having to prick you finger 6 times a day.
Hi ShipModeler, i am also on Zytiga 1000 and predni5mg. My FBS wentup to diabetic levels 6.78 mol during my last blood test . I was not diabetic nor had any issues with my sugar levels in my blood. My Onco said this is a side effect of the medicines.
When I was on Zytiga I didn't have any issue keeping my BS under control, got my A1C down to 6.1. Going to really be variable based on weight, amount of exercise, the diabetic medications your on, etc.
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