Now I'm diabetic too?

[MaryWR]

Hello all. I'm now down to 5mg prednisolone after 2 years of PMR and trying hard to reduce on DSNS. I've put on a good stone on top of what was already an overweight body. I read with interest the other day of a forum member who had great success with the blood sugar diet. I read up on it and thought it sounded interesting. OK, I said, let's do it and I started by checking my fasting blood sugar with my husband's kit. To my horror it was 7.2. This morning it was 8 . In spite of my weight it was always normal in the past as I have a pretty healthy diet favouring whole grains, veg and fruit . Today I initiate the BSD and the scare has been a wake up call for me. My question is - can pred-induced diabetes be managed in this way or is it less responsive. The diet is 800 calories per day with practically zero carbohydrates and built in exercise.

I so don't want any more medication, but I have written to my GP telling her of my levels and my diet. I just don't want to wait for an appointment before I get started.

[PMRpro Ambassador]

I'm not sure but I don't think the 800 cal diet will reverse the diabetes in the way it has been shown to do for just Type 2 diabetes. Part of the problem is that pred seems to lead to random spikes in blood sugar levels which don't always correlate with food intake. However - that extra stone is enough to tip you over from pre-diabetes to diabetes so losing it and more should make a big difference as will cutting carbs generally. The only way you can find out is to try.

Just a warning though: I'll lay odds though that your GP will have a canary! You may have a bit of a fight on your hands. She will be horrified at the thought of 8 weeks of an 800 calorie diet and will tell you it is a fad so if you are going to argue your corner make sure you have some references about the Newcastle study. She might be more accepting if you say you are doing the middle combo - the 5:2 diet with intermittent fasting. I'd just tell my doctor I want to try with diet (not specifying what) before any extra medication - and I know that is what they would start with here where I live.

It will probably be a bit hard the first week or so - cutting carbs almost entirely can induce some interesting physiological effects for a while until your body gets into ketogenic mode. They aren't as bad as some detractors will make out but you could be a bit ratty for a few days (nothing new there with pred of course!).

Good luck - and do keep us up to date with how you get on.

[MaryWR in reply to PMRpro]

Thanks so much PMRPro. I expect you are right about the doctor. I think that's why I wrote instead of just going to see her - put the ball in her court and hope she's too busy to respond! I sent her some references so hopefully she will look them up before she has the canary! Well I'm going to do it no matter what. I'll let you know how it goes. I'm hoping that because there are almost no carbs my blood sugar will behave.

[DorsetLady PMRGCAuk volunteer]

Hi Mary,

I've just got said book plus another with recipes only, and think I will follow some, but not all. Don't think going down to 800 for 8 weeks is a good idea for most, especially as you are only pre-diabetic.

As I said the other day on another post the diabetic nurse used to say to my late hubby who was Type 2 diabetic - a good diet is a diabetic diet!

The most important thing is to watch your portions, and to cut out the processed and naughty eats we're apt to nibble on between meals.

Consensus of opinion is that if you go too drastic, you will not stick to it, and you'll end up feeling a failure. Some of the advice in the book is good, but as PMRpro says if you can lose just a little weight it will help. Plus if you attempt it sensibly you're likely to stick with it. Good luck!

[Ronnie101]

This is very interesting. Could one of you knowledgeable people clarify how we should look out for pre diabetes warning signs, blood markers etc? I'm trying to cut down on carbs where I can, but if anything I'm below my ideal weight. Thanks.

[PMRpro Ambassador in reply to Ronnie101]

The pre-diabetes warning signs should be covered by your GP doing regular blood tests - checking the Hba1c every few months or so is basic and reflects the average BS levels over the previous 3 months. As long as that is steady there isn't a problem, if it starts to climb some thought is required.

As Kate says - don't be afraid of full-fat products (which usually removes a lot of extraneous carbs) and enjoy the fact you don't have to worry about your weight!!

[Polywotsit PMRGCAuk team member]

If you are already at a satisfactory weight and wanting to cut down carbs, as I was when I discovered I had type 2 diabetes brought on by years of steroids, then you need to find some calories elsewhere. Don't be afraid to eat fats, i.e. 'good' fats like fish oil, olive oil etc. Even good old butter has been rehabilitated. When you have a chronic illness and need good nutrition, starving yourself isn't going to help a great deal.

[BonnyQuine in reply to Polywotsit]

My diabetes came on after 3 days of Pred - guess it was hovering, waiting to strike! BS in the 20s initially. Won't go into all the boring detail - ongoing ups and downs - but I do have a blood sugar meter and keep track of it. In addition to meds (with all their problems), I have to avoid virtually all carbs - otherwise the BS reading shoots up again. (For various reasons, I'm trying to avoid insulin.) Am hoping will improve as steroids decrease - down to 15mg since Nov.

It was horrendously difficult at first, but I've gradually got much better at it. Include lots of full fat, plain Greek yoghurt (a life saver!), full fat milk and as much cheese as you feel like eating; lots of aubergine, cauliflower, broccoli et al - you can eat real mayonnaise with it (no sugar). Plenty of fish, and I do eat meat too, but not 'processed'. Home-made veggie soup, if I ever have the energy. Breakfast = banana and blueberries with plenty of yoghurt, plus main diabetic meds.

Lining my stomach before tabs = main focus. Why is bread better than yoghurt or cauliflower? Definitely no starving, but also definitely no carbs.

Apart from fantasizing about choc ices etc, it's not too bad.

[PMRpro Ambassador in reply to BonnyQuine]

I do like roasted aubergine and broccoli/cauli and greek yoghurt with mint in - fabulous with grilled lamb chops but equally good without the meat.

[valrene]

My Gp advised me to buy the book The 8-week blood sugar diet by Dr Michael Mosley, he suggests don't buy fat free anything or low fat because they replace the fat with sugar, carbohydrates turn to sugar if not burnt off in excersise, I have stomach ulcers now so after years of keeping my weight down on a fat free diet, plenty of veg,fruit fat free meat, no bread, I now find myself with stomach ulcers, I have to eat whole meal bread with my salad or potatoes as I get too much stomach acid, I'm on omorezole but still burn up, have to eat pasta, rice, jacket potatoes with meals otherwise I'm so uncomfortable, have looked at Dr Mosley book and explained to him that's why I need the food we are being told not to eat, no it's not an excuse to eat carbohydrates, I think all our body's are different some people don't make so much acid as others, I was told to drink full fat milk, eat bread and pasta as it will help my stomach lining, has any one else have an opinion on this.

[PMRpro Ambassador in reply to valrene]

I'd say it was time you were trialled on a different stomach acid drug. Omeprazole does not work for about 1 in 3 patients - that may be the reason it isn't helping your acid problem. I'm assuming they have tried a higher dose? Have you seen a gastro specialist?

[valrene in reply to PMRpro]

Hi PMRpro take 40 mg of Pmerprazole, haven't seen a gastro specialist but have awful pains in top right of abdomen, having a ultrasound next Tuesday GP thinks I may have gall bladder trouble, so may be all connected, wonder if all these tablets we take are doing any damage, Val x

[PMRpro Ambassador in reply to valrene]

More than likely - especially when you are on approaching double figures of pills!

However - sometimes needs must!

[valrene in reply to PMRpro]

Think I would rather have gall bladder problems than not take all the pills and be in pain all the time, have managed to get down to 5mg preds and 10mg Leflunomide tried lowering preds to four and half but all the pain came back, so my Gp put me back to 5mg, not sure what Rheumy will say next month but he doesn't have to live with the pain.Valx

[PMRpro Ambassador in reply to valrene]

Quite - I'd say 5mg was pretty good. It is a low dose with few side effects for most people and is less corticosteroid than your body produces naturally anyway. If you have PMR you will need some pred as long as it is active. And nothing the rhuemy can do will change that.