diabetes type 1 insulin and biologics

[lindyloo2018]

Hello

is anyone else diabetic type 1 dependant on insulin like me and using biologics or jak inhibitors ?

I need to know the real risk of doing both together

please advise asap

many thanks

[KittyJ]

Are your doctors now putting you on biologics? Yesterday you were talking about sulphasalazine? Have you asked your doctors as they’re the best ones to advise you on this? They wouldn’t put you on biologics if they knew there were contraindications. You could also try the HU Diabetes group if you get no one here.

[lindyloo2018 in reply to KittyJ]

kitty, they are reviewing my meds because I stopped hydroxy and am now flaring. mtx gives me oral thrush, taking hydroxy stops me taking flucanazole. so replacing the hydroxy but keeping the mtx was one option. moving to biologics was a possible option but I don't know if you have to take a dmard with humira, if yes then taking mtx as the dmard with humira still gives the oral thrush problem, it would have to be humira + non mtx dmard not sure what is usually substituted. today they said go back on hydroxy or increase dose of mtx both of which leave me back in the same place where I was when I stopped hydroxy in the first place.

I questioned the biologics safety because of being diabetic, diabetes increases my infection risk, so does mtx and maybe even more so with biologics. I am again in a no win situation and can't seem to get it resolved...

[AgedCrone]

Presumably your Rheumatologist knows your medical history and if he is at all doubtful about anything he is thinking of prescribing for you….he will speak to the Doctor who deals with your diabetes..It will be up to those two doctors to decide. That is standard practice….so don’t worry you won’t be prescribed something unsuitable.

We can’t advise on clinical details like that I’m afraid….unless there maybe a member here with T1 Diabetes who maybe able to give their personal experience…but whatever other health problems we may have, our rheumatologist will always consult with the specialist dealing with the non rheumy problems.

[Deeb1764]

Remember your GP and definitely RA team know th elinks between RA and diabetes so they will know a good med to work for you and one that hopefully gives you some relief. Just talk to them or send them an email about your concerns and I am sure they will help you out.

[owl123]

Hi, just small storyI have RA which was sorted out eventually by using embral.

Find for quite a few years the got diabetes.

Each med (about 6) they tried for diabetes (D) caused a flare. The D consultant wrote to the RA consultant saying he had to change my RA medallion, got told no.

I had lost all confidants in the diabetes consultant, so saw my GP, who passed me onto the diabetic nurse.

I then tried a 2 different meds, the 2nd one worked and I have been on it since. (I am on victoza)

Remember everyone reacts differently to each medication and each medication reacts differently to each other.

I know that when I do my injection of embral each week, my blood glucose level goes up.

Hope the med work OK for you, but don't give up, there will be a right combination for you

[lindyloo2018 in reply to owl123]

many thanks

[oldtimer2]

There is considerable research currently about using biological treatments for type one diabetes as it's an auto-immune disease. However - don't get your hopes up that one biological treatment will treat both conditions - the research doesn't seem at that stage! (The treatment seems to be aimed at B cells and given early in the development of the condition.)

Certainly there doesn't seem any logical reason why biological treatments would be any riskier for you. The aim is to reduce your over-active immune system to more normal levels. Although there might be some over-swing and make you less able to fight off infections , that risk is always there with treatment with immune suppressive treatments.

You have a to weigh up the risk/benefit ratio for you as an individual, but personally I would grasp any offer of biological treament because of the benefits of reduced damage to tissues (throughout the body not just joints) and reduction of pain.

[lindyloo2018 in reply to oldtimer2]

that's great, many thanks. but I don't think they will offer me biologics now even though I don't get on with either mtx or hydroxy. I am stuck with them at the moment..

[lindyloo2018 in reply to oldtimer2]

Hi, I have been asked to think about biologics now..please could you tell me if there is anywhere that I can look up the pros and cons of biologics? many thanks

[oldtimer2 in reply to lindyloo2018]

There is a useful summary here: webmd.com/rheumatoid-arthri... (copy & paste)

Otherwise look up the individual biological treatments onthe websites NRAS and Arthritis Care, both of which have excellent accounts of the individual treatments.

[lindyloo2018 in reply to oldtimer2]

many thanks, I can't find the answer to my question which is do biologics make you more immunosuppressed than methotrexate or differently than methotrexate?

I am scared of infections as I have diabetes type 1 also. many thanks

[oldtimer2 in reply to lindyloo2018]

Biologics target part of the immune response, and, as far as I understand, methotrexate tends to have a more generalised suppressive effect. So they act differently.

Each group of biological drugs target different parts of the immune response, so it's not possible to generalise. That's why, currently, it's still trial and error choosing which type of biologic to go for, although emerging evidence suggests various groups are more likely to help in some types of auto-immune diseases. You can see the groups to which the various groups belong in the lists provided on advice sites.

It's generally advised that people continue with methotrexate as there is some evidence that this helps to prevent the biological treatment from failing over time.

Your fear of infection has to be balanced against the protection against long-term damage to your body by inflammation. If you opted for a biologic aimed at suppressing B cells, it might, might, help with the diabetes as well. The only way you, as an individual, will discover how often you would have other infections is by trying a biologic under your normal living conditions.

Are you particularly likely to be exposed to infection? Working with young children, for example? or as a health professional? If your risk is that of the general population with diabetes then it might be worth trying - you can always stop the biologic if you are unhappy.

I have tended to use a chart to help me with this sort of decision - writing down the pros and cons AND my feelings about the issues. The pros and cons don't come without how you feel about them and how important they are to you. Good luck whatever you decide...

[lindyloo2018 in reply to oldtimer2]

thank you that is so helpful. I do the pros and cons a spreadsheet but often I come up with exactly the same amount of pros to cons so that does not help me. writing down how I feel about each one might help. I am due surgery on my wrist in the next 3 months and was wondering if surgery is safer with mtx than biologics...?

[oldtimer2 in reply to lindyloo2018]

If you start biologics as well as being on methotrexate it will suppress part of your immune system more, but also more specifically.

My personal preference would be to get the surgery out of the way and the healing process started before starting on a new unknown treatment. That way it's possible to disentangle which problem is associated with which treatment. I've always tried to add one thing at a time...

[lindyloo2018 in reply to oldtimer2]

change one thing at a time yes I agree on that one. I have been given the choice to up the mtx slightly or start biologics. if the mtx works, then I guess no biologics, if not then I will have to consider biologics, I know biologics are the 'gold' treatment for RA, but they come with their own risks, I take infections very seriously because of my diabetes type 1. But my immune system is creating havock, it's causing my diabetes type 1 , causing my RA and also attacking my thyroid now, although fortunately my thyroid is still working. Do you know what problems biologics with mtx causes with surgery? there must be lots of people that have surgery whilst on biologics ? many thanks

[bpeal1 in reply to lindyloo2018]

Another thing to add into your list of pros and cons is that uncontrolled inflammation also makes you more susceptible to infection.

[JEM95]

I’ve been on methotrexate for 9 years and Benepali for 2. I have recently (Christmas) been diagnosed with diabetes and put on insulin (Humulin) as my HBA1c was sky high. The HBA1c is coming down fast.

They initially thought I was type 2 but now think I may be type 1 so I’m waiting for extra tests. They are a bit concerned as I rocketed from HBA1c of 35 four years ago to 129 😱 am healthy, not overweight etc.

To answer your question after my waffling on, they are happy with me on insulin, MXT and Benepali. I also checked on the drug interactions website - seems ok.

I have massively changed my diet and my RA seems very happy with it too - for the first time in 7 years my LFTs have come back within range!

Good luck and hope you get sorted x

[lindyloo2018]

that's great news, so are you on benpali or humira now ? and what dose of mtx do you take ?

[born2runck]

I am a type 1 diabetic and have been on biologics for 7 years, along with methotrexate. I have had some bothersome infections at times (uti, eye, skin - all treatable with antibiotics) but the benefits outweigh those for me.

[lindyloo2018 in reply to born2runck]

ok thanks, I just was thinking that people on biologics were sheilding during covid. not sure what the recommendations are now that we have had all our boosters

[lindyloo2018 in reply to born2runck]

Hi please tell me what biologics you are on.

also I have a question re steroids to bring down a flare. whats best ? tablets or IM injection? I am told that the blood sugar rise on an injection only lasts a few days where I know that the tablets raise the blood sugar for the duration of the treatment. I have never had an IM injection before , our ra dept do 120MG methlprednisalone usually for a ra flare..

[born2runck in reply to lindyloo2018]

I am using the biologic Orencia. I did notice a rise in blood sugar for a few days after a steroid injection in my elbow a few years ago. I have only noticed a rise with the tablets on larger doses of 10mg or more. My diabetes doctor has instructed me to increase my long acting insulin temporarily during these times. You may contact your doctor to discuss this as well (I am assuming that you are not on an insulin pump).

[lindyloo2018 in reply to born2runck]

yes I am on a pump, but I control my own basal and bolus rates, thanks

[lindyloo2018 in reply to born2runck]

hi yes I am on insulin pump, medtronic, best thing I ever did for diabetes control.

but the RA is playing up bad at the moment due to me stopping hydroxy, RA dept do not believe that I am flaring because my crp and esr are just within range. even though the mri on my elbow says active RA. dohh. I need a new rheumy

[lindyloo2018 in reply to born2runck]

Hello

please could you tell me if you get oral thrush when using the prednisolone tablets ?

I always do, but I do not know if that is down to the steroids or down to the mixture of the immunosuppressants and raised BG with the steroids..

please reply

thanks

[born2runck in reply to lindyloo2018]

I have not had to deal with oral thrush. I would recommend that you eat an unsweetened yogurt every day to help prevent this from occurring. Are you on an antifungal to clear it now?

I do get mouth ulcers from the methotrexate even while taking folic acid.

[lindyloo2018 in reply to born2runck]

Hi how did you weigh up the benefits verses risks. I am now looking at biologics but I am lost in the decision.. many thanks

[Newhaven]

HI there,

Am type 1 since 1972. Currently well managed with insulin pump. RAdiagnosed 2017, used MTX for a while, chanced to biologic in 2018, due to severe nausea and vomiting on MTX. Works really well for me, some infections but worth it.

Good luck with it

[lindyloo2018 in reply to Newhaven]

many thanks. I was just wondering if the risk of infections is greater on biologics rather than dmards, seeing as we are already at a higher risk because of the diabetes..

[lindyloo2018 in reply to Newhaven]

wow how did you get biologics so quickly ??

also I have a question re steroids to bring down a flare. whats best ? tablets or IM injection? I am told that the blood sugar rise on an injection only lasts a few days where I know that the tablets raise the blood sugar for the duration of the treatment. I have never had an IM injection before , our ra dept do 120MG methlprednisalone usually for a ra flare..

[Newhaven in reply to lindyloo2018]

I'm in Ireland, must people here have health inurance, I suspect this makes going onto biologics a bit easier? My mom and I are both on biologics for RA, my sister in the uk is on MTX.{doing ok, mind you.

I don't have much experience with steroids. Before RA diagmosis, did have steroid injections in both knees, BS was raised for a few days. GP had suggested having steroid injections up to 4 times a year. Endocrinologist disaaagreed and advised knee replacements.. I have no experience with steroid tablets.

Maybe your endo could advocate for biologic for you?

Good luck withit

[lindyloo2018 in reply to Newhaven]

Hi.please could you tell me what biologics you are on ? thanks

[Newhaven in reply to lindyloo2018]

I am on Roactemra, (tocillinab). Has worked very well for me