Blood sugar level, any idea?

[DevonMichael]

Had GCA for 5 months. Just had a call to book an appointment with GP who wants to discuss raised sugar level from an earlier blood test. Any idea what this means? So I can prepare and be on the front foot! Thanks.

[DorsetLady PMRGCAuk volunteer]

Hi DevonMichael,

Unfortunately in some people Pred can cause a rise in blood sugars. It doesn't necessarily mean you will become diabetic, but it's something that you have to be aware of.

Mine were slightly high all though, but fortunately didn't progress any further.

Guess your GP will tell you to be careful with what you eat and suggest you have your blood sugars monitored fairly regularly.

There's a very fine line between being pre-diabetic and diabetic- hopefully you can prevent the latter.

[DevonMichael in reply to DorsetLady]

Thanks that is both helpful and reassuring! I have been trying to divert my increased hunger towards the fruit bowl and not the biscuit jar, to avoid too much sugar and to hit my five a day!

[Rose54 in reply to DevonMichael]

Hi

Just be aware that fruit has natural sugar in it .

I had raised blood sugar levels and put on weight due to preds .Stopped eating so much fruit blood sugar levels improved and lost a few pounds .

[DevonMichael in reply to Rose54]

Thanks for the advice duly noted. I can't win!!

[PMRpro Ambassador in reply to DevonMichael]

Carrots and cucumbers...

Of course you have won - you belong here!!

[Rokerman in reply to DevonMichael]

Hi Michael - my stand-in GP (a gloomy woman, if ever I met one....) told me to look at the fruit bowl and think 'sugar!'. It seems that berries are best - raspberries, strawberries, blueberries etc. I think oranges, bananas etc may be the worst offenders - don't know where that leaves us as regards Vit C...?!

You wouldn't mind but, last time I looked, raspberries were £4 a punnet in Waitrose!

Happy Eating!

[PMRpro Ambassador in reply to Rokerman]

I eat no fruit - and don't have scurvy yet!

"High vitamin C foods include bell peppers, dark leafy greens, kiwifruit, broccoli, berries, citrus fruits, tomatoes, peas, and papayas." I'm OK - tomatoes, peppers and broccoli will do me fine!

[PMRpro Ambassador]

One of the potential side effects of pred is raised blood sugar levels - it makes the liver release too much into the blood. There are still doctors who don't know that - or panic unnecessarily. You have probably had a single raised blood sugar - does he tell you to have your blood tests done fasting? How often does he check them? To be fair, the risk will be higher with the higher doses used in GCA.

A single raised fasting BS is also not particularly significant either. More important here is the Hba1c test - a reflection of your average blood sugar levels over the last 3 months. My husband has raised fasting BS levels, his Hba1c is absolutely normal. You can probably improve that if it is raised by cutting the amount of processed and simple carbohydrates you eat although it may not make much difference to the single raised readings. That's one of the reasons we push cutting processed carbs when you are on pred - it reduces the risk of weight gain and raised blood sugars.

If the Hba1c is creeping up it is a sign you may be developing steroid-induced diabetes and the first approach to manage it is diet and exercise. If it still creeps up to the pre-diabetes level, then possibly medication will be suggested.

But don't let him use scare tactics to get you to reduce the pred too fast. As the dose reduces the BS's will probably improve - but if you try to reduce too fast you may have a flare and need a higher dose again - exactly the opposite of what he wants to achieve.

[DevonMichael in reply to PMRpro]

Thanks for your helpful information. I have had a number of tests each time I have seen rheumatologist but they were not preceded by fasting but just done in conjunction with other diagnostic work. To day I moved from 12.5mg to 10mg and I have been advised to move in 1mg steps at monthly intervals. I am bracing myself for flare and keeping everything crossed!

[DorsetLady PMRGCAuk volunteer in reply to DevonMichael]

You may find 12.5 to 10mg too big a drop, it is a recognised step, but some find it too much, so just be aware. If you begin to feel symptoms returning after a couple of weeks or so you might have to think about going up a mg to help. You may be okay, many are, but just be aware.

Plus of course when you get into single figures, reductions can become more difficult - so might be worthwhile following a slow reduction plan.

Don't be rushed into reducing by your doctors, you need to go by your symptoms, or hopefully lack of them, and how you feel personally. What might look okay on paper doesn't always work out in practice.

[DevonMichael in reply to DorsetLady]

Thanks for the advice. I have some standby stock of prednisolone ready to react as I am feeling a little nervous to say the least.

[DorsetLady PMRGCAuk volunteer in reply to DevonMichael]

Yes I can understand that. In the last few days we have been talking about not reducing during the winter months, many doctors now seem to be advising that, so if you don't feel up to it, don't.

[piglette in reply to DevonMichael]

I was told that below 10mg half a mg drop per month is preferable, although men in general seem to have less problems than women. Good luck with your reductions.

[DevonMichael in reply to piglette]

Thanks I will dip my toe in the water and see how it goes!

[DevonMichael in reply to PMRpro]

PMRpro your point on Hba1c proved useful thanks - in challenging the call up I have learnt that the GP surgery was doing a sweep on pre-diabetic candidates and I fell into this pool from a blood test back in June (taken for GCA diagnostics). It appears the scale of good is 20-42 and I came out as 44. However it has been agreed that I take a fresh batch which I have done today and see the GP in a few days to discuss outcome.

I am expecting to be pre-diabetic and therefore I think lifestyle changes are the order of the day given my weight at bone density scan to GP visit (3 months) has seen me put on 5 kilos. Funny enough the GP thought with a BMI of 25.5 it might be helpful if I lost half a stone without knowing the detail of my weight gain!

It has to be goodbye to sticky toffee pudding, clotted cream and many of the nice things in life!

[PMRpro Ambassador in reply to DevonMichael]

Bless him - just as well he isn't my doctor then! A BMI of 25.5 is in my dreams!!! I probably passed it somewhere on the way up - it is not my fault I'm undertall...

Another nugget for you Mike: how old are you? It is felt that once we are 65-ish and above a slightly HIGHER BMI is advisable:

medlineplus.gov/ency/articl...

"In older adults it is often better to have a BMI between 25 and 27, rather than under 25. If you are older than 65, for example, a slightly higher BMI may help protect you from thinning of the bones (osteoporosis)."

and

huffingtonpost.ca/2014/03/2...

is even better if you want to live longer:

""It is time to reassess the healthy weight guidelines for older people," Professor Nowson said. "Our results showed that those over the age of 65 with a BMI of between 23 and 33 lived longer, indicating that the ideal body weight for older people is significantly higher than the recommended 18.5-25 'normal' healthy weight range." "

I just checked - barely into the "obese" category at 30.9. And well in Prof Nowson's range.

And here is the link for the paper: ajcn.nutrition.org/content/...

So tell your GP to put that in his pipe and smoke it...

[DevonMichael in reply to PMRpro]

65 in May so nearly there! The links and extracts are encouraging, thanks!