Bit of history - I am a type 2 diabetic and was not on insulin until needed preds.
Began on 60mg of preds nearly 16months ago and am not on 17mg. Being treated for GCA / PMR but as a poss prob with right eye developed my 2 consultants from eye hosp and rhumy decided to try 150mg Azaithiaprine and lower pred. Constantly observed by both
However, that said, am on 46units of Insulatrd as BGS get high around lunch to early afternoon.
In addition, my sleep has been really affected this past 3/4 months worse than it was before. In fact am almost a total insomniac. Tried almost everything my research suggested, so now the latest suggestion was the preds are causing this ..
Therefore, thinking and tried this last 2 nights, taking preds and insulin at 8pm instaed of 8am. 1st night , no difference. Last night got more sleep but was up n down to loo like 4 times in 4 hours!!!
Any ideas?
I am waiting to talk to my Diabetic Nurse this week but thought others may have experience...
Thanks in advance.
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pms543
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pms, I'm sorry I haven't got any experience with diabetes but hopefully those who do will be along soon to help you in that direction from their own personal experience.
With regard to the timing of taking your Prednisolone, have you tried splitting the dose, taking two-thirds in the morning and the remainder at night? This could certainly help if the experience of others with a similar problem is anything to go by. Hopefully, adjusting in this way will avoid another night like the one you have just experienced?
Also, try to avoid all caffeinated drinks later in the day (including chocolate), and look out for some soporific foods to help you sleep: turkey, lettuce, just to name a couple. Meanwhile, catnap as much as you can during the day to make up for the lost sleep at night. Good luck.
Hi pms, as Celtic suggests splitting your dose morning and evening works for me - I'm presently on 16mg after a flare so going cautiously down. I take 2 x 5mg enteric coated plus 1mg plain at 8a.m. and 5mg e/c at 9p.m. The slow release coated pred deals with the inflammation at about 4a.m. and although I wake in the night for a trip to the loo I get back to sleep (mostly).
I've had periods of not being able to sleep and tried Nytol which helped to break the pattern, just one a night every now and then when you really crave a good sleep. I also drink Clipper tea Organic Sleep Easy infusion and have a small bowl of porridge around 9pm which seems to have a soporific effect. I can't speak re. diabetes/insulin but I hope something works for you, those wakeful wee small hours are dire. Best of luck.
There is no evidence that aza works reliably to reduce pred dose in GCA - so if your problems have coincided with starting that I would discuss whether that is necessary.
Pred causes your liver to release random spikes of glucose into the blood - so it is very difficult to organise insulin well. Have you had it suggested that you should cut carbs a lot? The American Diabetic Association now approves that as a way of managing diabetes. The more you can reduce the glucose levels from diet, the better your Hba1c level will be even though you have occasional spikes and that alone will help against the long term damage done by high blood sugar levels.
The others have also made good suggestions, especially taking you dose split between morning and evening. The other point is, maybe taking the pred immediately before bed might allow you to get to sleep - taking it at 8pm it will be at its peak in your blood as you go to bed.
Thanks everyone, I appreciate the tips and advice.
I actually cant recall when the insomnia kicked in completely but yes its possible it started not long after starting Aza. In saying that I was getting up a few nights a week due to pain from my back and legs due to arthritis. The reason my eye consult suggested this med was coz a year ago a swelling occurred behind my right eye on the disc. In 12 months no change. Then he started me on Aza and after 1 month the swelling reduced. He thinks the pred was the cause???
Am also a Coeliac so have to avoid some foods suggested but agree with a low carb diet, which, funnily enough keeps cropping up so should prob attempt this.
Not sure how to go about splitting pred and take insulin...and my guess is the diabetic team wont be happy anyhow , o boy!!
Since I started taking my pred and insulin at 10.30pm ish at night, the past 3 nights, I have slept!!!!! For me this is def good. I feel physically alive. my diabetic nurse ok'd my regime and sdo I feel my decision to reverse the timing of taking thse meds has workd or me.
I tried taking my 20mg dose "sometime" in the night usually around 3:00am when I woke up to use the bathroom (states)...worked great for damping down morning stiffness and soreness, but my dr wants it taken more toward the traditional dose time of 8...currently working my way toward that time, last two days it was around 5:30...I will look for the link where a rheumy study says lower doses of pred CAN be taken around 2 am to alleviate morning stiffness...why wait till noon to be able to function better?
At 20mg your adrenal function will be compromised anyway if you are taking pred for more than a few weeks. So taking the pred when it works best for you makes sense. Just don't tell him...
GCA - started on 40mg pred ~ 11 mths ago, now down to 9.5mg. Steroid-induced diabetes since first week, but not on insulin. Had every possible symptom/side effect at first - v much better now. BGs often a bit high, never low - best when can do some walking. Had to stop Metformin - gastritis - and also Adcal - too hard on stomach. Now take vit D3 + K2 with lots of milk and plain yoghurt. No carbs.
At first wanted to sleep nearly all the time. (GCA + also Pred.) Later went through a phase of not sleeping at all. Now it varies. Occasional Nytol, but not often. Hope that, like the diabetes, this will improve as Pred dose reduces. Fingers crossed.
I try not to take all tabs together - stomach protested a great deal, esp in early days, enteric coatings notwithstanding. Diabetic tabs: main one = 2 x 3 or 4 times a day; two daily ones, morning and evening. Other assorted tabs either morning or evening.
Tried all sorts of different schedules for the Pred - split, not split, different times . . . Worst flare I ever had was after rheumy insisted on taking it all early in the morning. Might have been coincidence . . . Eventually found that I felt best taking it all together towards midnight, before going to bed - and that's what I've done ever since.
Loo in night = par for course, but only once or occasionally twice. Unless 'wired', is not much of a problem. Strangely, Dapagliflozin has not made that any worse.
Stopped Omeprazole months ago. Hardly ever need ranitidine. Consume lots of bio-live Greek style yoghurt every day. Okay apart from fatigue and muscle weakness, but not as bad as before, + w a few joint aches. Anticipating struggle to reactivate the adrenals.
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The difference 
An up date to my post 2 months ago ( what is feeling normal) 
Prednisalone 
